Ovarian manipulation in ART: going beyond physiological standards to provide best clinical outcomes

• Published in: Journal of assisted reproduction and genetics Vol. 35; no. 10; pp. 1751 - 1762
• Main Authors: Ortega, Israel, García-Velasco, Juan A., Pellicer, Antonio
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2018; Springer Nature B.V
• Subjects: 17β-Estradiol; Chorionic Gonadotropin - metabolism; Commentary; Female; Fertilization in Vitro; Folliculogenesis; Gonadotropins; Gynecology; Human Genetics; Humans; Literature reviews; Luteal Phase - metabolism; Luteal Phase - physiology; Medicine; Medicine & Public Health; Ovarian Follicle - growth & development; Ovarian Follicle - pathology; Ovarian Hyperstimulation Syndrome - epidemiology; Ovarian Hyperstimulation Syndrome - pathology; Ovary - growth & development; Ovary - pathology; Ovulation Induction - methods; Pituitary (anterior); Pregnancy; Pregnancy Rate; Reproductive Medicine; Reproductive system; Reproductive Techniques, Assisted - trends; Fertility preservation; Double stimulation; Random-start ovarian stimulation; Dual triggering; Poor responders; Luteal phase ovarian stimulation
• ISSN: 1058-0468; 1573-7330
• DOI: 10.1007/s10815-018-1258-6

Current knowledge on ovarian physiology has challenged the traditional concept of folliculogenesis, creating the basis for novel ovarian stimulation protocols in assisted reproduction technology. The purpose of this review was to evaluate the efficacy of novel clinical interventions that could aid clinicians in individualizing their protocols to patients’ characteristics and personal situations. We conducted a literature review of the available evidence on new approaches for ovarian stimulation from both retrospective and prospective studies in the PubMed database. Here, we present some of the most important interventions, including follicle growth in the gonadotropin-independent and dependent stage, manipulation of estradiol production throughout ovarian stimulation, control of mid-cycle gonadotropin surges, and luteal phase support after different stimulation protocols and trigger agents. The latest research on IVF has moved physicians away from the classical physiology, allowing the development of new strategies to decouple organ functions from the female reproductive system and challenging the traditional concept of IVF.