Human Reproduction Update, Vol.6, No.4 pp.307-312, 2000
© European Society of Human Reproduction and Embryology 2000; all rights reserved
Regulation of follicle development and novel approaches to ovarian stimulation for IVF
1 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
To whom correspondence should be addressed at: N. S. Macklon, Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Phone: ; Fax 0031 10 436 7306; e-mail: macklon{at}gyna.azr.nl
Abstract
Current ovarian stimulation regimens for IVF are complex and not without risk. Increasing our knowledge of the physiology of follicle development and dominant follicle selection may enable the design of less complex, safer and cheaper ovarian stimulation regimens for IVF. Decremental serum FSH concentrations during the follicular phase of the menstrual cycle are required for single dominant follicle selection. Only the most mature follicle will continue its development due to increased sensitivity for stimulation by FSH. FSH stimulation becomes insufficient for less mature follicles and remaining cohort follicles will therefore go into atresia. The number of days during which FSH is above the threshold for stimulation of follicle development is limited, resulting in a narrow FSH window. More medium sized and large pre-ovulatory follicles and increased oestradiol output can be induced by the administration of small doses of exogenous FSH during the mid- to late follicular phase, preventing the physiological decrease in FSH stimulation. Intervention with decremental serum FSH concentrations in combination with gonadotrophin-releasing hormone (GnRH) antagonists to prevent a premature rise in serum LH may induce ongoing growth of multiple follicles sufficient for IVF. The benefits and risks of these minimal hyperstimulation protocols require further evaluation.
Key words: follicle development / GnRH antagonists / IVF / ovarian stimulation
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