The Parkes Lecture - Controlled ovarian stimulation in women

Recent advances in knowledge of the endocrine and paracrine mechanisms that regulate human ovarian folliculogenesis have been parallelled by the intro duction into clinical practice of new drugs that can be used safely and eff ectively to stimulate ovarian function in infertile women. Most notably, re combinant DNA technology has been applied to the production of molecularly pure forms of the gonadotrophins, FSH and LH, opening the way to the develo pment of improved strategies for manipulating the ovarian paracrine system. The clinical objectives of controlled ovarian stimulation fall into two ca tegories, depending on patient needs: (1) induction of multiple follicles f rom which mature oocytes can be harvested for use in assisted reproduction protocols such as ill vitro fertilization and embryo transfer; or (2) induc tion of spontaneous ovulation of a single mature follicle so that conceptio n might occur in vivo. This review summarizes the physiological principles upon which the use of gonadotrophins for clinical purposes is based, highli ghting new opportunities for improved treatment as a result of the availabi lity of recombinant FSH and LH.