Ovulation induction – Protocol

Ovarian stimulation is one of the most important parts of in vitro fertilization. The protocol followed for each case is adjusted according to the woman’s age and the ability of the ovaries to produce oocytes. Since 1985, analogues are used in long ovulation induction protocols. Since 1999, the use of antagonists started which resulted in shorter protocols, smaller gonadotrophin doses, smaller risk of hyperstimulation syndrome, less injections and less visits for ultrasound and hormonal checks and finally less psychological and emotional stress.

The use of antagonists aimed to aid mainly women who were poor responders and those with a history of a hyperstimulation syndrome [1]. For this reason specialists preferred the use of antagonist protocols to those using analogues for all women. Other researchers have shown that the use of antagonists is safe and effective in all women and mainly those that are poor responders and those with polycystic ovarian syndrome [2]. In our Centre, the use of antagonists started in 2000. Our experience throughout the years has resulted in positive outcome and success rates similar to those published in medical journals during 2013.

Apart from the use of gonadotrophin and antagonists for ovarian stimulation, recent studies have shown that the use of clomiphene citrate with gonandotrophins and for some cases with antagonists, produces good results. The clomiphene citrate protocol gives comparable results to the gonadotrophin protocol. Moreover, the chance of hyperstimulation syndrome is reduced with the use of clomiphene citrate [3].

  1. Marci R, Graziano A, Lo Monte G, Piva I, Soave I, Marra E, Lisi F, Moscarini M, Caserta D. 2013. GnRH antagonists in assisted reproductive techniques: a review on the Italian experience. Eur Rev Med Pharmacol Sci. 17(7): 853-73.
  2. Copperman AB, Benadiva C. 2013. Optimal usage of the GnRH antagonists: a review of the literature. Reprod Biol Endocrinol. 11:20. doi: 10.1186/1477-7827-11-20.
  3. Gibreel A, Maheshwari A, Bhattacharya S. 2012. Clomiphene citrate in combination with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilization. Cochrane Database Syst Rev. 2012 Nov 14;11:CD008528. doi: 10.1002/14651858.CD008528.pub2.