Clinical outcomes from assisted reproductive technology in predicted hyper-responders: a narrative review

The management of assisted reproductive technology (ART) in predicted hyper-responders to ovarian stimulation represents a complex and challenging clinical scenario, whereby the benefits of higher oocyte yield must be balanced against the drawbacks and risks of ovarian hyperstimulation syndrome. This review explores advances in ART for hyper-responders, focusing on adapted stimulation protocols, ovulation triggering, cryopreservation, and personalized strategies to optimize outcomes. In-vitro maturation of oocytes, an emerging alternative, is gaining traction for increasing live birth rates in selected cases and expert centers. A comprehensive review of the literature was conducted. Articles were selected based on relevance, rigor, and contributions to advancing the management of hyper-responders in assisted reproductive technology. Key findings were synthesized to provide an overview of evidence and emerging trends. Findings suggest a paradigm shift from indiscriminate oocyte retrieval towards achieving a target range, with 15-19 oocytes per cycle correlating with an optimal balance between live birth rates and complication risks. However, challenges remain in predicting ovarian response accurately, particularly in patients with elevated Anti-Müllerian Hormone levels or specific clinical profiles. The variability of ovarian response in these categories underscores the need for individualized protocols, incorporating patient-specific factors of age, Body Mass Index, and ovarian reserve markers. Strategies like tailored gonadotropin dosing and advances in cryopreservation techniques, such as embryo and oocyte vitrification, have shown promise but still require refinement. Future research should aim to refine dosing algorithms, explore genetic contributions, and enhance personalized, patient-centered approaches that prioritize safety, comfort, and improved outcomes in managing hyper-responders.