Hormonal, functional and genetic biomarkers in controlled ovarian stimulation: tools for matching patients and protocols

Modern medical science has made great advances in the understanding and treatment of subfertility. This review is not an evidence-based meta-analysis, but rather provides our opinion on what we foresee as the future for controlled ovarian stimulation (COS) and how treatment protocols could be optimised to improve the outcome for individual patients. It is worth noting that some of the studies available in the literature and reported here have limited sample sizes and may not be adequately powered to show significance.Novel technologies have created new ways to evaluate and treat patients and provide them with a prognosis for overcoming their subfertility. Basic and clinical research coupled with advances in technology have led to the development of a wide variety of new treatment options, particularly in the area of COS. Follicle-stimulating hormone (FSH [urinary or recombinant (u-FSH/r-FSH)]) levels can be used alone or associated with luteinising hormone (LH) activity, which in turn can be provided in the form of human menopausal gonadotrophin (hMG), recombinant human LH (r-hLH) or human chorionic gonadotrophin (hCG [urinary or recombinant (u-hCG/r-hCG)]). In addition, the optional use of steroid hormones such as progesterone, oestrogen, testosterone or dehydroepiandrosterone (DHEA), and even the possibility of growth hormone treatment, could be considered following further research. Taken together, all these options tend to increase the complexity of treatment decisions. The discussion around gonadotrophin-releasing hormone (GnRH) agonist versus antagonist protocols during COS is another example highlighting the expanding number of treatment options and the urgent need to develop a rationale for making the best choice of treatment for each single patient.Currently, demographic and anthropomorphic data are the primary sources of information used to provide a prognosis and guide treatment. Along with basic medical and nutritional information, functional, hormonal a