Individualization of the starting dose of follitropin delta reduces the overall OHSS risk and/or the need for additional preventive interventions: cumulative data over three stimulation cycles

Reprod Biomed Online. 2019 Apr;38(4):528-537. doi: 10.1016/j.rbmo.2018.12.032. Epub 2018 Dec 23.


Research question: Is individualization of dosing with follitropin delta in sequential ovarian stimulation cycles an effective preventive strategy for ovarian hyperstimulation syndrome risk? If so, for which patients does an individualized strategy provide the greatest OHSS risk reduction and/or the need for additional preventive interventions?

Design: A secondary analysis of three ovarian stimulation cycles in IVF/intracytoplasmic sperm injection patients included in one randomized, assessor-blinded trial comparing two recombinant FSH preparations (ESTHER-1, NCT01956110), and a second trial in women undergoing up to two additional cycles (ESTHER-2, NCT01956123). Of 1326 women (aged 18-40 years) randomized and treated with follitropin delta or alfa in cycle 1, 513 continued to cycle 2 and 188 to cycle 3. Follitropin delta and alfa doses were maintained/adjusted according to ovarian response in the previous cycle.

Results: Individualized dosing with follitropin delta significantly reduced moderate/severe OHSS and/or preventive interventions (P=0.018) versus conventional dosing with follitropin alfa in patients undergoing up to three ovarian stimulation cycles. The greatest benefit was observed in patients in the highest anti-Müllerian hormone (AMH) quartile (P=0.012). On evaluating separately, individualized dosing with follitropin delta significantly lowered the incidences of moderate/severe OHSS (P=0.036) and preventive interventions (P=0.044) versus follitropin alfa.

Conclusion: An individualized follitropin delta dosing regimen decreased the risk of moderate/severe OHSS as well as the incidence of preventive interventions versus a conventional follitropin alfa regimen. An analysis per AMH quartile indicated that these statistically significant differences are driven mainly by patients with the highest pretreatment AMH levels.

Keywords: Anti-Müllerian hormone; Follitropin delta; GnRH agonist triggering; OHSS; Ovarian stimulation; Preventive interventions.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Cryopreservation
  • Data Interpretation, Statistical
  • Female
  • Fertilization in Vitro
  • Follicle Stimulating Hormone, Human / administration & dosage*
  • Follicle Stimulating Hormone, Human / therapeutic use
  • Humans
  • Ovarian Hyperstimulation Syndrome / prevention & control*
  • Ovary / drug effects
  • Ovulation Induction* / adverse effects
  • Recombinant Proteins / administration & dosage
  • Recombinant Proteins / therapeutic use
  • Risk
  • Sperm Injections, Intracytoplasmic
  • Treatment Outcome
  • Young Adult


  • Follicle Stimulating Hormone, Human
  • Recombinant Proteins
  • follitropin alfa
  • follitropin delta