Algorithm vs clinical experience: controlled ovarian stimulations with follitropin delta and individualised doses of follitropin alpha/beta

In the registration trials, follitropin delta was compared with a fixed dose of 150 UI of follitropin alpha/beta, finding higher chances to reach a target response of 8–14 oocytes compared to controls. For this reason, follitropin delta is marketed as particularly useful in expected hyper-responder patients. The main outcome of this study is to report if comparable results are reached in a real-life scenario with follitropin alpha/beta doses chosen by the physician, based on patients’ characteristics. This is a retrospective study performed in two public fertility centres. All first cycles from January 2020 to June 2022 with either follitropin delta (cases) or alpha/beta (controls) in patients with anti-Müllerian hormone >2.5 ng/mL were compared by an inverse probability weighting approach based on propensity score. The follitropin total dose was higher in controls (1179.06 ± 344.93 vs 1668.67 ± 555.22 IU, P < 0.001). The target response of 8–14 oocytes was reached by 40.2% of cases and 40.7% of controls (odds ratio (OR): 0.99, 95% confidence interval (CI): 0.65–1.53, P = 0.98). Fewer than 8 oocytes were collected in 24.1% of cases and 22% of controls (OR: 1.10, 95% CI: 0.71–1.69, P = 0.67); more than 14 oocytes in 35.7% of cases and 37.3% of controls (OR: 0.83, 95% CI: 0.54–1.28, P = 0.40). Our experience did not find worse results in term of proportion of patients who reached the target response with an algorithm-chosen dose of follitropin delta compared to a personalised starting dose of follitropin alpha/beta, with follitropin delta having the advantage of objectivity. However, larger numbers are needed to confirm these results.