oa Editorial [Hot Topic: Frontiers in Ovarian Stimulation (Guest Editor: Gian Mario Tiboni)]

Infertility, or the inability to conceive, is a problem affecting millions of couples around the world. In many cases, the infertility can be treated effectively only by means of assisted reproductive techniques (ART). Ovarian stimulation is a key component of ART and is directed towards the ultimate goal of obtaining an adequate number of good quality oocytes while preventing excessive ovarian response. Recent years have witnessed a significant expansion of the pharmacological armamentarium useful in ovarian stimulation protocols. In this issue Current Pharmaceutical Biotechnology a wide spectrum of relevant and fascinating topics in the area of ovarian stimulation are analyzed and discussed by a panel of distinct international authors. In the first article of this series, De Leo and co-workers offer a comprehensive review on the pharmacological aspects and different clinical applications of recombinant gonadotropins in the treatment of infertility in all its aspects. The manuscript from Fatemi et al. give a full analysis of the pharmacological agents available for ART programs. New hope and challenges in the area are also illustrated. The outcome of ART is largely influenced by the ovarian reserve, i.e. the capacity of the ovary to provide eggs that are capable of fertilization. La Marca and associates evaluate the current literature on ovarian reserve testing. The potential role of LH supplementation in ovarian stimulation remains controversial. The manuscript from Munoz and associates, besides discussing the issues surrounding the use of this gonadotropin in ovarian stimulation, focuses on the identification of patient subpopulations that may benefit from LH supplementation. Pharmacogenetics deals with the study of the relationship between individual gene variants and variable drug effects. The manuscript from Loutradis et al., reviews evidences linking gene polymorphism and ovarian response to gonadotropin stimulation. The potential clinical role of pharmacogenetic, especially in predicting ovarian response, is also outlined. In a related research paper presented by Anagnostou et al., the occurrence of differences in ovarian stimulation outcome and pregnancy rates among patients with different genotype combination profiles is presented. McCulloh and associates provide in their manuscripts a clear and novel description of how FSH levels change in blood during gonadotropin administration and provide understanding of how the underlying controllers affect FSH levels, and provide methods for administration that may improve the results of gonadotropin administration. The topic of progesterone elevation during ovarian stimulation, and its possible negative impact on ART outcome is addressed by a meta-analysis by Kolibianakis et al., showing that progesterone elevation on the day of hCG administration reduces the probability of clinical pregnancy in patients treated with GnRH antagonists and gonadotropins. It has been an honor working with the authors and editing this journal issue. I wish to acknowledge the referees for their conscientious efforts and constructive remarks.