Individualization of treatment in controlled ovarian stimulation: myth or reality?

Variability in the infertile population excludes the possibility of a single approach to controlled ovarian stimulation. The modern technology has led to the development of new drugs, treatment options and quantitative methods that allow an individualized approach to in vitro fertilization. The personalization of treatments requires a comprehensive evaluation of several important aspects. Age still remains the best predictive factor of gametes euploidy rate. It was estimated that the percentage of abnormal embryos/oocytes increased dramatically in women >35 years old. Strategies to improve the number of vital and euploid embryos in those women represents the most intriguing challenge nowadays, considering that more and more women seeking assisted reproductive technologies are in advanced age. On the other hand, ovarian reserve markers, namely follicle stimulating hormone, anti-Mullerian hormone and antral follicle count are also considered the most accurate predictor of ovarian reserve and could be successfully used to guide controlled ovarian stimulation. Finally, there is an emerging evidence in literature which suggests that the ovarian sensitivity to exogenous gonadotropins could be also influenced by specific genotypes characteristics. If these data will be confirmed, a genetic screening might allow in the future a pharmacogenomic approach to better control ovarian stimulation.