Development of a nomogram based on markers of ovarian reserve for the individualisation of the follicle‐stimulating hormone starting dose in in vitro fertilisation cycles

Please cite this paper as: La Marca A, Papaleo E, Grisendi V, Argento C, Giulini S, Volpe A. Development of a nomogram based on markers of ovarian reserve for the individualisation of the follicle‐stimulating hormone starting dose in in vitro fertilisation cycles. BJOG 2012;119:1171–1179. Objective To elaborate a nomogram based on markers of ovarian reserve for the calculation of the appropriate starting dose of follicle‐stimulating hormone (FSH). Design Cohort study of infertile women. Setting In vitro fertilisation (IVF) unit, University Hospital of Modena, Italy. Population Women aged 18–40 years ( n = 346) and undergoing their first IVF cycle. Methods Serum FSH and anti‐Müllerian hormone (AMH) measurement. Main outcome measures Development of a model for the prediction of ovarian response to FSH. Results A model based on age, AMH and FSH was able to accurately predict the ovarian sensitivity and accounted for 30% of the variability of ovarian response to FSH. An FSH dosage nomogram was constructed and overall it predicts a starting FSH dose <225 IU in 55.1 and 25.9% of women younger and older than 35 years, respectively. Conclusions In the present study we clearly demonstrated that the daily FSH dose may be calculated on the basis of a woman’s age and two markers of ovarian reserve, namely AMH and FSH, with the first two vari;s (age and AMH) being the most significant predictors. The nomogram we developed seems easily applicable for clinicians during their daily clinical practice.