title: Best protocol for controlled ovarian hyperstimulation in assisted reproductive technologies: fact or opinion?
abstract: From the early ages of assisted reproductive technologies (ARTs), different protocols have been developed with different gonadotropin preparations at different dosages with or without gonadotropin releasing hormone agonist or antagonist cotreatment. Various adjuvants have also been incorporated in controlled ovarian hyperstimulation (COH) protocols in an attempt to increase the efficacy and safety. The "best" protocol for COH should minimize stimulation burden while maintain the highest healthy, singleton, term live birth rates. Understandably, the one that meets all these expectations may not exist and COH should be individualized. Currently, there are worldwide differences in COH protocols and gonadotropin dose algorithms used depending on the country, demographics, funding stream, and existing guidelines/legislations. In 2014, despite efforts to individualize COH, currently, many of the protocols employ lack of high-quality evidence-based data. The aim of this review is to overview the efficacy and safety of available COH protocols, in normal responders, poor responders, and hyperresponders from evidence-based medicine perspective.
authors.affiliation: Anatolia IVF and Women's Health Center, Ankara, Turkey.
authors.forename: Mehtap
authors.initials: M
authors.lastname: Polat
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Gurkan
authors.initials: G
authors.lastname: Bozdag
authors.affiliation: Anatolia IVF and Women's Health Center, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Yarali
mesh_terms: D002985:Clinical Protocols; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005298:Fertility / Q000187:drug effects*; D005299:Fertility Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D018579:Patient Selection; D011247:Pregnancy; D012307:Risk Factors; D013480:Superovulation / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005299:Fertility Agents