Ovarian stimulation: today and tomorrow

Area of Science:

• Reproductive Endocrinology
• Assisted Reproductive Technology (ART)

Background:

• Medications and ovarian stimulation are vital in assisted reproductive technology (ART).
• Gonadotrophins and GnRH analogues enable tailored stimulation protocols.
• Common protocols involve urinary hMG or recombinant FSH with GnRH agonists or antagonists.

Purpose of the Study:

• To evaluate novel strategies for optimizing controlled ovarian hyperstimulation (COH) in IVF.
• To mitigate risks of Ovarian Hyperstimulation Syndrome (OHSS) and multiple pregnancies.
• To improve clinical outcomes in ART cycles using GnRH antagonists and specific triggers.

Main Methods:

• Comparison of different gonadotrophin preparations (urinary hMG, recombinant FSH, corifollitropin alfa).
• Utilizing GnRH agonists versus GnRH antagonists in stimulation protocols.
• Investigating GnRH agonist trigger for final oocyte maturation versus hCG trigger.
• Exploring cryopreservation and subsequent natural cycle frozen embryo transfer (SET).

Main Results:

• Recombinant FSH may increase the risk of premature progesterone rise if not triggered promptly.
• Corifollitropin alfa offers sustained follicular growth with GnRH antagonists.
• GnRH antagonists reduce OHSS risk compared to GnRH agonists.
• GnRH agonist trigger eliminates early OHSS but can cause luteal phase deficiency, necessitating embryo cryopreservation.
• GnRH agonist trigger in antagonist protocols leads to poor outcomes without cryopreservation.

Conclusions:

• GnRH antagonists significantly reduce OHSS risk.
• GnRH agonist trigger eliminates early OHSS but requires cryopreservation for optimal outcomes.
• A simplified corifollitropin alfa/GnRH antagonist cycle with GnRH agonist trigger and subsequent frozen embryo transfer offers a promising approach to eliminate major COH complications in IVF without compromising results.