For conception to occur, whether naturally or via assisted reproductive
technology (ART), three things are required; a healthy sperm for fertilization, an ovum
released from both ovaries (in the fallopian tubes for natural pregnancy or in the
laboratory in IVF/ICSI), and a healthy place for the embryo to implant (a healthy
receptive endometrial cavity), so any defect in any of the aforementioned pregnancy
requirements will affect the achievement of pregnancy in both types; the natural one or
that resulting from ART [1]. Ovarian stimulation is used to overcome any ovulatory
disorder or in ART to collect as many eggs as possible (10-15 eggs at least) [2] to
maximize the chances of pregnancy. Assessment of ovarian reserve is the first and
most important step in ovarian stimulation, as this will indicate the proper method and
dose needed for ovulation induction. We test for ovarian reserve using Biomarkers
(FSH and AMH) and physical markers (antral follicles count(AFC)) by transvaginal
ultrasound(TVS). Both AMH and AFC have similar accuracy in assessing ovarian
reserve and are both superior to FSH as they have no cyclic variations [3]. This chapter
will discuss all aspects of the physiology of the ovulation process and ovarian
stimulation.
Keywords: Anovulation, ART, Ovarian stimulation
