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44A - There Is No Place for Natural and Mild Stimulation IVF
from Section VIII - Ovarian Stimulation
- By Raj Mathur
Edited by Roy Homburg, Adam H. Balen, Robert F. Casper
Book:

50 Big Debates in Reproductive Medicine

Published online:

25 November 2021

Print publication:

16 December 2021, pp 228-229
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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.