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In Vitro Fertilization

In Vitro Fertilization

In vitro fertilization (IVF) is a form of assisted reproductive technology where an egg is fertilized with sperm in a controlled laboratory environment before transferring the resulting embryo into the uterus. This process is designed to help individuals and couples experiencing difficulties conceiving.
The IVF process begins with ovarian stimulation, during which reproductive endocrinologists prescribe hormonal medications to stimulate the ovaries to produce multiple eggs instead of the single...

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Updated: Sep 17, 2025

Fertility Preservation Through Oocyte Vitrification: Clinical and Laboratory Perspectives

Fertility Preservation Through Oocyte Vitrification: Clinical and Laboratory Perspectives

Published on: September 16, 2021

Controlled ovarian stimulation protocols for assisted reproduction: a network meta-analysis.

Pedro Melo^1,2, Abey Eapen³, Yealin Chung²

¹Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.

The Cochrane Database of Systematic Reviews

|July 1, 2025

Summary

This study compared controlled ovarian stimulation (COS) protocols for assisted conception. Short GnRH antagonist protocols may reduce OHSS without impacting live birth rates, while ovarian stimulation without pituitary suppression might lower success rates.

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Last Updated: Sep 17, 2025

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Published on: January 22, 2022

Area of Science:

Reproductive Medicine
In Vitro Fertilization (IVF)
Endocrinology

Background:

Controlled ovarian stimulation (COS) is crucial for assisted conception, but optimal protocols remain debated.
Existing COS protocols vary in effectiveness and safety, lacking a clear consensus for clinical practice.

Purpose of the Study:

To systematically assess and compare the effectiveness and safety of various controlled ovarian stimulation (COS) protocols.
To provide evidence-based guidance on selecting COS protocols in clinical practice for assisted conception.

Main Methods:

Conducted an extensive systematic review and meta-analysis of randomized controlled trials (RCTs) up to June 2024.
Included 338 RCTs involving 59,086 women, comparing different COS protocols with various pituitary suppression methods.
Performed pairwise and network meta-analyses, stratifying by predicted ovarian response (normal, high, low).

Main Results:

Short GnRH antagonist protocols may decrease OHSS rates in normal responders without affecting live birth/ongoing pregnancy rates (LBR/OPR).
Ovarian stimulation without pituitary suppression showed reduced LBR/OPR compared to short GnRH antagonist and GnRH agonist flare protocols.
In high responders, hMG with short GnRH antagonist protocols might reduce OHSS compared to recombinant FSH (rFSH).

Conclusions:

Short GnRH antagonist protocols appear favorable for reducing OHSS in normal responders, with comparable effectiveness.
Ovarian stimulation without pituitary suppression may lead to lower success rates (LBR/OPR) compared to other protocols.
Further research is needed on cumulative live birth rates considering all embryo transfers post-stimulation.