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An Ideal Ovulation Induction Regimen
An Ideal Ovulation Induction Regimen
INDUCTION REGIMEN
Types of ovarian stimulation
• Ovulation induction
• Superovulation
The goal
to develop follicles in anovulatory cycles as in PCOS and in
hypogonadotrophic hypogonadism
1 2 14 1 2 3
hCG OPU
1 2 14 21 1 2 3
hCG OPU
Gn
GnRHa
1 2 3
hCG OPU
Gn
GnRHa
1 2 3 4 5 6
hCG OPU
• Agonist given for 3 days
• Flare Up Effect
• Used in poor responders
GnRH Antagonist Protocol
0 1 2 3 4 5 6 7 8 9 10
Cycle Day
r FSH/hMG
Single dose
CETRORELIX - 3 mg hCG
r FSH/hMG
0 1 2 3 4 5 6 7 8 9 10
Cycle Day
r FSH/hMG
CETRORELIX 3 mg
Single dose hCG
GnRH agonist
trigger D2 ET
D3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
S Teramoto, O Kato; Minimal ovarian stimulation with CC: A Large-scale retrospective
Study: RBM Online: Volume 15, No 2, August 2007
LETROZOLE IN SOFT STIMULATION
hCG
Step Up Letrozole
ET
2.5 5.0 7.5 10.0 FSH OPU
Ultra Flare
150 150 150 150 150
GnRHa
D3 4 5 6 7 8 9 10 11 12 13 14 15
• Mild stimulation
• Short agonist
• Microflare
• Shanghai protocol
Kuang et al; 2014
• IVF Live Birth Rates Similar for GnRH Antagonist and GnRH
Agonist Protocols.
-Al – Inany HG, Youssef MA, Aboulghar M, et al 2011
Gonadotropin – releasing hormone antagonists for ART
Cochrane Database, Syst Rev 11, CDOO1750
• COS in IVF - significantly improved outcomes, but current stimulation protocols are
not optimal for all patient groups.
• Alternatives to standard COS protocols, including mild and natural cycles, have
shown some success, but no single approach is appropriate for all patients in a
given population.
• Treatment should be adapted for individual patients through iCOS and that,
together with the further development of objective biomarkers of response, will be an
important first step towards implementing personalised medicine in reproductive
science