Controlled ovarian hyperstimulation

ovarian hyperstimulationsuperovulationovulation suppressionSuperovulatedcontrol ovarian stimulationControlled ovarian stimulationhyperstimulatedovarian stimulationstimulated cyclesuppression of ovulation during ovarian hyperstimulation
Controlled ovarian hyperstimulation is a technique used in assisted reproduction involving the use of fertility medications to induce ovulation by multiple ovarian follicles.wikipedia
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Fertility medication

fertility drugsfertility drugfertility agents
Controlled ovarian hyperstimulation is a technique used in assisted reproduction involving the use of fertility medications to induce ovulation by multiple ovarian follicles.
FSH and recombinant FSH analogues are mainly used for controlled ovarian hyperstimulation as well as ovulation induction.

Ovulation induction

ovarian stimulationinduce ovulationinduced
In contrast, ovulation induction is ovarian stimulation without subsequent IVF, with the aim of developing one or two ovulatory follicles (the maximum number before recommending sexual abstinence with such treatment).

Artificial insemination

intrauterine inseminationartificially inseminatedIUI
To improve the success rate of AI, drugs to create a stimulated cycle may be used, but the use of such drugs also results in an increased chance of a multiple birth.

Ovulation

ovulateovulatingovulated
Controlled ovarian hyperstimulation is a technique used in assisted reproduction involving the use of fertility medications to induce ovulation by multiple ovarian follicles.
Usually, ovarian stimulation is used in conjunction with ovulation induction to stimulate the formation of multiple oocytes.

Gonadotropin preparations

corifollitropin alfaFollitropin alfaFollitropin beta
In most patients injectable gonadotropin preparations are used, usually FSH preparations.
Gonadotropin preparations are drugs that mimic the physiological effects of gonadotropins, used therapeutically mainly as fertility medication for ovarian hyperstimulation and ovulation induction.

Anti-Müllerian hormone

AMHAnti-Mullerian hormoneMüllerian inhibiting factor
According to NICE guidelines of in vitro fertilization, an anti-Müllerian hormone level of less than or equal to 5.4 pmol/l (0.8 ng/mL) predicts a low response to ovarian hyperstimulation, while a level greater than or equal to 25.0 pmol/l (3.6 ng/mL) predicts a high response.

Folliculogenesis

primordial folliclesprimordial folliclefollicular depletion
The response to gonadotropins may be roughly approximated by antral follicle count (AFC), estimated by vaginal ultrasound, which in turn reflects how many primordial follicles there are in reserve in the ovary.
Performing controlled ovarian hyperstimulation leads to a greater recruitment of follicles, growing at about 1.6 mm per day.

In vitro fertilisation

IVFin vitro fertilizationin-vitro fertilization
These multiple follicles can be taken out by oocyte retrieval (egg collection) for use in in vitro fertilisation (IVF), or be given time to ovulate, resulting in superovulation which is the ovulation of a larger-than-normal number of eggs, generally in the sense of at least two. When used in conjunction with IVF, ovarian hyperstimulation may be followed by final maturation of oocytes, using human chorionic gonadotropin (hCG), or a GnRH agonist if a GnRH antagonist protocol is used for ovulation suppression.
The additional techniques that are routinely used in IVF include ovarian hyperstimulation to generate multiple eggs, ultrasound-guided transvaginal oocyte retrieval directly from the ovaries, co-incubation of eggs and sperm, as well as culture and selection of resultant embryos before embryo transfer into a uterus.

Transvaginal oocyte retrieval

oocyte retrievalegg retrievalTransvaginal ovum retrieval
These multiple follicles can be taken out by oocyte retrieval (egg collection) for use in in vitro fertilisation (IVF), or be given time to ovulate, resulting in superovulation which is the ovulation of a larger-than-normal number of eggs, generally in the sense of at least two.
It is not unusual to remove 20 oocytes as women are generally hyperstimulated in advance of this procedure.

Antral follicle

Antral follicle countantralantral follicles
The response to gonadotropins may be roughly approximated by antral follicle count (AFC), estimated by vaginal ultrasound, which in turn reflects how many primordial follicles there are in reserve in the ovary.
It is also a major determinant of the success of ovarian hyperstimulation.

Final maturation induction

Induction of final maturationfinal oocyte maturationinduction of final oocyte maturation
When used in conjunction with IVF, ovarian hyperstimulation may be followed by final maturation of oocytes, using human chorionic gonadotropin (hCG), or a GnRH agonist if a GnRH antagonist protocol is used for ovulation suppression.
Induction of final maturation of oocytes is a procedure that is usually performed as part of controlled ovarian hyperstimulation to render the oocytes fully developed and thereby resulting in optimal pregnancy chances.

Ovarian hyperstimulation syndrome

Hyperstimulation of ovarieshyperstimulation syndromeovarian hyperstimulation syndrome (OHSS)
The optimal dosage is mainly a trade-off between the pregnancy rate and risk of ovarian hyperstimulation syndrome.
The risk of OHSS is smaller when using GnRH antagonist protocol instead of GnRH agonist protocol for suppression of ovulation during ovarian hyperstimulation.

Gonadotropin-releasing hormone antagonist

GnRH antagonistantagonistGHRH antagonist
GnRH antagonists are also used for short periods in the prevention of premature LH surge and endogenous ovulation in patients undergoing ovarian hyperstimulation with FSH in preparation for in-vitro fertilization (IVF).

Follicle-stimulating hormone

FSHfollicle stimulating hormonefollicle-stimulating hormone (FSH)
FSH is used commonly in infertility therapy, mainly for ovarian hyperstimulation as part of IVF.

Menstrual cycle

menstrual periodmenstrualmenstruating
Ovulation induction and controlled ovarian hyperstimulation are techniques used in assisted reproduction involving the use of fertility medications to treat anovulation and/or produce multiple ovarian follicles.

In vitro maturation

In animalsin vitroIn Vitro [Oocyte] Maturation
In typical IVF practice, controlled ovarian hyperstimulation is performed, which is where supraphysiological levels of gonadotropins are administered to the patient in order to hyperstimulate the antral follicles and hence induce oocyte maturation to metaphase II at a rate that is above normal physiological capabilities.

Anovulation

anovulatoryanovulatory cyclesdo not ovulate
The standard procedure of in vitro fertilization includes controlled ovarian hyperstimulation with gonadotropins, but in larger doses, with the intention to induce development of supernumerary follicles.

Insemination

inseminateinseminateddonor insemination
When ovulated follicles are fertilised in vivo, whether by natural or artificial insemination, there is a very high risk of a multiple pregnancy.

Multiple birth

tripletstripletquadruplets
When ovulated follicles are fertilised in vivo, whether by natural or artificial insemination, there is a very high risk of a multiple pregnancy.

Sexual abstinence

abstinenceabstainnot having sex
In contrast, ovulation induction is ovarian stimulation without subsequent IVF, with the aim of developing one or two ovulatory follicles (the maximum number before recommending sexual abstinence with such treatment).

Reference range

reference valuesreference rangescut-off
The cut-offs used to predict poor responders versus normal versus hyper-responders upon vaginal ultrasonography vary in the literature, with that of likely poor response varying between an AFC under 3 and under 12, largely resulting from various definitions of the size follicles to be called antral ones.

Vaginal ultrasonography

transvaginal ultrasonographytransvaginal ultrasoundvaginal ultrasound
The response to gonadotropins may be roughly approximated by antral follicle count (AFC), estimated by vaginal ultrasound, which in turn reflects how many primordial follicles there are in reserve in the ovary. The cut-offs used to predict poor responders versus normal versus hyper-responders upon vaginal ultrasonography vary in the literature, with that of likely poor response varying between an AFC under 3 and under 12, largely resulting from various definitions of the size follicles to be called antral ones.