Ovarian stimulation & ART
ESHRE 2025: antagonist protocols, FSH dosing, OHSS prevention
Last updated: October 2026 — Sources: Cochrane / EAU / ESHRE / WHO / CDC
Key takeaways
ESHRE 2025 (121 recs) & Cochrane Antagonist 2023 make stimulation prediction-based: AMH/AFC to predict, not auto-dose; antagonist preferred to cut OHSS with same birth rate; conventional FSH, no unproven add-ons.
AMH or AFC to predict response — Strong; don't auto-adjust in normal responders.
Antagonist cuts OHSS ~50% with similar live birth (Cochrane).
FSH 150–225 IU conventional; high responders reduce to 100–150 IU.
No benefit GH/DHEA/aspirin/sildenafil/myo-inositol add-on — Strong/Conditional.
When to evaluate?
- Pre-IVF: AMH+AFC to predict response, OHSS risk, choose protocol.
- Prior high responder — antagonist + low dose + selective freeze-all.
- Want fewer injections/cost — antagonist shorter, less OHSS.
What not to do?
- Don't add GH/DHEA routinely for oocytes — no evidence.
- Don't raise dose in normal responders hoping for more oocytes — Conditional against.
- Don't use add-ons outside trials.
Healthcare-professional notice
This hub is independent of NPF products and does not promote them. It is informational only and does not replace individual clinical judgment. Surrogate outcomes (SDF, motility, HOMA, IIEF) are never converted into pregnancy/cure promises, and GRADE certainty is quoted as published.
Binding rule: surrogate outcomes are never converted into patient outcomes. Every certainty grade and limitation is quoted as published.
Deep dive
AMH vs AFC
Both acceptable to predict — Strong; choose by availability/cost.
0 high-certainty among 121 recs — individualise by age/reserve.
Antagonist vs agonist
Cochrane >80 trials: less OHSS with antagonist, similar live birth.
Preferred in high responders & prior OHSS — with GnRH agonist trigger.
Evidence in this domain
Each study broken into five questions: why it was run, who was studied, how it was done, the finding, and why it came out that way — then the clinical takeaway and limits, as published.
FAQ
Is delta better?
ESHRE Strong: delta = alpha/beta — choose by cost/preference, no birth diff.
Notice: this reference is informational only and not a substitute for medical advice. Consult your doctor before making any treatment decision.