Vol.:(0123456789) 1 3 Archives of Gynecology and Obstetrics https://doi.org/10.1007/s00404-018-4906-2 GYNECOLOGIC ENDOCRINOLOGY AND REPRODUCTIVE MEDICINE Are we choosing the correct FSH starting dose during controlled ovarian stimulation for intrauterine insemination cycles? Potential application of a nomogram based on woman’s age and markers of ovarian reserve Rossana Di Paola 1  · Simone Garzon 1  · Sara Giuliani 1  · Antonio Simone Laganà 2  · Marco Noventa 3  · Francesca Parissone 1  · Carlotta Zorzi 1  · Ricciarda Rafaelli 1  · Fabio Ghezzi 2  · Massimo Franchi 1  · Stefano Zafagnini 1 Received: 7 June 2018 / Accepted: 12 September 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Purpose To evaluate the potential application of a nomogram based on woman’s age and ovarian reserve markers as a tool to optimize the follicle-stimulating hormone (FSH) starting dose in intrauterine insemination (IUI) cycles. Methods We conducted a retrospective analysis enrolling 179 infertile women undergoing controlled ovarian stimulation (COS), followed by IUI. Each woman received an FSH starting dose according to clinical decision. After collecting data about COS and IUI procedures, we calculated the FSH starting dose according to the nomogram. The main outcomes measured were women’s baseline characteristics, COS, and clinical outcomes. Results The FSH starting dose calculated by the nomogram was signifcantly lower than the one actually prescribed (p < 0.001), in only 14.8% of the cycles nomogram calculated a higher starting dose. When gonadotropin dose was decreased during COS, and similarly in case of hyper-response (more than two follicles ≥ 16 mm retrieved), the FSH starting dose calculated by the nomogram would have been lower in most of the cases (81.8% and 48.8%, respectively). Conversely, when gonadotropin dose was increased during COS and in case of low ovarian response (no follicle ≥ 16 mm retrieved), the FSH starting dose calculated by the nomogram would have been lower in most of the cases (64.7% and 100%, respectively); in these groups median anti-Müllerian hormone (AMH) level was 5.62 ng/mL. Conclusions The application of this nomogram in IUI cycles would lead to a more tailored FSH starting dose and improved cost-efectiveness, although in PCOS women, particularly the ones with high AMH, it does not seem adequate. Keywords Follicle-stimulating hormone · Starting dose · Anti-Müllerian hormone · Controlled ovarian stimulation · Intrauterine insemination · Nomogram Introduction Intrauterine insemination (IUI) has been widely used as a common treatment for infertile couples. It is less invasive and less expensive than in vitro fertilization (IVF), despite the live birth rate (LBR) ranging from 8.5 to 12.2% [1]. Diferent protocols (natural or stimulated cycles) and difer- ent medications (clomiphene or gonadotropins) have been proposed to increase its efectiveness [1]. A recent Cochrane meta-analysis [2] reported that a protocol based on exog- enous gonadotropins increases the LBR compared to natu- ral cycle or other medications. Nevertheless, this increase in LBR is associated with a non-negligible rate of adverse events, including hyper-stimulation syndrome and multiple * Simone Garzon simone.garzon@univr.it 1 Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona, VR, Italy 2 Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Piazza Biroldi 1, 21100 Varese, VA, Italy 3 Department of Woman and Child Health, University of Padua, Via Nicolò Giustiniani, 3, 35128 Padua, PD, Italy