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The future trends of induction of ovulation.

The aim of this paper was to discuss future trends of induction of ovulation in women with ovulatory disorders who are not trying to intentionally make multiple follicles for the purpose of in vitro fertilization. Modern methods of correcting ovulatory disorders are compared historically to older techniques. Older techniques include the use of the selective estrogen receptor modulators, e.g., clomiphene citrate and relatively impure gonadotropin preparations, e.g., human menopausal gonadotropins. The "newer" drugs include other ways to temporarily lower estrogen to induce a rise in endogenous gonadotropin, e.g., aromatase inhibitors. Though purported to have less adverse effect on endometrial thickness and/or cervical mucus no clear-cut advantages have emerged. Though there was promise that higher pregnancy rates would be obtained by replacing impure gonadotropins with either all follicle stimulating hormone (FSH) products especially recombinant FSH if anything there is a trend to add luteinizing hormone (LH) back. New drugs are merely more convenient, i.e., present subcutaneous vs. intramuscular injection with trends for less frequent injections. New trends include more emphasis on maximizing efficacy of follicle maturing drugs, e.g., luteal phase support with progesterone, and carefully striving to find techniques to avoid over stimulation. Multiple gestations are much less tolerated today than yesterday. Cumulative evidence suggests diminished oocyte reserve does not indicate diminished oocyte quality and pregnancy can be achieved by consideration of the biologically adverse effect of elevated serum FSH on FSH receptors.