ESHRE guideline on ovarian stimulation for IVF/ICSI – 2025

Abstract

The aim of the ovarian stimulation guideline is to provide clinicians with evidence-based information on the different options for ovarian stimulation for in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI), taking into account issues such as the ‘optimal’ ovarian response, live birth rates, safety, patient compliance, and individualisation. Special attention has also been given to pre- and adjuvant treatments in low responders and the prevention of ovarian hyperstimulation syndrome in high responders.
The guideline provides recommendations on all steps of ovarian stimulation: pre-stimulation management, pituitary suppression and gonadotropin stimulation, monitoring during ovarian stimulation, triggering of fifinal oocyte maturation and luteal support and the prevention of ovarian hyperstimulation syndrome.
As an update to the original guideline published in 2019, it contains new key question on fertility preservation that has been split into three parts, to reflect the best available evidence on fertility preservation for women facing gonadotoxic treatment, elective oocyte cryopreservation or oocyte donation. In addition, several new interventions were added to the existing key questions. Overall, these changes resulted in 46 new recommendations.
The guideline was developed according to the structured methodology for development of ESHRE guidelines.