Individualized follicle-stimulating hormone dosing and in vitro fertilization outcome in agonist downregulated cycles: a systematic review

INTRODUCTION: This systematic review examines whether individualised gonadotropin dosing in in-vitro fertilisation (IVF) leads to better outcomes with respect to safety, costs and live birth rates compared to standard dosing. MATERIAL AND METHODS: Electronic databases searched were PubMed, Embase and Cochrane. The primary outcome was live birth rate. The secondary outcomes included pregnancy rate, costs and safety. Papers were critically appraised by two reviewers. RESULTS: A total of 7,022 articles were retrieved and assessed for eligibility, of which seven randomised controlled trials were selected. All studies used gonadotropin releasing hormone agonist co-treatment. Clinical and methodological heterogeneity was present, so data could not be pooled for meta-analysis. Only one study, that mainly included women with a good prognosis, revealed an increased chance of ongoing pregnancy in the individualised dosing group compared to standard treatment. With respect to safety, individualised dosing might reduce the occurrence of hyper response and ovarian hyperstimulation syndrome, without affecting the outcome of pregnancy. In predicted poor responders higher than standard dosages do not reduce the incidence of poor response. A cost-efficacy analysis was not performed in any of the studies included. CONCLUSION: It is currently not possible to conclude whether individualised dosing leads to higher pregnancy or live birth rates as compared to standard dosing, since evidence from well-designed studies that are adequately powered for one of these outcomes is lacking. So, large well-designed studies that evaluate the impact of individualised dosing on live birth rates are needed to assess whether individualised dosing should become the standard in IVF practice. This article is protected by copyright. All rights reserved.