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Folliculogenesis--the stimulated way
1Department of Obstetrics & Gynaecology, University of Melbourne, Victoria.
Summary
Ovulation induction treatments have evolved from human pituitary gonadotrophin (hPG) to more effective methods like GnRH agonists. These advancements improve pregnancy rates in assisted reproductive technologies, including in vitro fertilization (IVF).
Area of Science:
- Reproductive Endocrinology
- Assisted Reproductive Technologies
Background:
- Initial anovulation treatments used human pituitary gonadotrophin (hPG), leading to risks like hyperstimulation and multiple pregnancies.
- Development of oral medications (clomiphene citrate, bromocriptine) and pulsatile gonadotrophin-releasing hormone (GnRH) offered simpler alternatives.
Purpose of the Study:
- To review the evolution of ovulation induction techniques.
- To highlight the shift towards controlled ovarian hyperstimulation (COH) in assisted reproduction.
- To discuss the impact of GnRH agonists on oocyte maturation and pregnancy rates.
Main Methods:
- Historical review of ovulation induction agents.
- Description of current treatment protocols for anovulatory infertility and IVF/GIFT.
- Analysis of outcomes associated with gonadotrophin-releasing hormone agonists (GnRH-a).
Main Results:
- Ovulation induction is now highly successful, except in women with elevated FSH.
- Controlled ovarian hyperstimulation (COH) is standard for IVF/GIFT, increasing embryo availability and pregnancy rates.
- GnRH agonists improve oocyte maturity, reduce cycle cancellations, and further enhance pregnancy rates.
Conclusions:
- Modern ovulation induction and COH techniques significantly improve fertility outcomes.
- Ongoing research aims to mitigate adverse effects and advance oocyte cryopreservation.