Ovarian Stimulation Yields Oocytes, neither More, nor Less

Editorial

Ovarian stimulation is pivotal in the in vitro fertilization (IVF) process. Its primary objective is to obtain an optimal number of oocytes, which, after fertilization through IVF, develop into embryos, reaching the blastocyst stage. After a genetic selection (PGT-A), a unique blastocyst will be transferred into the uterus.

The odds of achieving a full-term and normal pregnancy depend mainly upon the quality of the transferred blastocyst. Such quality predominantly correlates with the age of the woman undergoing the treatment. But, simultaneously, the likelihood of obtaining a transferable blastocyst increases proportionally with the number of oocytes retrieved after ovarian stimulation. However, this quantity, in turn, is contingent upon the ovarian reserve.

It is not within the scope of a specific stimulation protocol to enhance oocyte quality. Instead, we aim to maximize the number of oocytes produced through ovarian stimulation. In essence, by administering gonadotropins and other adjuvant medications, we may promote adequate follicular development without necessarily improving the quality of the obtained oocytes and, subsequently, the developed embryos.

Hence, once this is acknowledged, we should prescribe a protocol that prioritizes patient comfort over that of the physician and requires the fewest additional monitoring procedures.

Moreover, it is standard for physicians to recommend a protocol change after a poor ovarian response. Nevertheless, these modifications lack a scientific basis and may, instead, demonstrate to the patient that the specialist is pursuing “a different course of action.” It is frequently observed that the ovarian response may exhibit variability, even when utilizing the identical protocol, albeit always within the confines established by the patient’s ovarian reserve.

Hence, let us refrain from expecting gonadotropins to enhance oocyte quality, as they cannot do it. Instead, we should prioritize the simplicity and comfort of administration devices for the patient’s benefit rather than the physician’s convenience.