Patient-friendly ovarian stimulation.
The ultimate goal of successful IVF is the birth of a healthy child with no maternal complications. Advances in ovarian stimulation protocols using gonadotrophin-releasing hormone agonists (GnRHa) and high doses of gonadotrophins have resulted in increased oocyte numbers with improved pregnancy and birth rates. However, the efficacy of such therapy is controversial when measured against the potential side effects. These side effects include those arising from oestrogen deprivation during desensitization, complications associated with an increased risk of ovarian hyperstimulation syndrome (OHSS), and an increased possibility of multiple births. Additionally, the increased cost due to more frequent monitoring and increased drug dosage negatively impacts on patient care. Thus, refinements in drug regimens are needed not only to address these side effects, but also to target the quality, not the quantity, of oocytes. In studies comparing GnRH antagonist (GnRHnt) to GnRHa, patients receiving GnRHnt underwent a shorter induction using less gonadotrophin, the incidence of OHSS was reduced and they reported a better quality of life. While larger studies are needed to confirm these promising findings, it appears that milder stimulation protocols could represent an interesting option, at least for selected patients.
Olivennes
François
F
Unit of Reproductive Medicine, Obstetric and Gynecology Department, 123 Boulevard de Port Royal, 75014 Paris, France. francois.olivennes@cch.ap-hop-paris.fr
D004967:Estrogens / Q000378:metabolism; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005307:Fertilization in Vitro / Q000379:methods; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006062:Gonadotropins / Q000378:metabolism; D006801:Humans; D007246:Infertility / Q000628:therapy; D007752:Obstetric Labor, Premature; D016471:Ovarian Hyperstimulation Syndrome; D010062:Ovulation Induction; D011247:Pregnancy; D011272:Pregnancy, Multiple; D008941:Spindle Apparatus / Q000378:metabolism
D004967:Estrogens; D005300:Fertility Agents, Female; D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone