Induction of Superovulation in Assisted Reproduction Programs

The article presents ovulation stimulation protocols used in modern clinics; the mechanisms of action of different drugs, their advantages and disadvantages are presented; recommendations for a practicing physician.

Key words: ovulation stimulation, ovulation programs.

Over the past 20 years, the reproductive medicine industry has made significant strides. This concerns, first of all, the development of an individual approach to the use of different programs for stimulating ovulation and controlling follicle development. The goal of classic IVF (in vitro fertilization) is to obtain 2-3 mature eggs and at least 2 good embryos for transfer. In this case, the main task is to avoid the development of ovarian hyperstimulation syndrome and multiple pregnancies.

When performing ICSI (intracytoplasmic sperm injection), MESA (epididymal sperm aspiration), TESA (testicular sperm aspiration), the pregnancy rate is significantly better than with routine IVF. This is explained by the younger age of patients and the significantly lower incidence of endocrinopathy in women.

When performing ICSI after TESA and MESA, it is desirable to use frozen material obtained from a biopsy specimen, as well as obtain a large number of oocytes. All this allows you to avoid repeating the painful procedure of biopsy of the ovary or its appendages.

The success of the ovulation stimulation procedure largely depends on the state of the woman’s endocrine system. Patients who respond to stimulation with a larger number of follicles have a better pregnancy prognosis [38]. As can be seen from table. 1, the pregnancy rate is higher in cases where more than 5 eggs can be aspirated during follicular puncture.

Table 1. Fertilization and pregnancy rates after ICSI in relation to the number of oocytes (review 1995)

Oocytes...