Superovulation Strategies for Assisted Reproductive Technologies

ABSTRACT

Assisted reproductive technologies (ART) pregnancy rates improve with the replacement of multiple embryos. The specific number of embryos to be transferred (typically between two and four) is based on a patient's age and past history and a morphologic assessment of embryo quality. Superovulation, with the goal of multifollicular recruitment and the harvest of multiple preovulatory oocytes, is therefore an integral aspect of in vitro fertilization and related techniques. Given the considerable interindividual variability in response to superovulation, the selection of an appropriate ovarian stimulation protocol is critical both for the safety and success of ART. Specific superovulation strategies have therefore been developed for treatment of abnormal response patients as well as for patients expected to manifest a ``normal'' response to ovulation inducing agents.

KEYWORD

In vitro fertilization - superovulation - assisted reproductive technologies - ovarian stimulation

REFERENCES

• 1 Steptoe P C, Edwards R G. Birth after reimplantation of a human embryo [letter].  Lancet . 1978;  2 366
• 2 Jones G S. Update on in vitro fertilization.  Endocr Rev . 1984;  5 62-75
• 3 Abbasi R, Kenigsberg D, Danforth D, Falk R J, Hodgen G D. Cumulative ovulation rate in human menopausal/human chorionic gonadotropin-treated monkeys: ``step-up'' versus ``step-down'' dose regimens.  Fertil Steril . 1987;  47 1019-1024
• 4 Meldrum D R, Wisot A, Hamilton F, Gutlay A L, Kempton W F, Huynh D. Routine pituitary suppression with leuprolide before ovarian stimulation for oocyte retrieval.  Fertil Steril . 1989;  51 455-459
• 5 Hughes E G, Federkow D M, Daya S, Sagle M A, Van de Koppel P, Collins J A. The routine use of gonadotropin-releasing hormone agonists prior to in vitro fertilization and gamete intrafallopian transfer: a meta-analysis of randomized controlled trials.  Fertil Steril . 1992;  58 888-896
• 6 Liu H-C, Lai Y M, Davis O. Improved pregnancy outcome with gonadotropin-releasing hormone agonist (GnRH-a) stimulation is due to the improvement in oocyte quantity rather than quality.  J Assist Reprod Genet . 1992;  9 338-344
• 7 Society for Assisted Reproductive Technology and American Society for Reproductive Medicine. Assisted reproductive technology in the United States: 1997 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.  Fertil Steril . 2000;  74 641-653
• 8 Muasher S J, Oehninger S, Simonetti S. The value of basal and/or stimulated serum gonadotropin levels in prediction of stimulation response and in vitro fertilization outcome.  Fertil Steril . 1988;  50 298-307
• 9 Scott R T, Hofmann G E, Oehninger S, Muasher S J. Intercycle variability of day 3 follicle-stimulating hormone levels and its effect on stimulation quality in in vitro fertilization and embryo transfer.  Fertil Steril . 1990;  54 297-302
• 10 Licciardi F L, Liu H-C, Rosenwaks Z. Day 3 estradiol serum concentrations as prognosticators of stimulation response and pregnancy outcome in patients undergoing in vitro fertilization.  Fertil Steril . 1995;  64 991-994
• 11 Navot D, Rosenwaks Z, Margolioth E J. Prognostic assessment of female fecundity.  Lancet . 1987;  2 645-647
• 12 Land J A, Yarmolinskaya M, Dumoulin J C, Evers J L. High-dose human menopausal gonadotropin stimulation in poor responders does not improve in vitro fertilization outcome.  Fertil Steril . 1996;  65 961-965
• 13 Feldberg D, Farhi J, Ashkenazi J, Dicker D, Shalev J, Ben-Rafael Z. Minidose gonadotropin releasing hormone agonist is the treatment of choice in poor responders with high follicle-stimulating hormone levels.  Fertil Steril . 1994;  62 343-346
• 14 Kowalik A, Barmat L, Damario M, Liu H-C, Davis O, Rosenwaks Z. Ovarian estradiol production in vivo: inhibitory effect of leuprolide acetate.  J Reprod Med . 1998;  43 413-417
• 15 Toth T L, Awwad J T, Veeck L L, Jones Jr W H, Muasher S J. Suppression and flare regimens of gonadotropin-releasing hormone agonist: use in women with different basal gonadotropin values in an in vitro fertilization program.  J Reprod Med . 1996;  41 321-326
• 16 Schoolcraft W, Schlenker T, Gee M, Stevens J, Wagley L. Improved controlled ovarian hyperstimulation in poor responder in vitro fertilization patients with a microdose follicle-stimulating hormone flare, growth hormone protocol.  Fertil Steril . 1997;  67 93-97
• 17 San Roman A G, Surrey E S, Judd H L, Kerin J F. A prospective randomized comparison of luteal phase versus concurrent follicular phase initiation of gonadotropin-releasing hormone agonist for in vitro fertilization.  Fertil Steril . 1992;  58 744-749
• 18 Smitz J, Camus M, Devroey P, Erard P, Wisanto A, Van Steirteghem C A. Incidence of severe ovarian hyperstimulation syndrome after gonadotropin releasing hormone agonist/hMG superovulation for in vitro fertilization.  Hum Reprod . 1990;  5 933-937
• 19 Tanbo T, Dale P O, Kjekshus E, Haug E, Abyholm T. Stimulation with human menopausal gonadotropin versus follicle-stimulating hormone after pituitary suppression in polycystic ovarian syndrome.  Fertil Steril . 1990;  53 798-803
• 20 Scott R T, Rosenwaks Z. Ovulation induction for assisted reproduction.  J Reprod Med . 1989 (suppl 1);  34 (108-114)
• 21 Damario M A, Barmat L, Liu H-C, Davis O K, Rosenwaks Z. Dual suppression with oral contraceptives and gonadotropin releasing hormone agonists improves in vitro fertilization outcome in high responder patients.  Hum Reprod . 1997;  12 2359-2365
• 22 Benadiva C A, Davis O, Kligman I, Moomjy M, Liu H C, Rosenwaks Z. Withholding gonadotropin administration is an effective alternative for the prevention of ovarian hyperstimulation syndrome.  Fertil Steril . 1997;  67 724-727