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Optimal control of dosage decisions in controlled ovarian hyperstimulation

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  • Miao He
  • Lei Zhao
  • Warren Powell

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. Copyright Springer Science+Business Media, LLC 2010

Suggested Citation

  • Miao He & Lei Zhao & Warren Powell, 2010. "Optimal control of dosage decisions in controlled ovarian hyperstimulation," Annals of Operations Research, Springer, vol. 178(1), pages 223-245, July.
    • Handle: RePEc:spr:annopr:v:178:y:2010:i:1:p:223-245:10.1007/s10479-009-0563-y
    DOI: 10.1007/s10479-009-0563-y
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    References listed on IDEAS

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    1. David C. Schmittlein & Donald G. Morrison, 2003. "A Live Baby or Your Money Back: The Marketing of In Vitro Fertilization Procedures," Management Science, INFORMS, vol. 49(12), pages 1617-1635, December.
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    5. Oguzhan Alagoz & Lisa M. Maillart & Andrew J. Schaefer & Mark S. Roberts, 2007. "Determining the Acceptance of Cadaveric Livers Using an Implicit Model of the Waiting List," Operations Research, INFORMS, vol. 55(1), pages 24-36, February.
    6. Marne C. Cario & Barry L. Nelson, 1998. "Numerical Methods for Fitting and Simulating Autoregressive-to-Anything Processes," INFORMS Journal on Computing, INFORMS, vol. 10(1), pages 72-81, February.
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    Cited by:

    1. He, Miao & Zhao, Lei & Powell, Warren B., 2012. "Approximate dynamic programming algorithms for optimal dosage decisions in controlled ovarian hyperstimulation," European Journal of Operational Research, Elsevier, vol. 222(2), pages 328-340.

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