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PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian
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.
199. PIVET algorithm for control of OHSS [Forum/Discussion]
from: James Stanger (office@fertaid.com ), Australia on 2/09/2016 11:39:27 PM Profession:
Comment: The PIVET algorithm seeks to modify the FSH dose to patient factors to minimise excessive oocytes
Submission Pioneer clinic PIVET has further developed its rFSH dosing Algorithms to enable precision by applying small increments based on 6 variables namely age and antral follicle count grading with adjustments for anti-Mullerian hormone level, BMI, day-2 FSH and smoking history. This has been enabled by the introduction of rFSH pens with metered dosing of ~8.3 IU or 12.5 IU per click. Close adherence to the Algorithms provides a mean of 10.0 oocytes per woman <40 years with few cases exceeding 15 oocytes and potentially complete avoidance of OHSS. The starting dose was <150 IU for 24% of cases and dosage adjustment was infrequently required, even when the start dose was <=75 IU. Luteal support schedules were adjusted according to oocyte numbers retrieved and livebirth productivity rates per initiated cycle was 57% for women <30 years, 52% for age group 30-34 years and 33% for those aged 35-39 years. These high rates are achieved with a single embryo transfer policy being 80% overall and >90% for <35 years.
This study indicates that ovarian stimulation by gonadotrophins can indeed be conducted safely even when antral follicle counts are high (40% displayed AFC >=20 follicles and included young women in low BMI categories). These data could now be compared with other strategies to avoid OHSS, namely IVM protocols and freeze-all regimens. PIVET is extending its Algorithm studies to include the long acting gonadotrophin corifollitropin, and plans to develop specific computer applications (Apps) to present comprehensive protocols which adjust for not only the ovarian stimulation schedule, but also ovarian Trigger adjustments and optimized luteal support schedules. Such developments should remove the guess-work and variable responses associated with current systems of COH (controlled ovarian stimulation).
Overall the long-term expectations are to simplify treatment schedules, reduce the need for monitoring and enable a smaller staffing structure to manage the majority of infertility cases. Cost-benefits should automatically ensue, reducing the expense for the increasing number of women desiring to access ART services.
Dr John Yovich
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