title: Strategies for Controlled Ovarian Stimulation in the Setting of Ovarian Aging.
abstract: In the context of assisted reproduction, the term ovarian aging is often used to refer to declining potential of ovaries to produce oocytes in adequate number or quality in response to controlled ovarian stimulation (COS). Different aspects of COS have been modified with the intention to increase the number and quality of oocytes obtained for in vitro fertilization. In the setting of ovarian aging, suppression of the luteinizing hormone (LH) surge with gonadotropin-releasing hormone (GnRH) antagonist or short GnRH agonist protocol and stimulation with a daily gonadotropin dosage of ≤ 300 IU/day seem to be appropriate first choices, and there is a strong need for well-designed randomized controlled trials investigating effects of addition of LH activity, estradiol priming, transdermal testosterone administration, and growth hormone supplementation. Given the lack of high-quality evidence showing effectiveness of one approach over another, other factors such as duration of stimulation, total gonadotropin consumption and cost of medication, patient friendliness, and possible side effect profiles must be considered in tailoring the COS protocol according to each individual's needs and desires.
authors.affiliation: Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey.
authors.forename: Baris
authors.initials: B
authors.lastname: Ata
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Emre
authors.initials: E
authors.lastname: Seli
mesh_terms: D000328:Adult; D000367:Age Factors; D000375:Aging / Q000473:pathology; D002470:Cell Survival; D016922:Cellular Senescence; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007247:Infertility, Female / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D009865:Oocytes / Q000473:pathology; D065851:Ovarian Reserve; D010053:Ovary / Q000503:physiopathology*; D010060:Ovulation; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female