Optimal control of dosage decisions in controlled ovarian hyperstimulation

Miao He, Lei Zhao, Warren Buckler Powell

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

In the controlled ovarian hyperstimulation (COH) cycle of the in vitro fertilization-embryo transfer (IVF-ET) therapy, the clinicians observe the patients' responses to gonadotropin dosages through closely monitoring their physiological states, to balance the trade-off between pregnancy rate and ovarian hyperstimulation syndrome (OHSS) risk. In this paper, we model the clinical practice in the COH treatment cycle as a stochastic dynamic program, to capture the dynamic decision process and to account for each individual patient's stochastic responses to gonadotropin administration. We discretize the problem into a Markov decision process and solve it using a slightly modified backward dynamic programming algorithm. We then evaluate the policies using simulation and explore the impact of patient misclassification. More specifically, we focus on patients with polycystic ovary syndrome (PCOS) or potential, that is, the patients that tend to be more sensitive to gonadotropin administration.

Original languageEnglish (US)
Pages (from-to)223-245
Number of pages23
JournalAnnals of Operations Research
Volume178
Issue number1
DOIs
StatePublished - Jan 1 2010

All Science Journal Classification (ASJC) codes

  • Decision Sciences(all)
  • Management Science and Operations Research

Keywords

  • Controlled ovarian hyperstimulation
  • Dosage decisions
  • Markov decision process
  • OHSS risk
  • Pregnancy rate

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