Adjuvant therapy in assisted fertilization procedures

Abstract

Introduction. Despite continuous advances in assisted reproductive technologies (ART), their outcomes are limited. Before introducing adjuvant therapy to improve the in vitro fertilization (IVF) outcome, it is important to identify appropriate groups of patients, and avoid equal approach for everyone. Objective The objective of this paper was to review the available literature on the most commonly used adjuvant therapy aiming to improve the outcome of IVF. The guidelines of the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) were used, and the available literature was analyzed by searching the Medline-PubMed and Cochrane databases using appropriate keywords for each entity. Discussion. A review of the literature found no consistent evidences for the standard use of metformin in patients with polycystic ovarian syndrome (PCOSy), nor for use of dehydroepiandrosterone (DHEA), testosterone (T) and growth hormone (GH) in patients with premature ovarian failure or those with poor response to stimulation. The standard usage of prednisone and aspirin in the general population of patients in ART is also not recommended. Recently, the significance of the oxidative stress has been emphasized, which is why the use of antioxidants in the form of supplementation (Melatonin, vitamins C, A, E, Coenzyme Q) might be important in improving reproductive outcomes. Conclusion. The modern approach to the problem of infertility has become strictly individual. The application of adjuvant therapy in order to improve the outcome of ART procedures requires an analytical and critical approach in each individual case.