Manual of Ovulation Induction and Ovarian Stimulation Protocols 3/e

Manual of Ovulation Induction and Ovarian Stimulation Protocols encompasses all aspects of ovulation induction and
current stimulation protocols in detail. This detailed text provides the reader with a reliable overview of the
principles involved and the management required for ovulation induction in the treatment of infertility.

This book is comprised of 68 chapters which cover the tailoring of ovarian stimulation regimens to a patient’s medical
history and previous response to treatment. Both the clinical and sonographic findings in evaluating ovulatory function
and dysfunction are discussed in detail.

Methods for monitoring folliculogenesis, which in turn allows the ART specialist to accurately predict the number, as
well as the timing of the high quality of oocyte retrieval, are discussed in detail.

The book features discussion on basic and clinical research evidence, which is accumulating to propose the future use
of recombinant FSH and LH in order to achieve controlled ovarian stimulation. The inclusion of the most current
research in this third edition makes Manual of Ovulation Induction and Ovarian Stimulation Protocols a valuable book
for gynaecologists, infertility specialists, and healthcare professionals dealing with IVF.

Key Points
•Includes current research and future implications
•60+ full colour images and illustrations
•New edition. First published 2005


Author information

Gautam Allahbadia MD DNB FNAMS
Consultant Fertility Physician, Dr LH Hiranandani Center for Human Reproduction, Dr LH Hiranandani Hospital, Powai,
Mumbai, India

Rubina Merchant
Deccan Fertility Clinic, Rotunda – Center for Human Reproduction, Mumbai, India


Table of Contents
Fundamentals of Stimulation
 Regulation of the menstrual cycle and the effect of controlled ovarian hyperstimulation on
cycle characteristics
 Regulation of Gonadotropin Secretion
 The role of gonadotropins in follicular development and their use in ovulation induction
protocols for assisted reproduction
 Predictors of ovarian response to controlled ovarian stimulation: are they useful?
 Clinical significance of antral follicle count and anti-Müllerian hormone in predicting the
stimulation outcome
 Human Ovulation and Transvaginal Sonography
 The significance of monitoring folliculogenesis
 Identification of patients at high risk for excessive response to ovarian stimulation
 The impact of repeated ovulation stimulations on the ovarian reserve
 Luteinizing hormone activity in ovarian stimulation for IVF: is it Ovulation Induction and
Ovulation indispensible?
 Luteal phase support in controlled ovarian hyperstimulation protocols: why and how?
Ovarian Stimulation Regimens
 Ovarian Stimulation Protocols
 Clomiphene Citrate for Ovarian Stimulation
 Combination Protocols Using Clomiphene Plus Gonadotropins
 Route of Administration of Gonadotropins and Ovarian Response
 Clinical Application of Recombinant Follicle Stimulating hormone
 Induction Protocols of the 2000’s Using r-hLH and r-Hcg
 Step-up Protocols
 Step-down protocols for ovulation induction
 The Role of Gonadotropin-Releasing Hormone Agonists in Ovulation Induction
 Gonadotropin-releasing hormone antagonist protocols: fixed versus flexible
 GnRH agonists vs. GnRH antagonists for ovarian stimulation: pros and cons
 Fine-tuning the Role of GnRH Antagonists in ART Programs
 Evaluation of luteal phase in GnRH agonist/antagonist IVF protocols
 Recombinant human follicle-stimulating hormone vs. highly purified human menopausal
gonadotrophin for controlled ovarian stimulation in GnRH agonist down-regulated cycles
 Can endogenous LH support treatment with rFSH only in a GnRH antagonist protocol in
normogonadotropic patients?
 The efficacy of recombinant LH supplementation for controlled ovarian stimulation in r-FSH
and GnRH-agonist protocols
 Substitution of recombinant FSH (rFSH) by low-dose hCG in the late follicular phase in a
GnRH antagonist protocol: Is it clinically effective?
 The benefit of luteal estradiol pre-treatment in GnRH antagonist protocols vs. long GnRH
agonist protocols
 Impact of long GnRH agonist and GnRH antagonist stimulation protocols on endometrial
receptivity
 The efficacy of clomiphene citrate in preventing a premature LH surge during controlled
ovarian stimulation with human menopausal gonadotrophins (hMG)
 Pretreatment with combined oral contraceptives prior to stimulation: does it help?
Aromatase inhibitors for Ovarian Stimulation
 Aromatase inhibitors for ovulation induction: indications and clinical outcomes
 Clomiphene citrate vs. aromatase inhibitors: mechanism of action
 Clinical efficacy and safety of letrozole vs. clomiphene citrate for ovulation induction in
women with polycystic ovary syndrome
 Ovulation Induction in PCOS
 Management strategies for ovulation induction CC-resistant PCOS women
 Induction of Monofolliculogenesis in Patients with Polycystic Ovary Syndrome
 Low-dose step-down regimen for ovulation induction in PCOS
 Chronic ultra-low-dose step-up protocol for patients with polycystic ovary syndrome
 GnRH agonist vs. antagonist protocols for controlled ovarian stimulation in women with
PCOS
 Influence of BMI on the IVF outcome in PCOS patients undergoing stimulation with GnRH
agonists or antagonists
 Adjunctive Glucocorticoids in Ovulation Induction for Polycystic Ovarian Syndrome
 Metformin Treatment of Clomiphene-Resistant Polycystic Ovary Syndrome
 Mechanism of action of metformin for ovulation induction in PCOS patients
 Clomiphene citrate, Metformin, or both for the treatment of anovulatory women with
polycystic ovary syndrome: evidence-based recommendations
 Metformin and clomiphene citrate (CC) vs. highly purified FSH for ovulation induction in CCresistant
women with PCOS
 The current place of Metformin in infertile patients with PCOS: an evidence-based approach
 Laparoscopic ovarian drilling for surgical induction of ovulation in polycystic ovary syndrome
Ovulation triggering
 Role of GnRH Agonists as an Ovulation Trigger
 Recombinant LH, recombinant hCG and GnRH agonist to trigger ovulation: a critical
evaluation
 LH and FSH surges for final oocyte maturation: Is a dual surge beneficial?
Complications of COH
 Complications of ovulation induction
 Ovarian hyperstimulation syndrome: prevention strategies
 The role of in vitro maturation in high responders and patients at risk of OHSS undergoing
assisted reproductive technology
Poor Responders
 Cancelled Cycles in Poor Response—What Next? Ovulation Induction and Ovulation
 Management options for poor responders to controlled ovarian stimulation
 The efficacy of microdose GnRH agonist flare (MF) vs. GnRH antagonist/Letrozole protocols
in poor responders undergoing in vitro fertilization
 Optimum maximal gonadotropin dosage used in microdose flare-up cycles
 Role of androgens in the treatment of patients with low ovarian response
 Addition of growth hormone to stimulation protocols for poor responders: is it beneficial?
 Criteria for cycle cancellation in poor responders to ovarian stimulation
 Contribution of in vitro maturation to ovarian stimulation cycles in poor responder patients
Mild Stimulation Protocols and Natural Cycle IVF
 Embarking on natural cycle IVF: When and how?
 The value of modified natural cycle IVF in normal ovarian responders
 Advances in Stimulation Science
 Long-acting Recombinant FSH (FSH-CTP, Corifollitropin Alfa)
 Can corifollitropin alfa replace recombinant FSH (rFSH) for ovarian stimulation using a
gonadotrophin-releasing hormone antagonist protocol prior to IVF/ICSI?
 Applicability and reproducibility of Sonography-based Automated Volume Count (SonoAVC)
for monitoring folliculogenesis
 The ideal stimulation protocol: Is there one?