Mild ovarian stimulation for IVF.
Verberg MF, Macklon NS, Nargund G, Frydman R, Devroey P, Broekmans FJ, Fauser
BC.
Department of Reproductive Medicine and Gynaecology, University Medical Centre
Utrecht, Utrecht, The Netherlands. m.f.g.verberg@umcutrecht.nl
BACKGROUND: Mild ovarian stimulation for in vitro fertilization (IVF) aims to
achieve cost-effective, patient-friendly regimens which optimize the balance
between outcomes and risks of treatment. METHODS: Pubmed and Medline were
searched up to end of January 2008 for papers on ovarian stimulation protocols
for IVF. Additionally, references to related studies were selected wherever
possible. RESULTS: Studies show that mild interference with the decrease in
follicle-stimulating hormone levels in the mid-follicular phase was sufficient
to override the selection of a single dominant follicle.
Gonadotrophin-releasing hormone antagonists compared with agonists reduce
length and dosage of gonadotrophin treatment without a significant reduction in
the probability of live birth (OR 0.86, 95% CI 0.72-1.02). Mild ovarian
stimulation may be achieved with limited gonadotrophins or with alternatives
such as anti-estrogens or aromatase inhibitors. Another option is luteinizing
hormone or human chorionic gonadotrophin administration during the late
follicular phase. Studies regarding these approaches are discussed
individually; small sample size of single studies along with heterogeneity in
patient inclusion criteria as well as outcomes analysed does not allow a
meta-analysis to be performed. Additionally, the implications of mild ovarian
stimulation for embryo quality, endometrial receptivity, cost and the
psychological impact of IVF treatment are discussed. CONCLUSIONS: Evidence in
favour of mild ovarian stimulation for IVF is accumulating in recent
literature. However, further, sufficiently powered prospective studies applying
novel mild treatment regimens are required and structured reporting of the
incidence and severity of complications, the number of treatment days,
medication used, cost, patient discomfort and number of patient drop-outs in
studies on IVF is encouraged.
PMID: 19091755 [PubMed - in process]
