Jitendar P Vij

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© 2005, Gautam Nandkishore Allahbadia

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First Edition: 2005

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In 1967, Prof. Bruno Lunenfeld, and three consecutive former heads of the department whom I am currently heading (Profs. Rabau, Serr and Mashiach) published together a landmark paper on their early ground breaking experience since 1960 with “human menopausal gonadotropins for anovulation and sterility”. As the head of the Ob/Gyn department that prides in itself, to this day, as the pioneer of ovulation induction, it is a pleasure and privilege to have been asked to pen this Foreword.

For many decades, we have known that pituitary gonadotropins, both FSH and LH, are in control of menstrual cycle dynamics and ovulation. Over three decades ago the introduction of medications that were capable of inducing ovarian function through indirect (Clomiphene citrate) or direct (Menotropins) gonadotropin stimulation revolutionized the treatment of reproductive disorders in both men and women. The pharmacology of ovarian stimulation has been influenced by the 2-cell-two gonadotropin theory and, historically, follicular stimulation protocols have included both LH and FSH in an attempt to mimic the normal physiology of folliculogenesis. Differing views on the role of LH in ovarian stimulation and the availability of recombinant human FSH (recFSH) contribute to this divergence of treatment approaches for ovarian stimulation. Currently, many protocols for gonadotropin administration have eliminated LH bioactivity. The recent availability of human LH and FSH synthesized by recombinant DNA technology, and the availability of gonadotropin-releasing hormone antagonists, should allow a precise in vivo assessment and re-evaluation of the 2-cell-two gonadotropin hypothesis. These pharmacological tools may also permit new insights into the physiological roles of FSH and LH in follicular development and oocyte maturation. Finally, they give us the unique opportunity to tailor ovarian stimulation regimens according to the patient's medical history and previous response to treatment. Clinical studies comparing preparations containing LH activity with FSH-only regimens have focused on pregnancy outcome, number of oocytes retrieved and cancellation rates. However, in order to evaluate the importance of LH in ovarian stimulation, the endpoint studied should probably also include oocyte quality, fertilization rates, embryo growth rates and quality, implantation rates, embryo cryosurvival, and possibly blastocyst formation. In physiological circumstances LH and FSH can be seen as a team collaborating for the achievement of a common goal, the maturation and ovulation of reproductively competent oocytes. Does the same principle apply to ovulation induction? We have five chapters in this book that directly or indirectly address this important contemporary dilemma. As implied by the title, the textbook covers all aspects of ovulation induction that a clinician wants to know including all known current stimulation protocols and induction strategies. The book is directed at all gynaecologists, infertility professionals; both medical and paramedical including postgraduate students. The text is definitive as a practical, problem orientated handbook.14