title: History and challenges surrounding ovarian stimulation in the treatment of infertility.
abstract: OBJECTIVE
  To examine the history of superovulation for ovulation induction, its contributions to reproductive medicine, and its impact on multiple births.
  
  
  METHODS
  A search of the relevant literature using PubMed and other online tools.
  
  
  RESULTS
  Infertility has been a condition known and studied for thousands of years. However, it was not until this past century that effective treatments were developed. With the advancement of our knowledge of the hypothalamic-pituitary axis, therapies utilizing gonadotropins were developed to stimulate ovulation. Not only could we now treat anovulatory infertility but also induce superovulation for IVF. With these successes came consequences, including increased multiple pregnancies. Several countries recognized the high costs associated with multiple births and implemented regulations on the infertility industry. The rate of triplet and higher-order multiples has declined over the past decade. This is largely attributed to a decreased number of embryos transferred. Nonetheless, the twin rate has remained consistently high.
  
  
  CONCLUSIONS
  Superovulation has become a routine medical therapy used for ovulation induction and IVF. With the development of this technology have come effective therapies for infertility and new ethical and medical challenges. Since the advent of gonadotropin therapy we have already developed technologies to improve monitoring and decrease hyperstimulation and high-order multiple pregnancies. In the future we anticipate new tools devised to optimize one embryo for one singleton live birth.
authors.affiliation: Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1109, USA.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Beall
authors.forename: Alan
authors.initials: A
authors.lastname: DeCherney
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects / Q000266:history / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D006062:Gonadotropins / Q000009:adverse effects / Q000266:history / Q000627:therapeutic use*; D049669:History, 16th Century; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007246:Infertility / Q000266:history / Q000503:physiopathology / Q000628:therapy*; D009099:Multiple Birth Offspring; D010062:Ovulation Induction / Q000009:adverse effects / Q000266:history; D011247:Pregnancy; D011272:Pregnancy, Multiple; D018570:Risk Assessment; D012307:Risk Factors; D013480:Superovulation; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins