Several studies demonstrate that the use of high doses of gonadotropins (approximately 450 units daily or greater) does not result in an increased number of dominant follicles recruited, mature oocytes retrieved, nor good quality embryos produced compared with lower dosing regimens. Furthermore, higher doses of gonadotropins have been associated with an increased risk of ovarian hyperstimulation syndrome (OHSS). Given that there is a greater cost to the patient and potential for harm, with no evidence of an improved outcome, avoidance of high doses of gonadotropins is recommended. For more information:
Friedler S, et al. An upper limit of gonadotropin dose in patients undergoing ART should be advocated. Gynecol Endocrinol 2016 Dec;32(12):965-969. PMID: 27345589.
Haas J, et al. Do poor-responder patients benefit from increasing the daily gonadotropin dose during controlled ovarian hyperstimulation for IVF? Gynecol Endocrinol 2015 Jan;31(1):79-82. PMID: 25223892.
van Tilborg TC, et al. Individualized FSH dosing based on ovarian reserve testing in women starting IVF/ICSI: a multicentre trial and cost-effectiveness analysis. Hum Reprod 2017 Dec 1;32(12):2485-2495. PMID: 29121350.