Ovarian stimulation protocols in assisted reproductive technology: an update

Abstract

Controlled ovarian stimulation (COS) with gonadotropins to produce multiple follicular development and high-quality oocytes is the cornerstone of assisted reproductive technology. Today, recombinant human follicle-stimulating hormone (r-hFSH) is widely used for COS. A long-acting r-hFSH and a combination of r-hFSH and recombinant human luteinizing hormone have recently become available. Formulations of purified urinary FSH with or without luteinizing hormone activity (provided by human chorionic gonadotropin) are also available. COS protocols can now be individualized to optimize efficacy and safety – defined as singleton pregnancies with a low incidence of ovarian hyperstimulation syndrome. This is facilitated by an estimation of ovarian response using the antral follicle count and/or serum anti-Müllerian hormone levels; anti-Müllerian hormone is viewed as the most reliable single marker. However, an efficient management strategy for poor responders to COS is still required. Developments in biomarkers and other techniques for accurate identification of viable oocytes and embryos and optimal uterine receptivity are expected.

Keywords::

• assisted reproductive technology
• controlled ovarian stimulation
• follicle-stimulating hormone
• gonadotropin-releasing hormone antagonist
• human chorionic gonadotropin
• in vitro fertilization
• luteinizing hormone

Financial & competing interests disclosure

C Howles and D Ezcurra are employees of Merck Serono S.A., Geneva, Switzerland – a branch of Merck Serono S.A., Coinsins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance was provided by Jane Davies, Hannah Wills and Catherine Kidd of Caudex Medical Ltd, Oxford, UK (supported by Merck Serono S.A., Geneva, Switzerland – a branch of Merck Serono S.A., Coinsins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany).