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.
Keywords
In vitro fertilization - ovarian reserve - live birth - normal responder - poor responder
- hyperresponder - controlled ovarian hyperstimulation - individualization
