The impact of ovarian stimulation for IVF on the developing embryo.
The use of assisted reproductive technologies (ART) has been increasing over the past three decades, and, in developed countries, ART account for 1-3% of annual births. In an attempt to compensate for inefficiencies in IVF procedures, patients undergo ovarian stimulation using high doses of exogenous gonadotrophins to allow retrieval of multiple oocytes in a single cycle. Although ovarian stimulation has an important role in ART, it may also have detrimental effects on oogenesis, embryo quality, endometrial receptivity and perinatal outcomes. In this review, we consider the evidence for these effects and address possible underlying mechanisms. We conclude that such mechanisms are still poorly understood, and further knowledge is needed in order to increase the safety of ovarian stimulation and to reduce potential effects on embryo development and implantation, which will ultimately be translated into increased pregnancy rates and healthy offspring.
Santos
Margarida Avo
MA
University Medical Centre Utrecht, Reproductive Medicine and Gynaecology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. mavoribe@umcutrecht.nl
Kuijk
Ewart W
EW
Macklon
Nick S
NS
D000818:Animals; D010064:Embryo Implantation / Q000187:drug effects; D004622:Embryo, Mammalian / Q000187:drug effects*; D047108:Embryonic Development / Q000187:drug effects*; D044127:Epigenesis, Genetic / Q000187:drug effects; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D005640:Follicle Stimulating Hormone / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007246:Infertility / Q000628:therapy; D009865:Oocytes / Q000187:drug effects; D010062:Ovulation Induction / Q000009:adverse effects* / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome
D005640:Follicle Stimulating Hormone