I-38: Individualized Controlled Ovarian Stimulation: Matching Protocols with Patient Profile

The aim of all assisted reproductive techniques (ART) is a live birth of a single healthy baby. Many clinical and laboratory strategies can influence the ART clinical outcomes. In this lecture we try to explore the clinical and laboratory strategies to maximize success in ART. Three are the main issues: 1. optimize the number of oocyte retrieved with an individualized controlled ovarian superovulation standard protocol. This protocol must been defined having pre-defined the response to FSH (with AFC and AMH); only after that, we could consider a moderating approach in high responding women (avoiding the OHSS); simple maximizing approach in normal responding women and a lower treatment burden in the reduced responding women. Moreover,To avoid the risk of ovarian hyperstimulation syndrome the ovulation should be triggered with GnRH agonist in a GnRH antagonist stimulation protocol. All the embryos obtained should be cryopreserved with vitrification and then transferred in a natural cycle (cycle segmentation). The correct number of oocyte to be retrieved to maximize live birth rate seems 15. With this number we increase the chance to find the most competent oocytes to be fertilized and the number of embryos. 2. Single embryo transfer possibly at the blastocyst stage to reduce multiple pregnancies and cryopreserve with vitrification the supernumerary cleavage stage embryos or blastocysts or oocytes, or all the embryos in case of cycle segmentation. Cryopreservation offers a very good contribution to the cumulative live birth rates. 3. Improve the efficiency of IVF - number of babies born per transferred embryos - lowering the number of transfers, the abortion rate, the abnormal pregnancies and the number of multiple pregnancies by transferring one single euploid blastocyst after genetic screening of 24 chromosomes. At the moment, these strategies can maximize the live birth rates in patients undergoing IVF.