Archives of Gynecology and Obstetrics

, Volume 298, Issue 5, pp 1029–1035 | Cite as

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
  • Simone GarzonEmail author
  • Sara Giuliani
  • Antonio Simone Laganà
  • Marco Noventa
  • Francesca Parissone
  • Carlotta Zorzi
  • Ricciarda Raffaelli
  • Fabio Ghezzi
  • Massimo Franchi
  • Stefano Zaffagnini
Gynecologic Endocrinology and Reproductive Medicine



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.


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.


The FSH starting dose calculated by the nomogram was significantly 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.


The application of this nomogram in IUI cycles would lead to a more tailored FSH starting dose and improved cost-effectiveness, although in PCOS women, particularly the ones with high AMH, it does not seem adequate.


Follicle-stimulating hormone Starting dose Anti-Müllerian hormone Controlled ovarian stimulation Intrauterine insemination Nomogram 


Author contribution

Di Paola R and Zaffagnini S: study conceptualization and protocol planning, supervision. Garzon S: clinical data collection and analysis, manuscript writing/editing. Giuliani S, Parissone F and Zorzi C: clinical data collection and analysis. Laganà AS and Noventa M: clinical data analysis and manuscript writing/editing. Raffaelli R, Ghezzi F and Franchi M: project administration, methodology validation and supervision. All the authors conform to the International Committee of Medical Journal Editors (ICMJE) criteria for authorship, contributed to the intellectual content of the study and gave approval for the final version of the article. The authors alone are responsible for the content and writing of the paper.


This study was not funded.

Compliance with ethical standards

Conflict of interest

Di Paola R declares that she has no conflict of interest. Garzon S declares that he has no conflict of interest. Giuliani S declares that she has no conflict of interest. Parissone F declares that she has no conflict of interest. Zorzi C declares that she has no conflict of interest. Laganà AS declares that he has no conflict of interest. Noventa M declares that he has no conflict of interest. Raffaelli R declares that she has no conflict of interest. Ghezzi F declares that he has no conflict of interest. Franchi M declares that he has no conflict of interest. Zaffagnini S declares that he has no conflict of interest. The authors have no proprietary, financial, professional or other personal interest of any nature in any product, service or company.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The design, analysis, interpretation of data, drafting, and revisions conform to the Committee on Publication Ethics (COPE) guidelines (, and the RECORD (reporting of studies conducted using observational routinely collected health data) statement [38], available through the EQUATOR (enhancing the quality and transparency of health research) network ( The study was non-advertised, and no remuneration was offered to encourage patients to give consent for collection and analysis of their data. The retrospective study design and development, with anonymized handling of the data, was approved by the Institutional Review Board of the University of Verona.

Informed consent

Informed consent was obtained from all individual participants included in the study. Each patient enrolled in this study signed an informed consent for all the procedures and to allow data collection and analysis for research purpose.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Rossana Di Paola
    • 1
  • Simone Garzon
    • 1
    Email author
  • Sara Giuliani
    • 1
  • Antonio Simone Laganà
    • 2
  • Marco Noventa
    • 3
  • Francesca Parissone
    • 1
  • Carlotta Zorzi
    • 1
  • Ricciarda Raffaelli
    • 1
  • Fabio Ghezzi
    • 2
  • Massimo Franchi
    • 1
  • Stefano Zaffagnini
    • 1
  1. 1.Department of Obstetrics and Gynecology, AOUI VeronaUniversity of VeronaVeronaItaly
  2. 2.Department of Obstetrics and Gynecology, “Filippo Del Ponte” HospitalUniversity of InsubriaVareseItaly
  3. 3.Department of Woman and Child HealthUniversity of PaduaPaduaItaly

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