Ovarian hyperstimulation: past, present, and future.

The good physician treats the disease; the great physician treats the patient who has the disease. -William Osler.

History and challenges surrounding ovarian stimulation in the treatment of infertility.

OBJECTIVE: To examine the history of superovulation for ovulation induction, its contributions to reproductive medicine, and its impact on multiple births. DESIGN: A search of the relevant literature using PubMed and other online tools. RESULT(S): Infertility has been a condition known and studied for thousands of years. However, it was not until this past century that effective treatments were developed. With the advancement of our knowledge of the hypothalamic-pituitary axis, therapies utilizing gonadotropins were developed to stimulate ovulation. Not only could we now treat anovulatory infertility but also induce superovulation for IVF. With these successes came consequences, including increased multiple pregnancies. Several countries recognized the high costs associated with multiple births and implemented regulations on the infertility industry. The rate of triplet and higher-order multiples has declined over the past decade. This is largely attributed to a decreased number of embryos transferred. Nonetheless, the twin rate has remained consistently high. CONCLUSION(S): Superovulation has become a routine medical therapy used for ovulation induction and IVF. With the development of this technology have come effective therapies for infertility and new ethical and medical challenges. Since the advent of gonadotropin therapy we have already developed technologies to improve monitoring and decrease hyperstimulation and high-order multiple pregnancies. In the future we anticipate new tools devised to optimize one embryo for one singleton live birth.

Gonadotropin therapy: a 20th century relic.

Gonadotropin therapy has been a cornerstone of infertility therapy for half a century. From the very beginning, its use has been associated with a high rate of multiple births, particularly high order multiples, and ovarian hyperstimulation syndrome. Initially, success rates seemed acceptable when used for superovulation (SO)/IUI therapy. However, as data from RCTs have emerged, reported outcomes suggest that we question the use of injectible gonadotropins. This manuscript examines the studies that have challenged gonadotropin use for SO/IUI and other research that supports reduced doses of gonadotropins for IVF. We examine the challenges for its continued use for SO/IUI and for moving to lower doses worldwide for IVF. We propose a future that views gonadotropins as a relic of the twentieth century.

The use of controlled ovarian hyperstimulation (COH) in clinical in vitro fertilization: the role of Georgeanna Seegar Jones.

The use of controlled ovarian hyperstimulation (COH) to recruit multiple oocytes is now common practice worldwide in most clinical programs of in vitro fertilization (IVF). It was not always so. This is the story of the first successful use of exogenous gonadotropins in a clinical program of IVF.

Luteal-phase defect: the role of Georgeanna Seegar Jones.

The study and treatment of luteal phase defect since the late 1940s, particularly the work of Georgeanna Seegar Jones, are summarized.