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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Endocrinol. | doi: 10.3389/fendo.2019.00579

FSH requirements for follicle growth during controlled ovarian stimulation

 Ali Abbara1,  Aaran H. Patel1, Tia Hunjan1, Sophie Clarke1, Germaine Chia1, Pei C. Eng1,  Maria Phylactou1,  Alexander Comninos1, Stuart Lavery2, Geoffrey Trew2, Rehan Salim2, Raj Rai2,  Tom Kelsey3 and  Waljit Dhillo1*
  • 1Imperial College London, United Kingdom
  • 2Imperial College Healthcare NHS Trust, Faculty of Medicine, Imperial College London, United Kingdom
  • 3School of Computer Science, Faculty of Science, University of St Andrews, United Kingdom

Introduction: Ovarian follicle growth is a key step in the success of assisted reproductive treatment, but limited data exists to directly relate follicle growth to recombinant FSH (rFSH) dose. In this study, we aim to evaluate FSH requirements for follicular growth during controlled ovarian stimulation.

Method: Single centre retrospective cohort study of 1,034 IVF cycles conducted between January 2012-January 2016 at Hammersmith Hospital IVF unit, London, UK. Median follicle size after five days of stimulation with rFSH and the proportion of antral follicles recruited were analysed in women treated with rFSH alone to induce follicular growth during IVF treatment.

Results: Starting rFSH dose adjusted for body weight (iU/kg) predicted serum FSH level after 5 days of rFSH (r2=0.352, p<0.0001), median follicle size after 5 days of rFSH, and the proportion of antral follicles recruited by the end of stimulation. Day 5 median follicle size predicted median follicle size on subsequent ultrasound scans (r2=0.58-0.62; p<0.0001), and hence time to oocyte maturation trigger (r2=0.22, P<0.0001). Insufficient rFSH starting dose that required >5% dose-increase was associated with increased variability in follicle size on the day of oocyte maturation trigger, and negatively impacted the number of mature oocytes retrieved.

Conclusion: Weight-adjusted rFSH dose correlates with follicular growth during ovarian stimulation. Early recruitment of follicles using a sufficient dose of rFSH from the start of stimulation was associated with reduced variability in follicle size at time of oocyte maturation trigger and an increased number of mature oocytes retrieved.

Keywords: Ovarian response, Follicle growth, Recombinant FSH, In Vitro Fertilisation (IVF), Reproduction, Fertility

Received: 05 May 2019; Accepted: 08 Aug 2019.

Copyright: © 2019 Abbara, Patel, Hunjan, Clarke, Chia, Eng, Phylactou, Comninos, Lavery, Trew, Salim, Rai, Kelsey and Dhillo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Waljit Dhillo, Imperial College London, London, SW7 2AZ, United Kingdom, w.dhillo@imperial.ac.uk