title: Effect of repeated assisted reproductive technology on ovarian response.
abstract: OBJECTIVE
  Based on current rates of success, many infertile couples who desire pregnancy have to undergo repeated cycles of assisted reproductive technology. Concern has been raised that repeated cycles of assisted reproductive technology may have a detrimental effect on future ovarian response and function, as well as pregnancy. This review summarizes current knowledge of the effects of repeated assisted reproductive technology, highlighting recent publications.
  
  
  RESULTS
  The available published evidence so far indicates that the follicular response and the number of oocytes retrieved appears to be maintained with repeated treatment and the only significant decline in ovarian response is because of an increase in female age. Similarly pregnancy and live birth rates decline to a small degree only up to cycle 3 or 4, with increasing female age again being the prime determinant. Encouraging patients to undertake repeated treatment without undue delay leads to improved cumulative rates of pregnancy and live birth. Current evidence does not indicate that ovarian stimulation leads to an increased risk of ovarian malignancy.
  
  
  CONCLUSIONS
  Couples should be counselled from the outset that assisted reproductive technology treatment is a continuum and a number of treatment cycles may be necessary. At present, there is little indication that repeated cycles have a detrimental effect on ovarian function, although the outcome of further research is awaited.
authors.affiliation: McGill Reproductive Centre, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada. simon.kelly@muhc.mcgill.ca
authors.forename: Simon M
authors.initials: SM
authors.lastname: Kelly
authors.forename: William M
authors.initials: WM
authors.lastname: Buckett
authors.forename: Seang Lin
authors.initials: SL
authors.lastname: Tan
mesh_terms: D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008297:Male; D008423:Maternal Age; D009865:Oocytes / Q000502:physiology*; D011247:Pregnancy; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic