A low-dose stimulation protocol using highly purified follicle-stimulatinghormone can lead to high pregnancy rates in in vitro fertilization patients with polycystic ovaries who are at risk of a high ovarian response to gonadotropins

Objective: To study the benefits of a low-dose stimulation (LDS) protocol w ith purified urinary follicle-stimulating hormone in patients with polycyst ic ovaries who have presented previously with a very high ovarian response to a standard hMG stimulation. Design: Cohort study. Setting: Fertility center in a university hospital. Patient(s): Sixty-one patients involved in an IVF/ICSI program from January 1995 to December 1996. Intervention(s): The patients were first stimulated with a standard protoco l using hMG and presented with a very high ovarian response. These patients were then stimulated a second time using a low-dose protocol. Cryopreserve d embryos were transferred in later artificial or natural cycles until to D ecember 1999. Main Outcome Measure(s): Number of gonadotropin ampules; estradiol level on the day of ovulation induction; follicles, oocytes, and cryopreserved zygo tes; fertilization, implantation, and pregnancy rates; and number of ovaria n hyperstimulation syndromes (OHSS). Result(s): The number of ampules used, the estradiol level reached, and the number of oocytes obtained were significantly lower under the LDS than the standard protocol. High implantation (21.8%) and clinical pregnancy (38.4% ) rates were obtained after LDS. The cumulated deliveries per cycle started and per patient were, respectively, 41.6% and 52.5%. Five patients suffere d OHSS with the standard protocol, and none with the LDS. Conclusion(s): The LDS protocol offers a safe and efficient treatment for p atients who present with echographic polycystic ovaries and are at risk of an excessive ovarian response to standard IVF stimulation protocols. (Ferti l Steril(R) 2001;75:1131-5. (C)2001 by American Society for Reproductive Me dicine.).