Reproductive BioMedicine Online
Volume 20, Issue 2 , Pages 182-190, February 2010

Factors related to successful ovulation induction in patients with WHO group II anovulatory infertility

  • C.M. Howles

      Affiliations

    • Merck Serono S.A. – Geneva, Switzerland an affiliate of Merck KGaA, Darmstadt, Germany
    • Corresponding Author InformationCorresponding author.
    • ,
  • V. Alam

      Affiliations

    • Merck Serono S.A. – Geneva, Switzerland an affiliate of Merck KGaA, Darmstadt, Germany
    • ,
  • D. Tredway

      Affiliations

    • EMD Serono an affiliate of Merck KGaA, Darmstadt, Germany, Global Development, Rockland, MA, USA
    • ,
  • R. Homburg

      Affiliations

    • Barzilai Medical Centre, Ashkelon, Israel
    • ,
  • D.W. Warne

      Affiliations

    • Merck Serono S.A. – Geneva, Switzerland an affiliate of Merck KGaA, Darmstadt, Germany

Received 27 April 2009; received in revised form 4 June 2009; accepted 11 November 2009. published online 07 January 2010.

Declaration: CMH, VA and DWW are employees of Merck Serono S.A. – Geneva, Switzerland. DT was an employee of EMD Serono, Inc. when the manuscript was in development. RH reports no financial or commercial conflicts of interest. Studies 8209 and 22240 and the combined data analysis were funded by Merck Serono. Merck Serono and EMD Serono are affiliates of Merck KGaA, Darmstadt, Germany.

Abstract 

To identify baseline characteristics related to successful ovulation induction, data were analysed from oligo- or anovulatory patients undergoing their first cycle of human recombinant FSH (r-hFSH; follitropin alfa) in a chronic low-dose (75IU starting dose), step-up protocol in two clinical trials (n=446). Patients were grouped according to response: group A, ovulated within 14days (75IU follitropin alfa); group B, ovulated after 14days (>75IU follitropin alfa); group C, not administered human chorionic gonadotrophin (HCG) because of poor response; group D, cycle cancelled due to over-response (HCG not administered); group E, spontaneous ovulation prior to obtaining criteria for administration of HCG. Mean body mass index (BMI) of group A (25.0kg/m2) was significantly lower than groups B (27.1kg/m2, P<0.001) or C (28.2kg/m2, P<0.0001), but similar to group D (24.3kg/m2). Mean antral follicle count (AFC) of group A was also significantly lower than group C (18.3 versus 22.7; P=0.018), but not significantly different from groups B (21.5) or D (19.5); group E had the highest mean AFC (35.7). Comparatively low BMI, low AFC and higher (although still within the normal range) FSH concentration at baseline were associated with successful ovulation induction in infertile women undergoing a chronic low-dose, step-up stimulation protocol.

Keywords: antral follicle count, body weight, follicle-stimulating hormone, follitropin alfa, ovulation induction, prediction model

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 Dr Howles is Head of Medical Affairs Fertility, Europe, for Merck Serono S.A. – Geneva, Switzerland. Previously, he worked in clinical development, and spent almost 3years in the Far East. During the 1980s and 1990s he was involved in the development of the first highly purified recombinant FSH (follitropin alfa), human LH, human chorionic gonadotrophin and the gonadotropin-releasing hormone antagonist, cetrorelix. Dr Howles is the author or editor of more than 50 publications on reproductive endocrinology and two textbooks on reproductive medicine. His current research focuses on identifying patient characteristics as prognostic factors of ovarian response following FSH stimulation in ovulation induction and assisted reproduction treatment cycles.

PII: S1472-6483(09)00230-2

doi:10.1016/j.rbmo.2009.11.017

Reproductive BioMedicine Online
Volume 20, Issue 2 , Pages 182-190, February 2010

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