Chapter 13 - What superovulation protocol is best?

Summary

This chapter outlines the physiology of superovulation, and deals with how these stimulation protocols have evolved over the past 25 years, to allow the clinician to make evidence-based judgements on which protocol to use in individual patient groups. All in vitro fertilization (IVF) stimulation protocols attempt to widen the follicle stimulating hormone (FSH) window allowing more of the cohort of antral follicles to overcome their FSH threshold, a process known as recruitment, then continue to support their development through to maturity. Exogenous FSH can be sourced from urinary and recombinant preparations. Both sources provide highly purified gonadotropins. Although most of the comparative studies looking at the differing gonadotropin preparations have employed gonadotropin-releasing hormone (GnRH) agonist protocols, more recently GnRH antagonist studies have shown similar outcomes. Therefore it is reasonable to conclude that in most clinical scenarios clinician and patient choice should determine which preparation is employed.