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Semin Reprod Med 2015; 33(02): 077-082
DOI: 10.1055/s-0035-1546424
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Best Practices for Controlled Ovarian Stimulation in In Vitro Fertilization

Emily S. Jungheim
1   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Melissa F. Meyer
1   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Darcy E. Broughton
2   Oregon Health and Science University, Portland, Oregon
› Author Affiliations
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Publication History

Publication Date:
03 March 2015 (online)

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Abstract

As applications for IVF have expanded over the years, so too have approaches to controlled ovarian stimulation (COS) for IVF. With this expansion and improved knowledge of basic reproductive biology, there is increasing interest in how COS practice influences IVF outcomes, and whether or not specific treatment scenarios call for personalized approaches to COS. For the majority of women undergoing COS and their treating physicians, the goal is to achieve a healthy live birth through IVF in a fresh cycle. Opinions on how COS strategy best leads to this common goal varies among centers as many clinicians base COS strategy not on evidence obtained through prospective randomized trials, but rather through observational studies and experience. Overall, when it comes to COS most clinicians recognize the approach should not be “one size fits all,” but rather a patient-centered approach that takes the existing evidence into consideration. We outline the existing evidence for best practices in COS for IVF, highlighting how these practices may be incorporated into a patient-centered approach.

Keywords

controlled ovarian stimulation - gonadotropins - in vitro fertilization
 

  • References

  • 1 Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet 1978; 2 (8085) 366
    PubMedSearch in Google Scholar
  • 2 Jones Jr HW, Jones GS, Andrews MC , et al. The program for in vitro fertilization at Norfolk. Fertil Steril 1982; 38 (1) 14-21
    PubMedSearch in Google Scholar
  • 3 Jones Jr HW. The use of controlled ovarian hyperstimulation (COH) in clinical in vitro fertilization: the role of Georgeanna Seegar Jones. Fertil Steril 2008; 90 (5) e1-e3
    CrossrefPubMedSearch in Google Scholar
  • 4 Fritz MA. (2011). Clinical Gynecologic Endocrinology and Infertility, 8th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011
    Search in Google Scholar
  • 5 Van Voorhis BJ, Thomas M, Surrey ES, Sparks A. What do consistently high-performing in vitro fertilization programs in the U.S. do?. Fertil Steril 2010; 94 (4) 1346-1349
    CrossrefPubMedSearch in Google Scholar
  • 6 Beall SA, DeCherney A. History and challenges surrounding ovarian stimulation in the treatment of infertility. Fertil Steril 2012; 97 (4) 795-801
    CrossrefPubMedSearch in Google Scholar
  • 7 Gianaroli L, Racowsky C, Geraedts J, Cedars M, Makrigiannakis A, Lobo RA. Best practices of ASRM and ESHRE: a journey through reproductive medicine. Fertil Steril 2012; 98 (6) 1380-1394
    CrossrefPubMedSearch in Google Scholar
  • 8 Lyerly AD, Steinhauser K, Voils C , et al. Fertility patients' views about frozen embryo disposition: results of a multi-institutional U.S. survey. Fertil Steril 2010; 93 (2) 499-509
    CrossrefPubMedSearch in Google Scholar
  • 9 Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. In vitro maturation: a committee opinion. Fertil Steril 2013; 99 (3) 663-666
    CrossrefPubMedSearch in Google Scholar
  • 10 Verpoest W, Fauser BC, Papanikolaou E , et al. Chromosomal aneuploidy in embryos conceived with unstimulated cycle IVF. Hum Reprod 2008; 23 (10) 2369-2371
    CrossrefPubMedSearch in Google Scholar
  • 11 Baart EB, Martini E, Eijkemans MJ , et al. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Hum Reprod 2007; 22 (4) 980-988
    CrossrefPubMedSearch in Google Scholar
  • 12 Kovacs P, Sajgo A, Kaali SG, Pal L. Detrimental effects of high-dose gonadotropin on outcome of IVF: making a case for gentle ovarian stimulation strategies. Reprod Sci 2012; 19 (7) 718-724
    CrossrefPubMedSearch in Google Scholar
  • 13 Labarta E, Bosch E, Alamá P, Rubio C, Rodrigo L, Pellicer A. Moderate ovarian stimulation does not increase the incidence of human embryo chromosomal abnormalities in in vitro fertilization cycles. J Clin Endocrinol Metab 2012; 97 (10) E1987-E1994
    CrossrefPubMedSearch in Google Scholar
  • 14 Trounson A, Mohr L. Human pregnancy following cryopreservation, thawing and transfer of an eight-cell embryo. Nature 1983; 305 (5936) 707-709
    CrossrefPubMedSearch in Google Scholar
  • 15 Wong KM, Mastenbroek S, Repping S. Cryopreservation of human embryos and its contribution to in vitro fertilization success rates. Fertil Steril 2014; 102 (1) 19-26
    CrossrefPubMedSearch in Google Scholar
  • 16 Jungheim ES, Carson KR, Brown D. Counseling and consenting women with cancer on their oncofertility options: a clinical perspective. Cancer Treat Res 2010; 156: 403-412
    PubMedSearch in Google Scholar
  • 17 La Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Hum Reprod Update 2014; 20 (1) 124-140
    Search in Google Scholar
  • 18 Berkkanoglu M, Ozgur K. What is the optimum maximal gonadotropin dosage used in microdose flare-up cycles in poor responders?. Fertil Steril 2010; 94 (2) 662-665
    CrossrefPubMedSearch in Google Scholar
  • 19 Nardo LG, Bosch E, Lambalk CB, Gelbaya TA. Controlled ovarian hyperstimulation regimens: a review of the available evidence for clinical practice. Produced on behalf of the BFS Policy and Practice Committee. Hum Fertil (Camb) 2013; 16 (3) 144-150
    CrossrefPubMedSearch in Google Scholar
  • 20 Practice Committee of American Society for Reproductive Medicine, Birmingham, Alabama. Gonadotropin preparations: past, present, and future perspectives. Fertil Steril 2008; 90 (5, Suppl): S13-S20
    PubMedSearch in Google Scholar
  • 21 Coomarasamy A, Afnan M, Cheema D, van der Veen F, Bossuyt PM, van Wely M. Urinary hMG versus recombinant FSH for controlled ovarian hyperstimulation following an agonist long down-regulation protocol in IVF or ICSI treatment: a systematic review and meta-analysis. Hum Reprod 2008; 23 (2) 310-315
    PubMedSearch in Google Scholar
  • 22 Lehert P, Schertz JC, Ezcurra D. Recombinant human follicle-stimulating hormone produces more oocytes with a lower total dose per cycle in assisted reproductive technologies compared with highly purified human menopausal gonadotrophin: a meta-analysis. Reprod Biol Endocrinol 2010; 8: 112
    CrossrefPubMedSearch in Google Scholar
  • 23 van Wely M, Kwan I, Burt AL , et al. Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles. Cochrane Database Syst Rev 2011; (2) CD005354
    PubMedSearch in Google Scholar
  • 24 Wechowski J, Connolly M, Schneider D, McEwan P, Kennedy R. Cost-saving treatment strategies in in vitro fertilization: a combined economic evaluation of two large randomized clinical trials comparing highly purified human menopausal gonadotropin and recombinant follicle-stimulating hormone alpha. Fertil Steril 2009; 91 (4) 1067-1076
    CrossrefPubMedSearch in Google Scholar
  • 25 Propst AM, Hill MJ, Bates GW, Palumbo M, Van Horne AK, Retzloff MG. Low-dose human chorionic gonadotropin may improve in vitro fertilization cycle outcomes in patients with low luteinizing hormone levels after gonadotropin-releasing hormone antagonist administration. Fertil Steril 2011; 96 (4) 898-904
    CrossrefPubMedSearch in Google Scholar
  • 26 The European Recombinant Human LH Study Group. Recombinant human luteinizing hormone (LH) to support recombinant human follicle-stimulating hormone (FSH)-induced follicular development in LH- and FSH-deficient anovulatory women: a dose-finding study. J Clin Endocrinol Metab 1998; 83 (5) 1507-1514
    PubMedSearch in Google Scholar
  • 27 Youssef MA, Al-Inany HG, Aboulghar M, Mansour R, Abou-Setta AM. Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in IVF and ICSI cycles. Cochrane Database Syst Rev 2011; (4) CD003719
    PubMedSearch in Google Scholar
  • 28 Awwad JT, Farra C, Mitri F, Abdallah MA, Jaoudeh MA, Ghazeeri G. Split daily recombinant human LH dose in hypogonadotrophic hypogonadism: a nonrandomized controlled pilot study. Reprod Biomed Online 2013; 26 (1) 88-92
    CrossrefPubMedSearch in Google Scholar
  • 29 Fox JH, Jackson KV, Rein MS, Hornstein MD, Clarke RN, Friedman AJ. A randomized clinical trial to evaluate the clinical effects of split- versus single-dose human menopausal gonadotropins in an assisted reproductive technology program. Fertil Steril 1996; 65 (3) 598-602
    PubMedSearch in Google Scholar
  • 30 Sharara FI, Collins MG, Abdo G. Decreased gonadotropin requirements in once daily compared to twice daily administration: a prospective, randomized study. J Assist Reprod Genet 2012; 29 (4) 321-324
    CrossrefPubMedSearch in Google Scholar
  • 31 Dahan MH, Lathi RB. Twice-daily dosing of gonadotropins does not improve embryo quality during in vitro fertilization cycles in women with polycystic ovary syndrome, when compared to once-daily dosing: a pilot study. Arch Gynecol Obstet 2014; 289 (5) 1113-1118
    CrossrefPubMedSearch in Google Scholar
  • 32 Devroey P, Boostanfar R, Koper NP, Mannaerts BM, Ijzerman-Boon PC, Fauser BC ; ENGAGE Investigators. A double-blind, non-inferiority RCT comparing corifollitropin alfa and recombinant FSH during the first seven days of ovarian stimulation using a GnRH antagonist protocol. Hum Reprod 2009; 24 (12) 3063-3072
    CrossrefPubMedSearch in Google Scholar
  • 33 Boostanfar R, Mannaerts B, Pang S, Fernandez-Sanchez M, Witjes H, Devroey P ; Engage Investigators. A comparison of live birth rates and cumulative ongoing pregnancy rates between Europe and North America after ovarian stimulation with corifollitropin alfa or recombinant follicle-stimulating hormone. Fertil Steril 2012; 97 (6) 1351-1358
    CrossrefPubMedSearch in Google Scholar
  • 34 Azim AA, Costantini-Ferrando M, Oktay K. Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol 2008; 26 (16) 2630-2635
    CrossrefPubMedSearch in Google Scholar
  • 35 Fiedler K, Ezcurra D. Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment. Reprod Biol Endocrinol 2012; 10: 32
    CrossrefPubMedSearch in Google Scholar
  • 36 Leitao VM, Moroni RM, Seko LM, Nastri CO, Martins WP. Cabergoline for the prevention of ovarian hyperstimulation syndrome: systematic review and meta-analysis of randomized controlled trials. Fertil Steril 2014; 101 (3) 664-675
    CrossrefPubMedSearch in Google Scholar
  • 37 Mathur R, Alexander CJ, Yano J, Trivax B, Azziz R. Use of metformin in polycystic ovary syndrome. Am J Obstet Gynecol 2008; 199 (6) 596-609
    CrossrefPubMedSearch in Google Scholar
  • 38 Reynolds KA, Omurtag KR, Jimenez PT, Rhee JS, Tuuli MG, Jungheim ES. Cycle cancellation and pregnancy after luteal estradiol priming in women defined as poor responders: a systematic review and meta-analysis. Hum Reprod 2013; 28 (11) 2981-2989
    CrossrefPubMedSearch in Google Scholar
  • 39 Tso LO, Costello MF, Albuquerque LE, Andriolo RB, Macedo CR. Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2014; 11: CD006105
    PubMedSearch in Google Scholar
  • 40 Youssef MA, Van der Veen F, Al-Inany HG , et al. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology. Cochrane Database Syst Rev 2014; 10: CD008046
    PubMedSearch in Google Scholar
  • 41 Bentov Y, Hannam T, Jurisicova A, Esfandiari N, Casper RF. Coenzyme Q10 Supplementation and Oocyte Aneuploidy in Women Undergoing IVF-ICSI Treatment. Clin Med Insights Reprod Health 2014; 8: 31-36
    CrossrefPubMedSearch in Google Scholar
  • 42 Bromer JG, Cetinkaya MB, Arici A. Pretreatments before the induction of ovulation in assisted reproduction technologies: evidence-based medicine in 2007. Ann N Y Acad Sci 2008; 1127: 31-40
    CrossrefPubMedSearch in Google Scholar
  • 43 Meldrum DR, Fisher AR, Butts SF, Su HI, Sammel MD. Acupuncture—help, harm, or placebo?. Fertil Steril 2013; 99 (7) 1821-1824
    CrossrefPubMedSearch in Google Scholar
  • 44 Nardo LG, El-Toukhy T, Stewart J, Balen AH, Potdar N. British Fertility Society Policy and Practice Committee: Adjuvants in IVF: evidence for good clinical practice. Hum Fertil (Camb) 2014; 1-14
    PubMedSearch in Google Scholar
  • 45 Polanski LT, Barbosa MA, Martins WP , et al. Interventions to improve reproductive outcomes in women with elevated natural killer cells undergoing assisted reproduction techniques: a systematic review of literature. Hum Reprod 2014; 29 (1) 65-75
    CrossrefPubMedSearch in Google Scholar
  • 46 Allersma T, Farquhar C, Cantineau AE. Natural cycle in vitro fertilisation (IVF) for subfertile couples. Cochrane Database Syst Rev 2013; 8: CD010550
    PubMedSearch in Google Scholar
  • 47 Sato A, Otsu E, Negishi H, Utsunomiya T, Arima T. Aberrant DNA methylation of imprinted loci in superovulated oocytes. Hum Reprod 2007; 22 (1) 26-35
    PubMedSearch in Google Scholar
  • 48 Barnhart KT. Introduction: are we ready to eliminate the transfer of fresh embryos in in vitro fertilization?. Fertil Steril 2014; 102 (1) 1-2
    CrossrefPubMedSearch in Google Scholar
  • 49 van Tilborg TC, Eijkemans MJ, Laven JS , et al. The OPTIMIST study: optimisation of cost effectiveness through individualised FSH stimulation dosages for IVF treatment. A randomised controlled trial. BMC Womens Health 2012; 12: 29
    CrossrefPubMedSearch in Google Scholar
  • 50 Politi MC, Lewis CL, Frosch DL. Supporting shared decisions when clinical evidence is low. Med Care Res Rev 2013; 70 (1, Suppl): 113S-128S
    CrossrefPubMedSearch in Google Scholar
  • 51 van Peperstraten AM, Hermens RP, Nelen WL , et al. Deciding how many embryos to transfer after in vitro fertilisation: development and pilot test of a decision aid. Patient Educ Couns 2010; 78 (1) 124-129
    CrossrefPubMedSearch in Google Scholar