Decision points for individualized hormonal stimulation with recombinant gonadotropins for treatment of women with infertility

Bruno Lunenfeld, Wilma Bilger, Salvatore Longobardi, Jan Kirsten, Thomas D’Hooghe, Sesh K. Sunkara

Research output: Contribution to journalReview articlepeer-review


It is essential that fertility treatment is individualized based on a thorough diagnostic work-up, with treatment tailored to the patients’ requirements. This individualization should be kept in mind during the main decision points that occur before and during treatment. Treatment customization must include consideration of both the woman and her partner involved in the process together, including their collective treatment goals. Once treatment goals have been agreed and diagnostic evaluations performed, personalization based on patient characteristics, together with an understanding of treatment goals and patient preferences, enables the selection of appropriate treatments, protocols, products and their dosing. Following treatment initiation, monitoring and adaptation of product and dose can then ensure optimal outcomes. Currently, it is not possible to base treatment decisions on every characteristic of the patient and personalization is based on biomarkers that have been identified as the most relevant. However, in the future, the use of artificial intelligence coupled with continuous monitoring should enable greater individualization and improve outcomes. This review considers the current state-of-the-art related to decision points during individualized treatment of female infertility, before looking at future developments that might further assist in making individualized treatment decisions, including the use of computer-assisted decision making.

Original languageEnglish
Pages (from-to)1027-1036
Number of pages10
JournalGynecological Endocrinology
Issue number12
StatePublished - 2 Dec 2019

Bibliographical note

Funding Information:
BL has no conflict of interest to declare concerning this paper. WB is an employee of Merck Serono GmbH, Darmstadt, Germany. SL , JK and TDH are employees of Merck KGaA, Darmstadt, Germany. SKS has received grants and non-financial support from Merck and Ferring.

Funding Information:
Medical writing support was provided by Alexander Jones, inScience Communications, Springer Healthcare, UK, and was funded by Merck KGaA, Darmstadt, Germany.

Publisher Copyright:
© 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


  • ART
  • Gonadotropin
  • decision points
  • personalized medicine
  • treatment algorithm


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