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44A - There Is No Place for Natural and Mild Stimulation IVF

For

from Section VIII - Ovarian Stimulation

Published online by Cambridge University Press:  25 November 2021

By
Raj Mathur
Edited by
Roy Homburg ,
Adam H. Balen  and
Robert F. Casper
Roy Homburg
Affiliation:
Homerton University Hospital, London
Adam H. Balen
Affiliation:
Leeds Centre for Reproductive Medicine
Robert F. Casper
Affiliation:
Mount Sinai Hospital, Toronto
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Summary

The number of eggs retrieved is an important prognostic factor for IVF outcome, with low egg number associated with a lower likelihood of success. ‘Natural’ and ‘mild’ approaches to ovarian stimulation for IVF intentionally aim to limit the number of eggs retrieved. Hence, they are less effective than standard regimes at achieving live birth, particularly on a cumulative basis. In poor responders, these approaches yield fewer eggs and a higher cancellation rate. The risk of OHSS with standard regimes can be managed using GnRH antagonist, agonist trigger and freeze-all, without compromising the likelihood of live birth. Embryo aneuploidy is not increased by exogenous gonadotropin use. Hence, there is evidence that ‘natural’ and ‘mild’ stimulation reduces the likelihood of having a baby, and no evidence that the risks of standard stimulation are high enough to justify use of ‘natural’ and ‘mild’ IVF in modern practice.

Keywords

IVFnaturalmildFSH doseOHSSlive birth
Type
Chapter
Information
50 Big Debates in Reproductive Medicine , pp. 228 - 229
Publisher: Cambridge University Press
Print publication year: 2021

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References

Sunkara, SK, LaMarca, A, Polyzos, NP, et al. Live birth and perinatal outcomes following stimulated and unstimulated IVF: analysis of over two decades of a nationwide data. Hum Reprod. 2016;31(10):2261–7.CrossRefGoogle ScholarPubMed
Nargund, G, Fauser, BCJM, Macklon, NS, et al. The ISMAAR proposal on terminology for ovarian stimulation for IVF. Hum Reprod. 2007;22(11):2801–4.CrossRefGoogle ScholarPubMed
Polyzos, NP, Drakopoulos, P, Parra, J, et al. Cumulative live birth rates according to the number of oocytes retrieved after the first ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection: a multicentre multinational analysis including 15,000 women. Fert Steril. 2018;4:662–9.Google Scholar
Van Tilborg, TC, Torrance, HL, Oudshoorn, SC, et al. Individualized versus standard FSH dosing in women starting IVF/ICSI: an RCT. Part 1: The predicted poor responder. Hum Reprod. 2017;32(12):2496–505.CrossRefGoogle ScholarPubMed
Hong, KH, Franasiak, JM, Weiner, MM, et al. Embryonic aneuploidy rates are equivalent in natural cycles and gonadotropin-stimulated cycles. Fertil Steril. 2019;112:670–6.CrossRefGoogle ScholarPubMed

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