PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian hyperstimulation syndrome
The first PIVET algorithm for individualized recombinant follicle stimulating hormone (rFSH) dosing in in vitro fertilization, reported in 2012, was based on age and antral follicle count grading with adjustments for anti-Müllerian hormone level, body mass index, day-2 FSH, and smoking history. In 2...
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| creator | Yovich, John L Alsbjerg, Birgit Conceicao, Jason L Hinchliffe, Peter M Keane, Kevin N |
| description | The first PIVET algorithm for individualized recombinant follicle stimulating hormone (rFSH) dosing in in vitro fertilization, reported in 2012, was based on age and antral follicle count grading with adjustments for anti-Müllerian hormone level, body mass index, day-2 FSH, and smoking history. In 2007, it was enabled by the introduction of a metered rFSH pen allowing small dosage increments of ~8.3 IU per click. In 2011, a second rFSH pen was introduced allowing more precise dosages of 12.5 IU per click, and both pens with their individual algorithms have been applied continuously at our clinic. The objective of this observational study was to validate the PIVET algorithms pertaining to the two rFSH pens with the aim of collecting ≤15 oocytes and minimizing the risk of ovarian hyperstimulation syndrome. The data set included 2,822 in vitro fertilization stimulations over a 6-year period until April 2014 applying either of the two individualized dosing algorithms and corresponding pens. The main outcome measures were mean oocytes retrieved and resultant embryos designated for transfer or cryopreservation permitted calculation of oocyte and embryo utilization rates. Ensuing pregnancies were tracked until live births, and live birth productivity rates embracing fresh and frozen transfers were calculated. Overall, the results showed that mean oocyte numbers were 10.0 for all women |
| doi_str_mv | 10.2147/DDDT.S104104 |
| format | Article |
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In 2007, it was enabled by the introduction of a metered rFSH pen allowing small dosage increments of ~8.3 IU per click. In 2011, a second rFSH pen was introduced allowing more precise dosages of 12.5 IU per click, and both pens with their individual algorithms have been applied continuously at our clinic. The objective of this observational study was to validate the PIVET algorithms pertaining to the two rFSH pens with the aim of collecting ≤15 oocytes and minimizing the risk of ovarian hyperstimulation syndrome. The data set included 2,822 in vitro fertilization stimulations over a 6-year period until April 2014 applying either of the two individualized dosing algorithms and corresponding pens. The main outcome measures were mean oocytes retrieved and resultant embryos designated for transfer or cryopreservation permitted calculation of oocyte and embryo utilization rates. Ensuing pregnancies were tracked until live births, and live birth productivity rates embracing fresh and frozen transfers were calculated. Overall, the results showed that mean oocyte numbers were 10.0 for all women <40 years with 24% requiring rFSH dosages <150 IU. Applying both specific algorithms in our clinic meant that the starting dose was not altered for 79.1% of patients and for 30.1% of those receiving the very lowest rFSH dosages (≤75 IU). Only 0.3% patients were diagnosed with severe ovarian hyperstimulation syndrome, all deemed avoidable due to definable breaches from the protocols. The live birth productivity rates exceeded 50% for women <35 years and was 33.2% for the group aged 35-39 years. Routine use of both algorithms led to only 11.6% of women generating >15 oocytes, significantly lower than recently published data applying conventional dosages (38.2%; P<0.0001). When comparing both specific algorithms to each other, the outcomes were mainly comparable for pregnancy, live birth, and miscarriage rate. However, there were significant differences in relation to number of oocytes retrieved, but the mean for both the algorithms remained well below 15 oocytes. Consequently, application of both these algorithms in our in vitro fertilization clinic allows the use of both the rFSH products, with very similar results, and they can be considered validated on the basis of effectiveness and safety, clearly avoiding ovarian hyperstimulation syndrome.</description><identifier>ISSN: 1177-8881</identifier><identifier>EISSN: 1177-8881</identifier><identifier>DOI: 10.2147/DDDT.S104104</identifier><identifier>PMID: 27563236</identifier><language>eng</language><publisher>New Zealand: Dove Medical Press Limited</publisher><subject>Adult ; Algorithms ; Births ; Body mass ; Body mass index ; Body size ; Childbirth & labor ; Cryopreservation ; Dosage ; Dosage and administration ; Dose-Response Relationship, Drug ; Drug delivery systems ; Embryos ; Evaluation ; Female ; Female genital diseases ; Fertilization in Vitro ; Follicle Stimulating Hormone - administration & dosage ; Follicle-stimulating hormone ; Humans ; In vitro fertilization ; Mathematical analysis ; Middle Aged ; Miscarriage ; Oocytes ; Original Research ; Ovarian hyperstimulation syndrome ; Ovarian Hyperstimulation Syndrome - chemically induced ; Ovarian Hyperstimulation Syndrome - prevention & control ; Ovulation Induction - methods ; Pens ; Pregnancy ; Pregnancy Rate ; Prevention ; Productivity ; Recombinant Proteins - administration & dosage ; Reproductive technologies ; Retrospective Studies ; Smoking ; Testing ; Womens health</subject><ispartof>Drug design, development and therapy, 2016-01, Vol.10, p.2561-2573</ispartof><rights>COPYRIGHT 2016 Dove Medical Press Limited</rights><rights>2016. This work is licensed under https://creativecommons.org/licenses/by-nc/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2016 Yovich et al. This work is published and licensed by Dove Medical Press Limited 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c553t-113e8b5946317879003be7bfab7d3d0c1a197d655c3da20512f57ce5d7af24653</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986677/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986677/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,3848,27903,27904,53770,53772</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27563236$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yovich, John L</creatorcontrib><creatorcontrib>Alsbjerg, Birgit</creatorcontrib><creatorcontrib>Conceicao, Jason L</creatorcontrib><creatorcontrib>Hinchliffe, Peter M</creatorcontrib><creatorcontrib>Keane, Kevin N</creatorcontrib><title>PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian hyperstimulation syndrome</title><title>Drug design, development and therapy</title><addtitle>Drug Des Devel Ther</addtitle><description>The first PIVET algorithm for individualized recombinant follicle stimulating hormone (rFSH) dosing in in vitro fertilization, reported in 2012, was based on age and antral follicle count grading with adjustments for anti-Müllerian hormone level, body mass index, day-2 FSH, and smoking history. In 2007, it was enabled by the introduction of a metered rFSH pen allowing small dosage increments of ~8.3 IU per click. In 2011, a second rFSH pen was introduced allowing more precise dosages of 12.5 IU per click, and both pens with their individual algorithms have been applied continuously at our clinic. The objective of this observational study was to validate the PIVET algorithms pertaining to the two rFSH pens with the aim of collecting ≤15 oocytes and minimizing the risk of ovarian hyperstimulation syndrome. The data set included 2,822 in vitro fertilization stimulations over a 6-year period until April 2014 applying either of the two individualized dosing algorithms and corresponding pens. The main outcome measures were mean oocytes retrieved and resultant embryos designated for transfer or cryopreservation permitted calculation of oocyte and embryo utilization rates. Ensuing pregnancies were tracked until live births, and live birth productivity rates embracing fresh and frozen transfers were calculated. Overall, the results showed that mean oocyte numbers were 10.0 for all women <40 years with 24% requiring rFSH dosages <150 IU. Applying both specific algorithms in our clinic meant that the starting dose was not altered for 79.1% of patients and for 30.1% of those receiving the very lowest rFSH dosages (≤75 IU). Only 0.3% patients were diagnosed with severe ovarian hyperstimulation syndrome, all deemed avoidable due to definable breaches from the protocols. The live birth productivity rates exceeded 50% for women <35 years and was 33.2% for the group aged 35-39 years. Routine use of both algorithms led to only 11.6% of women generating >15 oocytes, significantly lower than recently published data applying conventional dosages (38.2%; P<0.0001). When comparing both specific algorithms to each other, the outcomes were mainly comparable for pregnancy, live birth, and miscarriage rate. However, there were significant differences in relation to number of oocytes retrieved, but the mean for both the algorithms remained well below 15 oocytes. Consequently, application of both these algorithms in our in vitro fertilization clinic allows the use of both the rFSH products, with very similar results, and they can be considered validated on the basis of effectiveness and safety, clearly avoiding ovarian hyperstimulation syndrome.</description><subject>Adult</subject><subject>Algorithms</subject><subject>Births</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Childbirth & labor</subject><subject>Cryopreservation</subject><subject>Dosage</subject><subject>Dosage and administration</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug delivery systems</subject><subject>Embryos</subject><subject>Evaluation</subject><subject>Female</subject><subject>Female genital diseases</subject><subject>Fertilization in Vitro</subject><subject>Follicle Stimulating Hormone - administration & dosage</subject><subject>Follicle-stimulating hormone</subject><subject>Humans</subject><subject>In vitro fertilization</subject><subject>Mathematical analysis</subject><subject>Middle Aged</subject><subject>Miscarriage</subject><subject>Oocytes</subject><subject>Original Research</subject><subject>Ovarian hyperstimulation syndrome</subject><subject>Ovarian Hyperstimulation Syndrome - chemically induced</subject><subject>Ovarian Hyperstimulation Syndrome - prevention & control</subject><subject>Ovulation Induction - methods</subject><subject>Pens</subject><subject>Pregnancy</subject><subject>Pregnancy Rate</subject><subject>Prevention</subject><subject>Productivity</subject><subject>Recombinant Proteins - administration & dosage</subject><subject>Reproductive technologies</subject><subject>Retrospective Studies</subject><subject>Smoking</subject><subject>Testing</subject><subject>Womens health</subject><issn>1177-8881</issn><issn>1177-8881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNptkl1rFDEUhgdRbK3eeS0BQbxw12QySWZvhNJtbaGg0NXbkEnO7KZkkm0yszD-Kn-iWbuuuyIJ5HDynDc5H0XxmuBpSSrxcT6fL6Z3BFd5PylOCRFiUtc1eXpgnxQvUrrHmFNe4ufFSSkYpyXlp8XPrzffLxcoXt1dIxOS9Uuk3DJE26-6hNoQkfXGbqwZlLM_wCAdfB-Dc9kMGxWt8ij1thuc6m3wCLxqHCQU1tn5O2AdYemV12O2ghl0n9X6EUXVZ0x5g9QmWJMBQKHda67GNcRD4TR6E0MHL4tnrXIJXu3Os-Lb1eXi4npy--XzzcX57UQzRvsJIRTqhs0qTomoxQxj2oBoWtUIQw3WRJGZMJwxTY0qMSNly4QGZoRqy4ozelZ8etRdD00HRkNOWzm5jrZTcZRBWXl84-1KLsNGVrOacyGywPudQAwPA6RedjZpcE55CEOSpCYVFzx_NKNv_0HvwxB9Tk-WZckrTuiM_aWWyoG0vg35Xb0VlecMc577ybbU9D9UXgY6m5sHrc3-o4B3BwErUK5fpeCGbdXTMfjhEdQxpBSh3ReDYLkdRbkdRbkbxYy_OSzgHv4ze_QX4BDdDw</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Yovich, John L</creator><creator>Alsbjerg, Birgit</creator><creator>Conceicao, Jason L</creator><creator>Hinchliffe, Peter M</creator><creator>Keane, Kevin N</creator><general>Dove Medical Press Limited</general><general>Taylor & Francis Ltd</general><general>Dove Medical Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7XB</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>KB0</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160101</creationdate><title>PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian hyperstimulation syndrome</title><author>Yovich, John L ; Alsbjerg, Birgit ; Conceicao, Jason L ; Hinchliffe, Peter M ; Keane, Kevin N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c553t-113e8b5946317879003be7bfab7d3d0c1a197d655c3da20512f57ce5d7af24653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Algorithms</topic><topic>Births</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Childbirth & labor</topic><topic>Cryopreservation</topic><topic>Dosage</topic><topic>Dosage and administration</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug delivery systems</topic><topic>Embryos</topic><topic>Evaluation</topic><topic>Female</topic><topic>Female genital diseases</topic><topic>Fertilization in Vitro</topic><topic>Follicle Stimulating Hormone - administration & dosage</topic><topic>Follicle-stimulating hormone</topic><topic>Humans</topic><topic>In vitro fertilization</topic><topic>Mathematical analysis</topic><topic>Middle Aged</topic><topic>Miscarriage</topic><topic>Oocytes</topic><topic>Original Research</topic><topic>Ovarian hyperstimulation syndrome</topic><topic>Ovarian Hyperstimulation Syndrome - chemically induced</topic><topic>Ovarian Hyperstimulation Syndrome - prevention & control</topic><topic>Ovulation Induction - methods</topic><topic>Pens</topic><topic>Pregnancy</topic><topic>Pregnancy Rate</topic><topic>Prevention</topic><topic>Productivity</topic><topic>Recombinant Proteins - administration & dosage</topic><topic>Reproductive technologies</topic><topic>Retrospective Studies</topic><topic>Smoking</topic><topic>Testing</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yovich, John L</creatorcontrib><creatorcontrib>Alsbjerg, Birgit</creatorcontrib><creatorcontrib>Conceicao, Jason L</creatorcontrib><creatorcontrib>Hinchliffe, Peter M</creatorcontrib><creatorcontrib>Keane, Kevin N</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Drug design, development and therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yovich, John L</au><au>Alsbjerg, Birgit</au><au>Conceicao, Jason L</au><au>Hinchliffe, Peter M</au><au>Keane, Kevin N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian hyperstimulation syndrome</atitle><jtitle>Drug design, development and therapy</jtitle><addtitle>Drug Des Devel Ther</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>10</volume><spage>2561</spage><epage>2573</epage><pages>2561-2573</pages><issn>1177-8881</issn><eissn>1177-8881</eissn><abstract>The first PIVET algorithm for individualized recombinant follicle stimulating hormone (rFSH) dosing in in vitro fertilization, reported in 2012, was based on age and antral follicle count grading with adjustments for anti-Müllerian hormone level, body mass index, day-2 FSH, and smoking history. In 2007, it was enabled by the introduction of a metered rFSH pen allowing small dosage increments of ~8.3 IU per click. In 2011, a second rFSH pen was introduced allowing more precise dosages of 12.5 IU per click, and both pens with their individual algorithms have been applied continuously at our clinic. The objective of this observational study was to validate the PIVET algorithms pertaining to the two rFSH pens with the aim of collecting ≤15 oocytes and minimizing the risk of ovarian hyperstimulation syndrome. The data set included 2,822 in vitro fertilization stimulations over a 6-year period until April 2014 applying either of the two individualized dosing algorithms and corresponding pens. The main outcome measures were mean oocytes retrieved and resultant embryos designated for transfer or cryopreservation permitted calculation of oocyte and embryo utilization rates. Ensuing pregnancies were tracked until live births, and live birth productivity rates embracing fresh and frozen transfers were calculated. Overall, the results showed that mean oocyte numbers were 10.0 for all women <40 years with 24% requiring rFSH dosages <150 IU. Applying both specific algorithms in our clinic meant that the starting dose was not altered for 79.1% of patients and for 30.1% of those receiving the very lowest rFSH dosages (≤75 IU). Only 0.3% patients were diagnosed with severe ovarian hyperstimulation syndrome, all deemed avoidable due to definable breaches from the protocols. The live birth productivity rates exceeded 50% for women <35 years and was 33.2% for the group aged 35-39 years. Routine use of both algorithms led to only 11.6% of women generating >15 oocytes, significantly lower than recently published data applying conventional dosages (38.2%; P<0.0001). When comparing both specific algorithms to each other, the outcomes were mainly comparable for pregnancy, live birth, and miscarriage rate. However, there were significant differences in relation to number of oocytes retrieved, but the mean for both the algorithms remained well below 15 oocytes. Consequently, application of both these algorithms in our in vitro fertilization clinic allows the use of both the rFSH products, with very similar results, and they can be considered validated on the basis of effectiveness and safety, clearly avoiding ovarian hyperstimulation syndrome.</abstract><cop>New Zealand</cop><pub>Dove Medical Press Limited</pub><pmid>27563236</pmid><doi>10.2147/DDDT.S104104</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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| source | Taylor & Francis Open Access; MEDLINE; DOVE Medical Press Journals; DOAJ Directory of Open Access Journals; PubMed Central Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Adult Algorithms Births Body mass Body mass index Body size Childbirth & labor Cryopreservation Dosage Dosage and administration Dose-Response Relationship, Drug Drug delivery systems Embryos Evaluation Female Female genital diseases Fertilization in Vitro Follicle Stimulating Hormone - administration & dosage Follicle-stimulating hormone Humans In vitro fertilization Mathematical analysis Middle Aged Miscarriage Oocytes Original Research Ovarian hyperstimulation syndrome Ovarian Hyperstimulation Syndrome - chemically induced Ovarian Hyperstimulation Syndrome - prevention & control Ovulation Induction - methods Pens Pregnancy Pregnancy Rate Prevention Productivity Recombinant Proteins - administration & dosage Reproductive technologies Retrospective Studies Smoking Testing Womens health |
| title | PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian hyperstimulation syndrome |
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