title: Does the ovarian reserve decrease from repeated ovulation stimulations?
abstract: OBJECTIVE
  The majority of infertility patients require more than one in-vitro fertilization cycles to achieve pregnancy, which results in repeated stimulation in the ovaries. There have been raising concerns for patients about the effect of repetitive assisted reproductive technology (ART) cycles on ovarian response in subsequent cycles. Whether or not there is deterioration in ovarian response with repetitive treatment will allow clinicians to provide better counseling to patients before treatment.
  
  
  RESULTS
  The single determinant factor that has been shown in affecting ovarian reserve for patients undergoing repeated ART cycles is age. Current evidence has suggested that repetitive ovarian stimulation cycles with intrauterine insemination can be performed without clinically impairing ovarian response. Oocyte donors can be invited for at least three cycles without a negative effect on ovarian response to gonadotropins, number of mature oocytes retrieved, embryo quality, or pregnancy rates.
  
  
  CONCLUSIONS
  There are limited available published data on this topic. Research studies have shown that there is no detrimental effect on ovarian function of egg donors who undergo repetitive ovarian hyperstimulation. Overall findings also show that there is no significant decline in ovarian reserve in patients who undergo up to three repeated in-vitro fertilization cycles. For patients undertaking more than three cycles, the results become equivocal because age becomes a determinant factor with both pregnancy and live birth rate declining with repetitive cycles.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA. Janelle.Luk@yale.edu
authors.forename: Janelle
authors.initials: J
authors.lastname: Luk
authors.forename: Aydin
authors.initials: A
authors.lastname: Arici
mesh_terms: D000367:Age Factors; D002996:Clomiphene / Q000009:adverse effects; D004715:Endometriosis / Q000453:epidemiology; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology; D018587:Oocyte Donation; D010049:Ovarian Diseases / Q000453:epidemiology / Q000209:etiology; D010053:Ovary / Q000166:cytology*; D010062:Ovulation Induction / Q000706:statistics & numerical data*; D011247:Pregnancy
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene