The value of increasing the dose of human menopausal gonadotropins in women who initially demonstrate a poor response

Deborah L. Manzi, D L Manzi, Kim L. Thornton, K L Thornton, L B Scott, Laura B. Scott, J C Nulsen, John Nulsen
Fertility and sterility · 1994 · vol. 62(2) , pp. 251–256 · doi:10.1016/s0015-0282(16)56874-5 · PMID:8034068 · W2262309978
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Increasing human menopausal gonadotropin dose in poor responders improved peak E2 and follicle development but did not significantly increase cycle fecundity.

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Abstract

OBJECTIVE: To evaluate the benefit of increasing the hMG dose in subsequent superovulation cycles for those individuals who demonstrate a poor response on up to three ampules of hMG daily. DESIGN AND SETTING: Retrospective analysis of all superovulation cycles at the University of Connecticut Health Center. PATIENTS: All women undergoing hMG therapy with IUI from January 1990 until December 1992. INTERVENTIONS: All patients were initially stimulated with up to three ampules of hMG daily. All patients who did not conceive on their first hMG cycle and demonstrated a poor response to hMG therapy were started on higher doses of hMG in an effort to obtain a good response. A maximum of eight ampules of hMG per day were used. MAIN OUTCOME MEASURES: Peak serum E2, the number of mature preovulatory follicles, and cycle fecundity were compared. RESULTS: The poor responders using up to three ampules daily had a peak E2 of 384 +/- 26 pg/mL (1,421 +/- 96 pmol/L), 1.4 +/- 0.1 mature follicles, and a cycle fecundity of 3.1% compared with an E2 of 900 +/- 83 pg/mL (3,330 +/- 307 pmol/L), 2.7 +/- 0.2 mature follicles, and a cycle fecundity of 4.3% when these poor responders had their dose increased to five or more ampules daily. Those individuals demonstrating a good response on less than or equal to three ampules of hMG daily had an average peak E2 of 1,159 +/- 41 pg/mL (4,288 +/- 151 pmol/L), 3.4 +/- 0.2 mature follicles, and a cycle fecundity of 16.5%. CONCLUSIONS: Despite significant improvement in peak E2 and the number of mature preovulatory follicles when the hMG dose was increased in poor responders, no significant increase in cycle fecundity was noted.

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MeSH descriptors

Chorionic Gonadotropin Superovulation Adult Chorionic Gonadotropin Chorionic Gonadotropin Dose-Response Relationship, Drug Drug Resistance Female Humans Retrospective Studies Treatment Outcome

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