Indication-oriented ovulation induction in assisted reproduction

Background: Ovulation induction plays an important role in the pregnancy outcome of assisted reproduction. Individualized controlled ovarian hyper-stimulation (COH) based on the prediction of the ovarian response for each individual is regarded as the treatment of choice. Objective: This review summarizes the various protocols available at present and then examines the use of COH protocols for different causes of infertility. Results: The advantage and efficacy of mild stimulation are proposed as suitable for poor responders and women of advanced age. For women with endometriosis or adenomyosis, the reproductive outcomes of assisted reproduction benefit from prolonged downregulation with a gonadotropin-releasing hormone (GnRH) agonist before the start of ovarian stimulation. For high responders, a GnRH antagonist protocol facilitates a GnRH agonist trigger and the segmentation of in vitro fertilization cycle to avoid ovarian hyperstimulation syndrome. The efficacy of various adjuvant therapies, including growth hormone, estrogen, levothyroxine, vitamin D, melatonin and myo-inositol is also reviewed.