Abstract

Ezenwaeze Malachy Nwaeze*, Nweze Sylvester Onuegbunam, Nwankwo Chibugo Ndidiamaka

ABSTRACT

Background: Infertility affects 10–15% of couples worldwide, and Assisted Reproductive Technology (ART) has transformed its management. Despite advances, live birth rates remain modest at 30–40% per cycle. Optimizing ovarian stimulation and endometrial receptivity is critical for improving outcomes, with pharmacology playing a central role. Objective: To provide a comprehensive overview of pharmacological agents and protocols in ART, emphasizing mechanisms of action, clinical applications, safety, and emerging individualized strategies. Methods: Narrative review of recent clinical trials, meta-analyses, and guidelines. Agents discussed include selective estrogen receptor modulators, aromatase inhibitors, gonadotropins, GnRH analogs, hCG, progesterone, and adjunctive therapies such as metformin, cabergoline, glucocorticoids, and anticoagulants. Results: Pharmacological strategies maximize oocyte yield, prevent premature LH surges, and enhance implantation. Clomiphene citrate and letrozole remain first-line oral agents; recombinant gonadotropins and hMG support controlled ovarian hyperstimulation. GnRH antagonists reduce OHSS risk, while luteal support with progesterone is essential. Adjuncts such as cabergoline and CoQ10 improve safety and outcomes in high-risk groups. Emerging approaches, including long-acting gonadotropins and guided dosing, support personalized therapy. Conclusion: Pharmacology underpins ART success by balancing efficacy and safety. Advances in gonadotropin formulations, GnRH analogs, and adjunctive agents have improved outcomes, yet challenges like OHSS and implantation variability persist. Precision medicine approaches incorporating pharmacogenomics and tailored stimulation represent the next frontier in ART.