Hiperestimulació ovàrica i tècniques de manipulació d’oòcits en el tractament de la infertilitat humana

Abstract

According to the Spanish Fertility Society (SEF) among 15-17% of the population of reproductive age have troubles having a baby. The causes of infertility may lie in the man, the woman, in both members of the couple or may be idiopathic. In order to give solution to fertility problems assisted reproductive techniques (ART) were developed. Such techniques involve the handling of oocytes or sperm in a laboratory. The ART, however, does not provide a solution to all cases of sterility. Currently the most commonly ART used are artificial insemination (AI), in vitro fertilization (IVF) and intracytoplasmatic sperm injection (ICSI), which is derived from IVF. To successfully perform these techniques, most patients undergo controlled ovarian hyperstimulation (COH) protocols. The COH has the purpose of stimulating the ovaries through hormonal treatments to obtain more than a mature follicle and to increase in this way the probabilities of pregnancy. There are several protocols available to develop these techniques, being the gonadotropins the most used treatment because of their intense stimulation. But if mild stimulations is desired clomiphene citrate may be an alternative. In addition, there is also the possibility of using an adjuvant treatment by using gonadotropin-releasing hormone (GnRH) analogues, both agonists and antagonist, which significantly increase success rates due to an improvement in oocyte quality. Complications and adverse effects such as oocyte abnormalities, problems in endometrial receptivity, or two of the most recurrent complications like multiple gestation and ovarian hyperstimulation syndrome (OHSS) can also arise from COH. There are a numerous protocols available to be followed, and each one derives advantages and disadvantages, so there is a need to individualize the technique to each patient considering age, ovarian reserve and medical history