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Controlled ovarian stimulation (COS) with gonadotropins to produce multiple follicular development and high-quality oocytes is the cornerstone of assisted reproductive technology. Today, recombinant human follicle-stimulating hormone (r-hFSH) as well as Biosimilars are widely used for COS. A long-acting r-hFSH and a combination of r-hFSH and recombinant human luteinizing hormone have recently become available. Formulations of purified urinary FSH with or without luteinizing hormone activity (provided by human chorionic gonadotropin) are also available. COS protocols can now be individualized to optimize efficacy and safety – defined as singleton pregnancies with a low incidence of ovarian hyperstimulation syndrome. This is facilitated by an estimation of ovarian response using the antral follicle count and/or serum anti-Müllerian hormone levels; anti-Müllerian hormone is viewed as the most reliable single marker. However, an efficient management strategy for poor responders to COS is still required. Developments in biomarkers and other techniques for accurate identification of viable oocytes and embryos and optimal uterine receptivity are expected.


Inter-individual variation in ovarian response represents a significant clinical and economical challenge. Undoubtedly, there is a need to reliably predict ovarian response to stimulation, to tailor stimulation protocols optimizing the probability of pregnancy and keep at the same time the risks of complications and costs at a minimum.


Special emphasis needs to be given on how to avoid excessive response and predict the occurrence of ovarian hyperstimulation syndrome (OHSS), as well as on maximizing tolerability of treatment from a patient's perspective.


Topics to be covered include :

Ovarian stimulation strategies;
Primary, secondary and tertiary prevention of OHSS;
development of protocols for patients with diminished ovarian reserve;
ovarian reserve testing and its practical implications;
mild stimulation and financial implications;
segmentation of IVF treatment;
impact of ovarian stimulation on the endometrium; and
emergency stimulation for onco-fertility patients.

LEARNING OBJECTIVES

Upon completion of this program, the participant will be able to:

1. Describe the physiologic process of the human menstrual cycle.
2. Describe the process of ovulation, ovulation induction, and augmentation therapy with clomiphene citrate, menotropins, urofollitropin, recombinant FSH, biosimilars and adjunct medications.
3. Review the impact of age on fertility with appropriate tests available to assess ovarian reserve.
4. Identify individuals with ovulatory abnormalities and determine if they will respond to ovulation induction.
5. Discuss the basic mechanism of action of agents used to induce ovulation.
6. Understand the risks associated with the use of ovulation induction.
7. Discuss the basic work up and treatment of the anovulatory female.
8. Identify the patients at risk for hyper-response or poor response to controlled ovarian stimulation.
9. Select the protocol most likely to optimize the ovarian response among patients with compromised ovarian reserve.
10. Summarize current evidence-based recommendations to achieve the best outcomes with GnRH analog regimens.
11. Identify effective and safe ovarian stimulation protocols for patients undergoing fertility preservation.