Table 3 Various approaches to improve treatment outcome after ovarian stimulation:

(1) Approaches involving ovarian stimulation protocols:

A: Reduce intensity of ovarian stimulation

- No stimulation: natural cycle

- Minimal stimulation

- Step-down protocol

B: The application of new medications

- Recombinant FSH

- Recombinant LH

- GnRH antagonists

C: The use of adjuvant medication

- Insulin sensitizers

- Corticosteroids

- Other medications

(2) Improving embryology techniques

- Improving embryo culture conditions, selection and extending embryo culture (blastocyst transfer)

- Preimplantation genetic diagnosis

- In vitro maturation

- Micromanipulation including: ICSI, assisted hatching, mitochondrial injection and cytoplasmic and nuclear transfer.

(3) The use of aromatase inhibitors for

- Improving implantation rates

- Reducing FSH dose required for ovarian stimulation:

- Other possible benefits:

* Improving response to FSH stimulation in poor responders

* Preventing premature endogenous gonadotropin surge

* Reducing the risk of severe ovarian hyperstimulation