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Ovarian Stimulation With Gonadotropins: An Individualized Approach
by Geoffrey Sher, M.D.
PREPARING FOR CONTROLLED OVARIAN HYPERSTIMULATION (COH) WITH GONADOTROPINS
It is advisable that at least one-month be allowed to elapse (the “resting cycle”) between IVF treatment cycles, in order to allow the ovaries to fully recover. It is also important to ensure that the plasma E2 level is below 70 picograms per milliliter following successful pituitary LH suppression (with GnRH agonist or antagonist), prior to initiating COH. The best time to measure the E2 level is soon after (i.e.; within days) the onset of lupron-induced menstruation. The commonest cause of an elevated blood E2 level around this time is the existence of one or more ovarian follicular cysts. These should be allowed to absorb, or be aspirated as soon as possible. Spontaneous absorption will usually occur with continued LH suppression using agonist/antagonist failing which; the cyst should be aspirated under local anesthesia, prior to initiating COH.
THE INDIVIDUALIZED APPROACH TO INDUCTION OF
In order for any organism to attain an optimal state of maturation (ripening) it must first undergo full growth and development. A fruit plucked from a tree before having developed fully or a poorly developed fruit might still ripen (mature) on the shelf and might even appear as enticing as one that had previously undergone proper development, but it will lack the same quality. The same principles apply to the development and maturation of human eggs. Proper development as well as precise timing in the initiation of egg maturation with LH or hCG is no less crucial to optimal egg maturation, fertilization and ultimately to embryo quality .In fact, in cases where egg maturation is improperly timed (LH or hCG is released/given too early, i.e. prematurely or too late, i.e. postmaturely) there is an increased risk of aneuploidy (structural and numerical chromosomal abnormalities) leading to compromised reproductive performance.