Editing In vitro fertilisation (section)

===Ovarian hyperstimulation===
{{Main|Controlled ovarian hyperstimulation}}
Ovarian hyperstimulation is the stimulation to induce development of multiple follicles of the ovaries. It should start with response prediction based on factors such as age, [[antral follicle count]] and level of [[anti-Müllerian hormone]].<ref name=LaMarca2013>{{cite journal | vauthors = La Marca A, Sunkara SK | title = Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice | journal = Human Reproduction Update | volume = 20 | issue = 1 | pages = 124–140 | year = 2014 | pmid = 24077980 | doi = 10.1093/humupd/dmt037 | doi-access = free }}</ref> The resulting prediction (e.g. poor or hyper-response to ovarian hyperstimulation) determines the protocol and dosage for ovarian hyperstimulation.<ref name=LaMarca2013/>

Ovarian hyperstimulation also includes suppression of spontaneous ovulation, for which two main methods are available: Using a (usually longer) [[GnRH agonist]] protocol or a (usually shorter) [[GnRH antagonist]] protocol.<ref name=LaMarca2013/> In a standard long GnRH agonist protocol the day when hyperstimulation treatment is started and the expected day of later oocyte retrieval can be chosen to conform to personal choice, while in a GnRH antagonist protocol it must be adapted to the spontaneous onset of the previous menstruation. On the other hand, the GnRH antagonist protocol has a lower risk of [[ovarian hyperstimulation syndrome]] (OHSS), which is a life-threatening complication.<ref name=LaMarca2013/>

For the ovarian hyperstimulation in itself, injectable [[gonadotropin]]s (usually [[Follicle stimulating hormone|FSH]] analogues) are generally used under close monitoring. Such monitoring frequently checks the [[estradiol]] level and, by means of [[gynecologic ultrasonography]], follicular growth. Typically approximately 10 days of injections will be necessary.

When stimulating ovulation after suppressing endogenous secretion, it is necessary to supply exogenous gonadotropines. The most common one is the [[Menotropin|human menopausal gonadotropin]] (hMG), which is obtained by donation of menopausal women. Other [[Gonadotropin preparations|pharmacological preparations]] are FSH+LH or coripholitropine alpha.