The DIVINE dose-selection model in daily ART practice: effects on live birth rate and safety

Abstract

Research question: Does implementation of the DIVINE dose calculator in routine care reduce treatment risk due to ovarian hyperstimulation whilst maintaining treatment efficacy? Design: A retrospective cohort study comparing assisted reproductive technology outcomes from women treated before and after implementation of the DIVINE dose calculator. Data were collected from two Dutch fertility centres. The dose calculator included female age, anti-Müllerian hormone concentration, and gonadotrophin-releasing hormone-(ant)agonist protocol to select the most appropriate starting dose of FSH between 100 and 225 IU. Baseline characteristics of subfertile women aged <39 years starting their first IVF/intracytoplasmic sperm injection (ICSI) treatment cycle, and fresh cycle treatment outcomes were collected. Inverse propensity weighting was applied to balance potential confounders. Weighted regression was performed using general linear models or ordered logistic regression models, according to the outcome variable. The primary outcome variables were live birth rate and safety risk. Results: Data were obtained for 601 women: 472 in the pre-dose calculator group and 129 in the post-dose calculator group. There was no difference in the live birth rate per fresh cycle before and after implementation of the dose calculator: 25.8% versus 24.0% respectively (OR 0.96, 95% CI 0.62–1.51). The treatment risk due to ovarian hyperstimulation decreased after implementation of the dose calculator from 10.8% in the pre-dose calculator period to 3.1% in the post-dose calculator period (OR 0.28, 95% CI 0.10–0.78), and the incidence of ovarian hyperstimulation syndrome decreased from 6.4% to 0% after implementation of the dose calculator. Conclusion: Implementation of the DIVINE dose calculator significantly reduces treatment risks caused by ovarian hyperstimulation, without affecting treatment efficacy in terms of the live birth rate in first fresh IVF/ICSI cycles.