We read with interest the trials published by the OPTIMIST trial group(Oudshoorn, et al., 2017, van Tilborg, et al., 2017, van Tilborg, et al., 2017). These three papers collectively suggest that the individualization of FSH dosing according to a baseline antral follicle count is not effective. We are concerned that this conclusion is driven by excessive reliance on live-birth rates, rather than outcomes which are directly modifiable by ovarian stimulation. Recognition of non-inferiority for live -birth rates, but the distinct advantages of fewer poor responses and improved patient safety with respect to a reduced risk of ovarian hyperstimulation syndrome (OHSS) have been reportedin other trials examining individualization of ovarian stimulation(Allegra, et al., 2017, Nyboe Andersen, et al., 2017). We would suggest that the data from the OPTIMIST trials in fact confirms the benefits of individualized FSH dosing, and it is notable that these advantages were achieved despite the very limited stratification of doses (100, 150, 225 and 450IU) that were initially assessed.
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