The effectiveness of in vitro fertilization programs depending on the type of ovarian response to stimulation

The paper identifies the main groups of patients in vitro fertilization (IVF) programs. The characterization of the unexpected (paradoxical) response and its association with the polymorphism of the FSHR gene is given. A comparative characteristic of СOS protocols with the original follitropin alpha and its domestic biosimilar is presented. The aim of the study is to increase the effectiveness of IVF programs in patients with an unexpected response by developing a differentiated approach to ovarian stimulation. Material and methods. At the 1st stage, 920 case histories were studied; at the 2nd, 197 patients were included — a characteristic of patients with an unexpected response and its association with FSHR gene polymorphism was given; at the 3rd, an algorithm for a differentiated approach to С OS was tested in 22 patients. Results. The main groups differ in age, efficacy, and the amount of gonadotropins. The frequency of the unexpected response was 42.8%. When comparing the original follitropin alpha and its domestic biosimilar, the effectiveness was 36.46 and 40.59% (p = 0.0511), respectively. Genotype G/A of the FSHR gene polymorphism is associated with a normal response; genotype A/A with a poor response; genotype G/G with a high response (p < 0.0001). The frequency of repeated unexpected response was 21.3%, the efficiency per cycle was 39.1% according to the results of testing the algorithm. Conclusion. Three main groups of IVF patients have been identified to calculate the required doses of gonadotropins. An unexpected ovarian response reduces the effectiveness of IVF programs by 8.5%. Polymorphism of the FSHR gene is a significant predictor of a repeated unexpected response. The developed algorithm of the differentiated approach to the С OS makes it possible to increase the effectiveness of IVF programs.