Ovulation induction for assisted reproduction.

The goal of ovulation induction in assisted reproduction is the development of multiple follicles, allowing the recovery of multiple mature, high-quality oocytes. Normally ovulatory women may respond very differently to gonadotropin stimulation. Most patients respond best to regimens that provide the highest quantities of gonadotropins in the early follicular phase followed by tapering dosages as the gonadotropin requirements of the developing follicles are reduced. Others, particularly those with inverted luteinizing hormone:follicle-stimulating hormone ratios, respond better to constant, low-dose, pure follicle-stimulating hormone protocols. Patients with elevated basal follicle-stimulating hormone concentrations may require upwards of eight ampules of gonadotropins per day to obtain multifollicular development. Gonadotropin releasing hormone agonists are of value in patients with exaggerated multifollicular responses as well as in those who have premature luteinizing hormone surges. In all cases, optimization of ovulation induction through the customization of stimulation regimens results in improved stimulation quality and outcomes.