Ovarian Stimulation Protocol in IVF: An Up-to-Date Review of the Literature

Abstract

The Assisted Reproductive Technology (ART) was born in order to help couples with infertility issues in having a baby. The first treatments of IVF used the spontaneous cycle of the women, with the retrieval of only one oocyte. Further studies have shown that it is possible to induce ovulation by administrating gonadotropins during the menstrual cycle, in order to obtain a higher number of oocytes. Many stimulation protocols have been introduced for controlled ovarian hyperstimulation of patients undergoing in vitro fertilization treatment. This review describe the different stimulation protocols using follicle-stimulating hormone (FSH) in combination with Gonadotropin releasing hormone (GnRH) either agonist or antagonist, oral supplementations and ovarian triggering. Using GnRH antagonist protocols have been demonstrated to improve significantly the clinical pregnancy rates for expected poor and high-responders, and in those women at high risk of developing ovarian hyperstimulation syndrome (OHSS). Two meta-analyses showed a better outcome in terms of the live birth rate when highly purified human menopausal gonadotropin (HMG) was used for ovarian stimulation compared with recombinant follicle stimulating hormone (rFSH) in the GnRH agonist long protocol. One of the most efficient stimulation protocol is the use of a combined protocol of human derived urinary FSH (uFSH) and rFSH. Combined protocol has resulted in a significant increase in the proportion of mature metaphase II oocytes and grade 1 embryos when compared to either rFSH or uFSH alone. A significantly higher delivery rate was achieved in rFSH+uFSH compared to the other protocols in poor and normal responders. Studying the combination of melatonin with myo-inositol and folic acid has also showed a higher percentage of mature oocytes in the melatonin group and a higher percentage of G1 embryos as well. However, It remains a crucial step to confirm the efficacy of such protocols for clinical application and it is still needs to comparison studies on larger scale with more focused on the differences in patients' response criteria and additional confounding variables, in order to draw more defined conclusions.

Does slow embryo development predict a high aneuploidy rate on trophectoderm biopsy?

“…The patients received ovarian stimulation according to the routine protocols of the clinic. Briefly, pituitary blockade was achieved with a GnRH antagonist (0.25 mg Orgalutran, MSD) or agonist (Lupron, Abbott) according to standard protocols (Al-Inany et al, 2016;Pacchiarotti et al, 2016;Siristatidis et al, 2015). Ovarian stimulation was conducted using recombinant FSH (Gonal, Merck Serono or Puregon, MSD), combined (or not) with human menopausal gonadotrophin (Menopur, Ferring), initiated on day 2 or 3 of the menstrual cycle.…”

Increased rounds of gonadotropin stimulation have side effects on mouse fallopian tubes and oocytes

“…Retrieval of human oocytes during assisted reproductive technology requires the use of stimulation protocols (Pacchiarotti et al 2016, Alper & Fauser 2017. Among these, the mild ovarian stimulation (MOS) protocol (Fauser et al 1999) became the preferable option for IVF treatments thanks to the reduction of patient discomfort, risk of developing ovarian hyperstimulation syndrome and costs, as well (Pennings & Ombelet 2007).…”

Differences in utilization of Intracytoplasmic sperm injection (ICSI) within human services (HHS) regions and metropolitan megaregions in the U.S.

“…With the incidence of infertility on the rise [3], use of ART is expected to increase further in the coming years in spite of access limitations. Further, recent innovation and advances in ART methods, ovarian stimulation protocols [4–6], diagnostic procedures [7], and genetic and morphokinetic markers of embryogenesis [8–10] have translated to substantial improvements in clinical outcomes including implantation, pregnancy and live birth rates.…”