A New Medical Therapy for Infertility with Ovulation Disorder

Recently, ovulation induction drugs have been widely used not only for the treatment of ovulatory disorders, but for the retrieval of multiple oocytes in the assisted reproductive technology (ART). In the polycystic ovary syndrome (PCOS), the major cause of ovulatory disorder, high ovutation rate can be achieved by the ovulation induction, however, pregnancy rate is not always satisfactory because of relatively low implantation rate. Furthermore, there exist two serious side-effects, namely, ovarian-hyperstimulation syndrome (OHSS) and multiple gestation in the ovulation induction for PCOS. Some authors have reported the new ovulation induction protocols ensuring low frequency of these side effects, Gonadotropin step down method and gonadotropin releasing hormone (GnRH) pulsatile administration may be suitable for this purpose. Laparoscopic surgery for PCOS is also reported to be a safety and useful tool because it generates adequate hormonal milieu and high pregnancy rate without using much gonadotropins. For the ovulation induction in ART, the existance of so-called "poor responder" is one of the difficult problems. To overcome it, some new attempts including GnRH short protocol and combined growth hormone (GH) therapy have been performed, however, their efficacy on the improvement of pregnancy rate is not yet elucidated. More recently, attention has been directed to the relationship between the use of ovulation induction drugs and the occurrence of ovarian cancer. Careful observation for the gonadotropin users will be required to the phisician participating in infertility treatment