ABSTRACT

Objective To identify the subset of the in vitro fertilization (IVF) population suitable for minimal monitoring by implementing a novel dosing regimen.

Methods A retrospective study conducted between April 2021 and August 2022. Eligible participants were aged 18 or older, had undergone IVF stimulation using an antagonist protocol, and were prescribed a combination of follitropin delta and human menopausal gonadotropin. The dosage was either based on a patient-specific dosing regimen developed by the ovo clinic utilizing weight and AMH levels (Group 1, n=356) or determined through clinical evaluation by the physician (Group 2, n=358). On day 6, ultrasound and serum hormone analyses were performed, with adjustments made solely to the menotropin dosage in necessary.

Results The study enrolled a total of 714 patients. In Group 1, 80,3% of patients were stimulated at maximal doses compared to 14,5% in Group 2. No cases of moderate or severe cases of ovarian hyperstimulation syndrome (OHSS) were recorded. The frequency of dose adjustments before day 10 was minimal. Patients treated with non-maximal doses according to the dosing regimen showed significantly fewer adjustments on day 6 compared to those treated according to physician’s assessment (24.6% versus 46.9%, p<0.001). Among this subgroup, OHSS risk was observed in 30.4% of cases.

Conclusion Our innovative dosing regimen suggests that initial monitoring on day 10 would suffice for IVF patients with low ovarian reserve undergoing maximal stimulation.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

NCT05737979

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by Veritas IRB, an independent research ethics committee.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

ABBREVIATIONSAIArtificial IntelligenceAMHAnti-Mullerian HormoneANOVAAnalysis of VarianceFSHFollicle Stimulating HormoneGnRHGonadotropin-Releasing HormonehCGHuman Chorionic GonadotropinHP-hMGHighly Purified Human GonadotropinsIUInternational UnitIVFIn Vitro FertilizationLHLuteinizing HormonePCOSPolycystic Ovary SyndromePGT-APreimplantation Genetic Testing for AneuploidyOHSSOvarian Hyperstimulation Syndrome