{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:15:48Z","timestamp":1788498948651,"version":"build-2803163510"},"reference-count":95,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009945","name":"Merck KGaA","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009945","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Delayed parenthood is a defining feature of contemporary reproductive medicine, fundamentally reshaping reproductive planning and increasing reliance on medically assisted reproduction (MAR). For women of advanced reproductive age (ARA), this shift exposes a potential disconnect between conventional treatment pathways and the biological constraints of ovarian ageing and a rapidly narrowing reproductive window. This risks preventable delays, cumulative treatment burden, and suboptimal outcomes in this population. Addressing these challenges requires deliberate adaptation of current clinical strategies to minimize avoidable delays in assessment and treatment, while ensuring timely, optimized, and outcome-focused care. In this Perspectives article, which is based on expert consensus opinion, we propose a hypothesis-generating framework \u2014 the Faster-Fewer-and-Finished (3F) approach \u2014 in which expedited evaluation, tailored cycle sequencing, and a patient-tailored \u2018finish\u2019 criterion are applied to maximize time-to-first-live birth or to arrive at a shared decision on how or if to continue, with treatment decisions anchored by individual age and ovarian reserve. The 3F approach prioritizes achieving a live birth or ideal family size in the shortest possible time by advocating the \u2018fewest\u2019 number of ovarian stimulation cycles necessary. While more than one cycle may be unavoidable, the emphasis is on early strategic tailoring of treatment according to age category, efficiency of intervention, and minimizing biological and emotional attrition. By aligning treatment strategies with both the realities of ovarian ageing and the wishes and life priorities of ARA patients, the 3F approach integrates established principles of MAR into a time-critical, outcome-driven theoretical framework for infertility care.<\/jats:p>","DOI":"10.3389\/fendo.2026.1845946","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:25:37Z","timestamp":1788495937000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing family building in women of advanced reproductive age: a Faster-Fewer-and-Finished approach"],"prefix":"10.3389","volume":"17","author":[{"given":"Sesh K.","family":"Sunkara","sequence":"first","affiliation":[{"name":"Division of Women\u2019s Health, Faculty of Life Sciences and Medicine, King\u2019s College London","place":["London, United Kingdom"]},{"name":"King\u2019s Fertility London, London, King\u2019s College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Venetis","sequence":"additional","affiliation":[{"name":"Unit for Human Reproduction, 1st Department of OB\/Gyn, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki","place":["Thessaloniki, Greece"]},{"name":"Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"D\u2019Hooghe","sequence":"additional","affiliation":[{"name":"Merck Healthcare KGaA","place":["Darmstadt, Germany"]},{"name":"Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven","place":["Leuven, Belgium"]},{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School","place":["New Haven, CT, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca E.","family":"Duncan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Hunter","sequence":"additional","affiliation":[{"name":"Monash IVF","place":["Perth, WA, Australia"]},{"name":"WOOM Women\u2019s Health","place":["Perth, WA, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Montenegro","sequence":"additional","affiliation":[{"name":"Merck Healthcare KGaA","place":["Darmstadt, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Broekmans","sequence":"additional","affiliation":[{"name":"Professor Em. in Reproductive Endocrinology and Surgery, Department of Reproductive Medicine, at the University Medical Center Utrecht","place":["Utrecht, Netherlands"]},{"name":"Consultant Reproductive Medicine, Center for Reproductive Medicine, Dijklander Hospital","place":["Purmerend, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","unstructured":"Estimated average age of women at the birth of their first child in the Asia-Pacific region between 2015 and 2020, by country\n          \n          \n          \n          2022"},{"key":"B2","unstructured":"Fertility Statistics\n          \n          \n          \n          2025"},{"key":"B3","unstructured":"Women in the EU are Having Their First Child Later\n          \n          \n          \n          2021"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004873","article-title":"Pregnancy at age 35 years or older: ACOG Obstetric Care Consensus No. 11","volume":"140","year":"2022","journal-title":"Obstet Gynecol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.46291","article-title":"Exploring the complex landscape of delayed childbearing: factors, history, and long-term implications","volume":"15","author":"Zabak","year":"2023","journal-title":"Cureus"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/der076","article-title":"Age at first birth, mode of conception and psychological wellbeing in pregnancy: findings from the parental age and transition to parenthood Australia (PATPA) study","volume":"26","author":"McMahon","year":"2011","journal-title":"Hum Reprod"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaa138","article-title":"Time as an outcome measure in fertility-related clinical studies: long-awaited","volume":"35","author":"Sunkara","year":"2020","journal-title":"Hum Reprod"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.fmre.2023.09.013","article-title":"The updated understanding of advanced maternal age","volume":"4","author":"Ye","year":"2024","journal-title":"Fundam Res"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2013.11.004","article-title":"The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening","volume":"101","author":"Franasiak","year":"2014","journal-title":"Fertil Steril"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2020.10.051","article-title":"Diminished ovarian reserve is associated with reduced euploid rates via preimplantation genetic testing for aneuploidy independently from age: evidence for concomitant reduction in oocyte quality with quantity","volume":"115","author":"Jaswa","year":"2021","journal-title":"Fertility Sterility"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2015.03.004","article-title":"Reproduction at an advanced maternal age and maternal health","volume":"103","author":"Sauer","year":"2015","journal-title":"Fertil Steril"},{"key":"B12","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/s1701-2163(16)35138-6","article-title":"Delayed child-bearing","volume":"34","author":"Johnson","year":"2012","journal-title":"J Obstet Gynaecol Can"},{"key":"B13","unstructured":"Centers for Disease Control ART Data\n          \n          \n          \n          2020"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dead197","article-title":"ART in Europe 2019: results generated from European registries by ESHRE\u2020","volume":"38","author":"Smeenk","year":"2023","journal-title":"Hum Reprod"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.11622\/smedj.2014081","article-title":"Female ageing and reproductive outcome in assisted reproduction cycles","volume":"55","author":"Tan","year":"2014","journal-title":"Singapore Med J"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s11113-023-09765-3","article-title":"Projecting the contribution of assisted reproductive technology to completed cohort fertility","volume":"42","author":"Lazzari","year":"2023","journal-title":"Popul Res Policy Rev"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2023.100686","article-title":"Childbirth timing and completed family size by the mode of conception-the role of medically assisted reproduction: a population-based cohort study in Australia","volume":"33","author":"Choi","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2021.01.005","article-title":"Evolution of cumulative live birth and dropout rates over six complete IVF\/ICSI cycles: a large prospective cohort study","volume":"42","author":"De Neubourg","year":"2021","journal-title":"Reprod BioMed Online"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2013.825677","article-title":"What do healthy women know about the consequences of delayed childbearing","author":"Gossett","year":"2013","journal-title":"J Health Commun"},{"key":"B20","doi-asserted-by":"publisher","first-page":"99","DOI":"10.5935\/1518-0557.20160024","article-title":"Age and fertility: a study on patient awareness","volume":"20","author":"Deatsman","year":"2016","journal-title":"JBRA Assist Reprod"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-016-0717-1","article-title":"Awareness, knowledge, and perceptions of infertility, fertility assessment, and assisted reproductive technologies in the era of oocyte freezing among female and male university students","volume":"33","author":"Meissner","year":"2016","journal-title":"J Assist Reprod Genet"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.09.030","article-title":"Knowledge of age-related fertility decline in women: a systematic review","volume":"230","author":"Garc\u00eda","year":"2018","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1007\/s10815-020-01967-4","article-title":"Guidelines informing counseling on female age-related fertility decline: a systematic review","volume":"38","author":"Trawick","year":"2021","journal-title":"J Assist Reprod Genet"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1093\/hropen\/hoaa052","article-title":"ESHRE guideline: female fertility preservation\u2020","volume":"2020","author":"Anderson","year":"2020","journal-title":"Hum Reprod Open"},{"key":"B25","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1016\/j.fertnstert.2025.03.031","article-title":"Assisted reproduction with advancing paternal and maternal age: an Ethics Committee opinion","volume":"123","year":"2025","journal-title":"Fertility Sterility"},{"key":"B26","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.fertnstert.2025.07.029","article-title":"Achieving two live births from one ovarian stimulation cycle: the one-and-done approach revisited","volume":"125","author":"Huttler","year":"2026","journal-title":"Fertil Steril"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2019.06.013","article-title":"Is there an association between oocyte number and embryo quality? A systematic review and meta-analysis","volume":"39","author":"Vermey","year":"2019","journal-title":"Reprod BioMed Online"},{"key":"B28","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1093\/humrep\/dey342","article-title":"Is more better? A higher oocyte yield is independently associated with more day-3 euploid embryos after ICSI","volume":"34","author":"Venetis","year":"2019","journal-title":"Hum Reprod"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/der106","article-title":"Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles","volume":"26","author":"Sunkara","year":"2011","journal-title":"Hum Reprod"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaa030","article-title":"Cumulative live birth rates for women returning to ART treatment for a second ART-conceived child","volume":"35","author":"Paul","year":"2020","journal-title":"Hum Reprod"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00099","article-title":"A novel predictive model to estimate the number of mature oocytes required for obtaining at least one euploid blastocyst for transfer in couples undergoing in vitro fertilization\/intracytoplasmic sperm injection: the ART Calculator","volume":"10","author":"Esteves","year":"2019","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00917","article-title":"Validation of ART Calculator for Predicting the Number of Metaphase II Oocytes Required for Obtaining at Least One Euploid Blastocyst for Transfer in Couples Undergoing in vitro Fertilization\/Intracytoplasmic Sperm Injection","volume":"10","author":"Esteves","year":"2019","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2025.04.023","article-title":"The number of autologous, vitrified mature oocytes needed to obtain three euploid blastocysts increases with age","volume":"124","author":"Namath","year":"2025","journal-title":"Fertil Steril"},{"key":"B34","unstructured":"Guideline on Ovarian Stimualation for IVF\/ICSI\n          \n          \n          \n          2025"},{"key":"B35","article-title":"Fertility and the aging male","volume":"13","author":"Harris","year":"2011","journal-title":"Rev Urol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/17.4.990","article-title":"The spectrum of DNA damage in human sperm assessed by single cell gel electrophoresis (Comet assay) and its relationship to fertilization and embryo development","volume":"17","author":"Morris","year":"2002","journal-title":"Hum Reprod"},{"key":"B37","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.fertnstert.2007.06.009","article-title":"Male age negatively impacts embryo development and reproductive outcome in donor oocyte assisted reproductive technology cycles","volume":"90","author":"Frattarelli","year":"2008","journal-title":"Fertil Steril"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1177\/1933719113506497","article-title":"The effect of paternal age on outcome in assisted reproductive technology using the ovum donation model","volume":"21","author":"Robertshaw","year":"2014","journal-title":"Reprod Sci"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.4137\/cmrh.s32769","article-title":"High aneuploidy rates observed in embryos derived from donated oocytes are related to male aging and high percentages of sperm DNA fragmentation","volume":"9","author":"Garc\u00eda-Ferreyra","year":"2015","journal-title":"Clin Med Insights Reprod Health"},{"key":"B40","volume-title":"WHO laboratory manual for the examination and processing of human semen","year":"2021"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2023.103647","article-title":"APHRODITE criteria: addressing male patients with hypogonadism and\/or infertility owing to altered idiopathic testicular function","volume":"48","author":"Esteves","year":"2024","journal-title":"Reprod BioMed Online"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1111\/andr.70035","article-title":"Normozoospermic men in infertile couples: Potential benefit of early medical diagnostic procedures","volume":"14","author":"Bier","year":"2025","journal-title":"Andrology"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1080\/00324728.2025.2561595","article-title":"Shifting the reproductive window: The contribution of ART and egg donation to fertility rates in the UK","volume":"80","author":"Bruckamp","year":"2025","journal-title":"Popul Stud (Camb)"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dev177","article-title":"ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff","volume":"30","author":"Gameiro","year":"2015","journal-title":"Hum Reprod"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2023.102341","article-title":"Number of oocytes and IVF outcomes: real-world evidence","volume":"89","author":"Sunkara","year":"2023","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deu272","article-title":"Can you ever collect too many oocytes","volume":"30","author":"Briggs","year":"2014","journal-title":"Hum Reprod"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2013.12.026","article-title":"Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth: an analysis of 256,381 in vitro fertilization cycles","volume":"101","author":"Steward","year":"2014","journal-title":"Fertil Steril"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2016.07.559","article-title":"Optimal oocyte yield for cumulative live-birth rate: analysis of 257,398 IVF cycles and their linked fresh and frozen embryo transfers","volume":"106","author":"Nelson","year":"2016","journal-title":"Fertility Sterility"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-017-0959-6","article-title":"Cumulative live birth and surplus embryo incidence after frozen-thaw cycles in PCOS: how many oocytes do we need","volume":"34","author":"Chen","year":"2017","journal-title":"J Assist Reprod Genet"},{"key":"B50","article-title":"Optimal number of oocytes: in vitro fertilization predictive model","volume":"85","author":"L\u00f3pez-Rioja","year":"2017","journal-title":"Ginecol Obstet Mex"},{"key":"B51","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1093\/humrep\/dex334","article-title":"The number of oocytes retrieved during IVF: a balance between efficacy and safety","volume":"33","author":"Magnusson","year":"2018","journal-title":"Hum Reprod"},{"key":"B52","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/j.fertnstert.2018.04.039","article-title":"Cumulative live birth rates according to the number of oocytes retrieved after the first ovarian stimulation for in vitro fertilization\/intracytoplasmic sperm injection: a multicenter multinational analysis including \u223c15,000 women","volume":"110","author":"Polyzos","year":"2018","journal-title":"Fertil Steril"},{"key":"B53","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.rbmo.2020.10.008","article-title":"Is there an optimal number of oocytes retrieved at which live birth rates or cumulative live birth rates per aspiration are maximized after ART? A systematic review","volume":"42","author":"Law","year":"2021","journal-title":"Reprod BioMed Online"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2020.11.010","article-title":"Female age is associated with the optimal number of oocytes to maximize fresh live birth rates: an analysis of 256,643 fresh ART cycles","volume":"42","author":"Zhang","year":"2021","journal-title":"Reprod BioMed Online"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/det303","article-title":"The optimum number of oocytes in IVF treatment: an analysis of 2455 cycles in China","volume":"28","author":"Ji","year":"2013","journal-title":"Hum Reprod"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dev316","article-title":"Conventional ovarian stimulation and single embryo transfer for IVF\/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos","volume":"31","author":"Drakopoulos","year":"2016","journal-title":"Hum Reprod"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dey295","article-title":"Cumulative live birth rates and number of oocytes retrieved in women of advanced age. A single centre analysis including 4500 women \u226538 years old","volume":"33","author":"Devesa","year":"2018","journal-title":"Hum Reprod"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dez100","article-title":"The number of oocytes associated with maximum cumulative live birth rates per aspiration depends on female age: a population study of 221\u2009221 treatment cycles","volume":"34","author":"Law","year":"2019","journal-title":"Hum Reprod"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1080\/03009734.2020.1734694","article-title":"DuoStim - a reproducible strategy to obtain more oocytes and competent embryos in a short time-frame aimed at fertility preservation and IVF purposes. A systematic review","volume":"125","author":"Vaiarelli","year":"2020","journal-title":"Ups J Med Sci"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1016\/s3050-5038(26)00054-3","article-title":"Safety and effectiveness of ten common in-vitro fertilisation add-ons: a systematic review and meta-analysis","volume":"2","author":"Lensen","year":"2026","journal-title":"Lancet Obstetrics Gynaecology Women\u2019s Health"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2026.105747","article-title":"PGT-A is associated with a reduced live birth rate in routine practice: evidence from the UK ART register","volume":"53","author":"Roberts","year":"2026","journal-title":"Reprod BioMed Online"},{"key":"B62","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.rbmo.2022.03.013","article-title":"PGDIS position statement on the transfer of mosaic embryos 2021","volume":"45","author":"Leigh","year":"2022","journal-title":"Reprod BioMed Online"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2023.08.969","article-title":"Clinical management of mosaic results from preimplantation genetic testing for aneuploidy of blastocysts: a committee opinion","volume":"120","year":"2023","journal-title":"Fertility Sterility"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dead184","article-title":"Good practice recommendations on add-ons in reproductive medicine\u2020","volume":"38","author":"Lundin","year":"2023","journal-title":"Hum Reprod"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2024.04.013","article-title":"The use of preimplantation genetic testing for aneuploidy: a committee opinion","volume":"122","year":"2024","journal-title":"Fertil Steril"},{"key":"B66","unstructured":"Treatment Add-Ons with Limited Evidence\n          \n          \n          \n          2025"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-018-1275-5","article-title":"The cost of a euploid embryo identified from preimplantation genetic testing for aneuploidy (PGT-A): a counseling tool","volume":"35","author":"Goldman","year":"2018","journal-title":"J Assist Reprod Genet"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-025-03400-0","article-title":"PGT-A: what's it for, what's wrong","volume":"42","author":"Viville","year":"2025","journal-title":"J Assist Reprod Genet"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/del284","article-title":"Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF: a randomized assessor-blind controlled trial","volume":"21","author":"Andersen","year":"2006","journal-title":"Hum Reprod"},{"key":"B70","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/den220","article-title":"Highly purified hMG versus recombinant FSH in ovarian hyperstimulation with GnRH antagonists--a randomized study","volume":"23","author":"Bosch","year":"2008","journal-title":"Hum Reprod"},{"key":"B71","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2007.05.039","article-title":"Effectiveness of highly purified human menopausal gonadotropin vs. recombinant follicle-stimulating hormone in first-cycle in vitro fertilization-intracytoplasmic sperm injection patients","volume":"89","author":"Hompes","year":"2008","journal-title":"Fertil Steril"},{"key":"B72","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2011.12.016","article-title":"A randomized assessor-blind trial comparing highly purified hMG and recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer","volume":"97","author":"Devroey","year":"2012","journal-title":"Fertil Steril"},{"key":"B73","doi-asserted-by":"publisher","DOI":"10.3109\/09513590.2011.650742","article-title":"Outcome of in vitro fertilization following stimulation with highly purified hMG or recombinant FSH in downregulated women of advanced reproductive age: a prospective, randomized and controlled trial","volume":"28","author":"Ye","year":"2012","journal-title":"Gynecol Endocrinol"},{"key":"B74","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2020.03.029","article-title":"Randomized, assessor-blinded trial comparing highly purified human menotropin and recombinant follicle-stimulating hormone in high responders undergoing intracytoplasmic sperm injection","volume":"114","author":"Witz","year":"2020","journal-title":"Fertil Steril"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd005354.pub3","article-title":"Recombinant follicle-stimulating hormone (rFSH) versus other recombinant or urinary gonadotropins for ovarian stimulation in assisted reproductive technology cycles","volume":"7","author":"Berkhout","year":"2026","journal-title":"Cochrane Database Syst Rev"},{"key":"B76","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24109020","article-title":"Follicle-stimulating hormone biological products: does potency predict clinical efficacy","volume":"24","author":"Lispi","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B77","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaf143","article-title":"Follitropin alfa biosimilars: unfounded doubts on the road to reproductive care","volume":"40","author":"de Mora","year":"2025","journal-title":"Hum Reprod"},{"key":"B78","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deae274","article-title":"Biosimilars versus the originator of follitropin alfa for ovarian stimulation in ART: a systematic review and meta-analysis","volume":"40","author":"Kiose","year":"2025","journal-title":"Hum Reprod"},{"key":"B79","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaf144","article-title":"Methodological concerns and clinical relevance: a critical appraisal of the meta-analysis on biosimilars versus originator follitropin alfa in ART","volume":"40","author":"Santulli","year":"2025","journal-title":"Hum Reprod"},{"key":"B80","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaf145","article-title":"Reply: biosimilars versus the originator of follitropin alfa in ART: eyes wide shut","volume":"40","author":"Venetis","year":"2025","journal-title":"Hum Reprod"},{"key":"B81","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2023.103725","article-title":"Effectiveness of recombinant human FSH: recombinant human LH combination treatment versus recombinant human FSH alone for assisted reproductive technology in women aged 35-40 years","volume":"48","author":"Bielfeld","year":"2024","journal-title":"Reprod BioMed Online"},{"key":"B82","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s12958-021-00759-4","article-title":"Recombinant human luteinizing hormone co-treatment in ovarian stimulation for assisted reproductive technology in women of advanced reproductive age: a systematic review and meta-analysis of randomized controlled trials","volume":"19","author":"Conforti","year":"2021","journal-title":"Reprod Biol Endocrinol"},{"key":"B83","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/der092","article-title":"ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria","volume":"26","author":"Ferraretti","year":"2011","journal-title":"Hum Reprod"},{"key":"B84","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012693.pub2","article-title":"Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing in vitro fertilisation plus intracytoplasmic sperm injection (IVF\/ICSI)","volume":"2","author":"Lensen","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"B85","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd012693.pub3","article-title":"Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing in vitro fertilisation plus intracytoplasmic sperm injection (IVF\/ICSI)","volume":"1","author":"Ngwenya","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"B86","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmae032","article-title":"Development and validation of a gonadotropin dose selection model for optimized ovarian stimulation in IVF\/ICSI: an individual participant data meta-analysis","volume":"31","author":"Schouten","year":"2025","journal-title":"Hum Reprod Update"},{"key":"B87","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2012.11.051","article-title":"Biomarkers of ovarian response: current and future applications","volume":"99","author":"Nelson","year":"2013","journal-title":"Fertil Steril"},{"key":"B88","doi-asserted-by":"publisher","DOI":"10.4274\/jtgga.2017.0058","article-title":"How to personalize ovarian stimulation in clinical practice","volume":"18","author":"Sighinolfi","year":"2017","journal-title":"J Turk Ger Gynecol Assoc"},{"key":"B89","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2018.00589","article-title":"Understanding ovarian hypo-response to exogenous gonadotropin in ovarian stimulation and its new proposed marker-the follicle-to-oocyte (FOI) index","volume":"9","author":"Alviggi","year":"2018","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B90","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2019.1650345","article-title":"Decision points for individualized hormonal stimulation with recombinant gonadotropins for treatment of women with infertility","volume":"35","author":"Lunenfeld","year":"2019","journal-title":"Gynecol Endocrinol"},{"key":"B91","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12958-021-00744-x","article-title":"Dose adjustment of follicle-stimulating hormone (FSH) during ovarian stimulation as part of medically-assisted reproduction in clinical studies: a systematic review covering 10 years, (2007-2017)","volume":"19","author":"Fatemi","year":"2021","journal-title":"Reprod Biol Endocrinol"},{"key":"B92","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.742089","article-title":"Recombinant human follicle-stimulating hormone alfa dose adjustment in US clinical practice: an observational, retrospective analysis of a real-world electronic medical records database","volume":"12","author":"Mahony","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B93","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-024-03159-w","article-title":"Too many embryos: a critical perspective on a global challenge","volume":"41","author":"Bartolacci","year":"2024","journal-title":"J Assist Reprod Genet"},{"key":"B94","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.952471","article-title":"Aging conundrum: a perspective for ovarian aging","volume":"13","author":"Wu","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B95","doi-asserted-by":"publisher","DOI":"10.1093\/biolre\/ioab241","article-title":"Age-associated changes in cumulus cells and follicular fluid: the local oocyte microenvironment as a determinant of gamete quality","volume":"106","author":"Babayev","year":"2022","journal-title":"Biol Reprod"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1845946\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:25:39Z","timestamp":1788495939000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1845946\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":95,"alternative-id":["10.3389\/fendo.2026.1845946"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1845946","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]},"article-number":"1845946"}}