RESUMO
To evaluate the merits of controlled ovarian hyperstimulation using low dose recombinant FSH in ICSI cycles in a group of patients with polycystic ovaries [PCO] who have presented with a history of very high ovarian response with moderate or severe hyperstimulation in a previous stimulation cycle using the standard gonadotropin stimulation. Cohort non randomized study. Twenty four PCO patients subjected to ICSI cycles from April 1999 through May 2002. All those patients were stimulated in a previous ICSI cycle with standard Gonadotropin protocols using FSh/hMG [225 IU/day] and developed very high ovarian response and/or severe ovarian hyperstimulation syndrome. The same 24 PCO cases were stimulated for the second time using low dose gonadotropin protocol with a starting dose of 100 IU of rec. FSH and the dose was tailored individually in a step-down regimen. Main Outcome Measures: Number of stimulation days, number of Gonadotropin ampoules used, peak E2 level on the day of hCG administration, number of oocytes aspirated, fertilized and transferred, implantation and pregnancy rates and OHSS cases. All these parameters were compared with the previous stimulation they had before using the standard protocol. The low dose gonadotropin protocol yielded lower ovarian response characterized by significantly lower peak E2 [1820 +/- 795 miu/ml], longer duration of stimulation [14 +/- 2.8 days]with less number of rec FSH amps used [11.5 +/- 4.6 amps.], and less number of oocytes aspirated [13.7 +/- 6.1], with significantly higher number of MII oocytes [10.7 +/- 3.4], and significantly higher fertilization [63.4% +/- 20.9], implantation 18.7% and ongoing pregnancy rates [37.5%]. None of the low dose stimulation cases developed severe OHSS. Low dose stimulation with rec. FSH provides a safer, convenient and efficacious stimulation protocol for ICSI in PCO patients who are at risk of OHSS