More follicle-stimulating hormone may not improve outcomes, but can it be counterproductive?

Peter M. Ahlering, MD

This is an excellent summary of a recent article in the journal Fertility and Sterility. For decades, there’s been a debate about how much stimulation medication is best, low amounts, average, or high amounts. In the old days, higher stimulation was utilized all the time (450- 750 units daily sometimes). Then, over time, there was a push to go with “mini“ IVF but the mistaken thought was that these lower dose protocols “made eggs better“. However, the lower dose protocols became popular as a cost savings maneuver, not because of a positive effect on egg quality.

There are IVF centers that routinely use lower dose protocols, but certainly their outcomes are not better (in fact, patients with lower stim protocols often need more egg retrievals compared to patients receiving standard stimulation), but yet patients are told that that higher dose protocols “make eggs, bad“ and lead to IVF failure. This certainly is false.

This narrative below is a summary of an article, showing all of this above, is indeed, correct. This is just another one in a long series of articles over the years substantiating these concepts.

More follicle-stimulating hormone may not improve outcomes, but can it be counterproductive?

Fertility and Sterility, December 2022
Molly M. Quinn, M.D.
Richard J. Paulson, M.D.

Many studies have sought to explore the impact of high-dose gonadotropin on stimulation outcomes based on a hypothesis that higher doses of follicle-stimulating hormone may harm the quantity or quality of oocytes and, therefore, be counterproductive. Herein, we describe the results of a narrative review aimed at elucidating any harm associated with “excess” follicle-stimulating hormone dosing in poor-to-moderate responders. Additionally, we sought to describe the outcomes associated with mild ovarian stimulation, with an eye toward determining whether this approach is superior. We concluded that there is no apparent harm to higher-dose gonadotropin stimulation for poor-to-moderate responders. Simultaneously, we did not find compelling data to suggest that mild stimulation is superior. Finally, we close by presenting data that suggest that more gonadotropin may be beneficial in specific clinical scenarios.