Best Practices for Controlled Ovarian Stimulation in In Vitro Fertilization

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. The pages that follow outline the existing evidence for best practices in COS for IVF highlighting how these practices may be incorporated into a patient-centered approach.

Effect of GnRH analogues for pituitary suppression on oocyte morphology in repeated ovarian stimulation cycles

“…Between 60-70% of the oocytes recovered after controlled ovarian stimulation (COS) exhibiting one morphological variation or more (de Cássia S Figueira et al, 2010), which may be explained by the fact that COS allows the maturation of oocytes, which under natural conditions would become atretic and regress (Jungheim et al, 2015). Morphological variations of oocytes may also result from intrinsic factors, such as age, or from extrinsic factors, such as stimulation protocols, culture conditions, and nutrition (Balaban & Urman, 2006).…”

Comparative economic study of the use of corifollitropin alfa and daily rFSH for controlled ovarian stimulation in older patients: Cost-minimization analysis based on the PURSUE study

“…Current guidelines recommend the use of an individualized starting dose based on factors such as age, body mass index, presence of polycystic ovaries and ovarian reserve ( NICE, 2013 ). Most protocols contemplate a starting daily dose of 150–300 IU gonadotropin ( Jungheim et al, 2015 ). Although higher doses of gonadotropins may be required to recruit oocytes in older women ( Boostanfar et al, 2015 ), it should be noted that the dose required may be lower in younger populations ( Naether et al, 2015 ).…”

Immature oocyte incidence: Contributing factors and effects on mature sibling oocytes in intracytoplasmic sperm injection cycles

“…In contrast to the in vivo process, where oocyte maturation occurs as the result of the natural selection, in assisted reproduction cycles, supra-physiologic gonadotropin doses induce multiple follicular growth and maturation, in order to ensure the maximum number of obtained embryos, and thereafter the highest probability of a successful pregnancy (Bosch & Ezcurra, 2011;Fatemi et al, 2012). Even though controlled ovarian stimulation (COS) has been developed and refined in attempt to obtain optimal oocytes number from each cycle, different COS protocols may result in follicular asynchrony and variations in oocyte number, quality, viability, and competence (Jungheim et al, 2015).…”