Abstract

The relatively few gonadotropin preparations and ovulation induction protocols have limited the choice of therapy for many years. Both factors, and the commonly used “physician’s-based experience approach”, rather than an evidence-based one, lead to the conventional paradigm in reproductive medicine that “one type fits all”. However, different characteristics of an individual patient account for large variability in ovarian response to stimulation, which is one of the most determining factors for success in assisted reproduction. It is generally accepted that most protocols work fairly well in young patients with normal ovarian reserve. However, patients with excessive high and low ovarian reserve, as well as obese, PCOS and aged women need special regimens.  

The identification of better prognostic factors that have been validated in daily clinical practice and the development of novel gonadotropin formulations allowed the introduction of the “individualized ovulation induction” concept. It means that the choice of therapy is patient-centered and may be tailored according to individual patient profiles. This individualized approach is especially relevant to optimize the likelihood of a successful treatment cycle and to prevent the risks of cycle cancellation (both for hypo and hyper-responders) and complications such as OHSS. Both are responsible for psychological and physical burden which represent the major causes of treatment dropout. 

It is now clear that environmental and life style factors influence the success of ART. An interdisciplinary approach can be used for screening risk factors and counseling. Interventions should be offered to optimize the couples’ overall health prior to initiating fertility treatment. In our clinic, a patient-centered healthcare program aiming to improve medical, psychological and nutritional status is offered to all patients (female and male partners) before initiation of therapy, and is continued throughout the treatment process. This strategy in combination with the individualized ovulation induction regimens increased patient adherence to treatment cycles, which ultimately resulted in increased cumulative live birth. 

Improving success in ovulation induction by treatment individualization