International Journal of Infertility & Fetal Medicine

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VOLUME 12 , ISSUE 2 ( May-August, 2021 ) > List of Articles


“One Size does not Fit All” during Ovarian Stimulation for IVF

Rupali Khurana, Vyshnavi Rao, Kamini Rao

Citation Information : Khurana R, Rao V, Rao K. “One Size does not Fit All” during Ovarian Stimulation for IVF. Int J Infertil Fetal Med 2021; 12 (2):37-39.

DOI: 10.5005/jp-journals-10016-1219

License: CC BY-NC 4.0

Published Online: 29-07-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Ovarian stimulation (OS) is the heart of IVF. Various OS protocols are developed and many of them are still being explored to provide an individualized approach, making the care more patient-centric. Premature LH surge is one of the potential side effects accompanying the OS, and to prevent this phenomenon either GnRH analogs or progesterone are being used. The following case report is of a PCOS patient undergoing COS using progesterone-primed ovarian stimulation (PPOS) which was modified by adding GnRH antagonist in the middle of stimulation due to accelerated growth of a single follicle in one ovary. The premature luteinization was prevented and the stimulation cycle was salvaged, giving a good outcome in terms of mature oocyte, grade of embryos, and pregnancy. This case report emphasizes the importance of strict monitoring as well as an individualization of each stimulation cycle to case to case basis for achieving the best outcome.

  1. Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet 1978;2(8085):366. DOI: 10.1016/s0140-6736(78)92957-4.
  2. Jungheim ES, Meyer MF, Broughton DE. Best practices for controlled ovarian stimulation in in vitro fertilization. Semin Reprod Med 2015;33(2):77–82. DOI: 10.1055/s-0035-1546424.
  3. Verpoest WM, Cahill DJ, Harlow CR, et al. Relationship between midcycle luteinizing hormone surge quality and oocyte fertilization. Fertil Steril 2000;73(1):75–77. DOI: 10.1016/s0015-0282(99)00481-1.
  4. Alper MM, Fauser BC. Ovarian stimulation protocols for IVF: is more better than less? Reprod Biomed Online 2017;34(4):345–353. DOI: 10.1016/j.rbmo.2017.01.010.
  5. Engel JB, Ludwig M, Felberbaum R, et al. Use of cetrorelix in combination with clomiphene citrate and gonadotrophins: a suitable approach to “friendly IVF”? Hum Reprod 2002;17(8):2022–2026. DOI: 10.1093/humrep/17.8.2022.
  6. Olivennes F, Belaisch-Allart J, Emperaire JC, et al. Prospective, randomized, controlled study of in vitro fertilization-embryo transfer with a single dose of a luteinizing hormone releasing hormone (LH-RH) antagonist (cetrorelix) or a depot formula of an LH-RH agonist (triptorelin). Fertil Steril 2000;73(2):314–320. DOI: 10.1016/S0015-0282(99)00524-5.
  7. Lambalk CB, Leader A, Olivennes F, et al. Treatment with the GnRH antagonist ganirelix prevents premature LH rises and luteinization in stimulated intrauterine insemination: results of a double-blind, placebo controlled, multicentre trial. Hum Reprod 2006;21(3):632–639. DOI: 10.1093/humrep/dei386.
  8. Ganirelix Dose Finding Study Group. A double blind, randomized, dose-finding study to assess the efficacy of the gonadotrophin releasing hormone antagonist ganirelix (Org 37462) to prevent premature luteinizing hormone surges in women undergoing ovarian stimulation with recombinant follicle stimulating hormone (Puregon®). Hum Reprod 1998;13(11):3023–3031. DOI: 10.1093/humrep/13.11.3023.
  9. European and Middle East Orgalutran Study Group. Comparable clinical outcome using the GnRH antagonist ganirelix or a long protocol of the GnRH agonist triptorelin for the prevention of premature LH surges in women undergoing ovarian stimulation. Hum Reprod 2001;16(4):644–651. DOI: 10.1093/humrep/16.4.644.
  10. Ertunc D, Tok EC, Savas A, et al. Gonadotropin-releasing hormone antagonist use in controlled ovarian stimulation and intrauterine insemination cycles in women with polycystic ovary syndrome. Fertil Steril 2010;93(4):1179–1184. DOI: 10.1016/j.fertnstert.2008.11.030.
  11. Stadtmauer LA, Sarhan A, Duran EH, et al. The impact of a gonadotropin-releasing hormone antagonist on gonadotropin ovulation induction cycles in women with polycystic ovary syndrome: a prospective randomized study. Fertil Steril 2011;95(1). DOI: 10.1016/j.fertnstert.2010.05.023.
  12. Loumaye E, Vankrieken L, Depreester S, et al. Hormonal changes induced by short-term administration of gonadotropin-releasing hormone agonist during ovarian hyperstimulation for in vitro fertilization and their consequences for embryo development. Fertil Steril 1989;51(1):105–111. DOI: 10.1016/s0015-0282(16)60437-5.
  13. Wang Y, Chen Q, Wang N, et al. Controlled ovarian stimulation using medroxyprogesterone acetate and hMG in patients with polycystic ovary syndrome treated for IVF: a double-blind randomized crossover clinical trial. Medicine 2016;95(9):e2939. DOI: 10.1097/MD.0000000000002939.
  14. Zhu X, Ye H, Fu Y. The utrogestan and hMG protocol in patients with polycystic ovarian syndrome undergoing controlled ovarian hyperstimulation during IVF/ICSI treatments. Medicine 2016;95(28):e4193. DOI: 10.1097/ MD.0000000000004193.
  15. Xiao ZN, Peng JL, Yang J, et al. Flexible GnRH antagonist protocol versus progestin-primed ovarian stimulation (PPOS) protocol in patients with polycystic ovary syndrome: comparison of clinical outcomes and ovarian response. Curr Med Sci 2019;39(3):431–436. DOI: 10.1007/s11596-019-2055-x.
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