Mild ovarian stimulation for IVF
Mild ovarian stimulation for IVF
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.
13-29
Verberg, M.F.G.
6cfc6f04-fe1f-45ac-9016-fb846dbc4a2c
Macklon, Nicholas S.
7db1f4fc-a9f6-431f-a1f2-297bb8c9fb7e
Nargund, G.
3bc3352e-8164-4808-b921-3cfdcb397baa
Frydman, R.
11cf09e3-0a25-4760-94fd-73d77069a35a
Devroey, P.
b8d975bc-f9fe-4374-8d58-f48f08e55505
Broekmans, F.J.
17ce14de-42f9-43cb-98be-194dc9430888
Fauser, B.C.J.M.
c265d1e7-d207-4400-a669-7502343e3b7e
January 2009
Verberg, M.F.G.
6cfc6f04-fe1f-45ac-9016-fb846dbc4a2c
Macklon, Nicholas S.
7db1f4fc-a9f6-431f-a1f2-297bb8c9fb7e
Nargund, G.
3bc3352e-8164-4808-b921-3cfdcb397baa
Frydman, R.
11cf09e3-0a25-4760-94fd-73d77069a35a
Devroey, P.
b8d975bc-f9fe-4374-8d58-f48f08e55505
Broekmans, F.J.
17ce14de-42f9-43cb-98be-194dc9430888
Fauser, B.C.J.M.
c265d1e7-d207-4400-a669-7502343e3b7e
Verberg, M.F.G., Macklon, Nicholas S., Nargund, G., Frydman, R., Devroey, P., Broekmans, F.J. and Fauser, B.C.J.M.
(2009)
Mild ovarian stimulation for IVF.
Human Reproduction Update, 15 (1), .
(doi:10.1093/humupd/dmn056).
Abstract
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.
This record has no associated files available for download.
More information
Published date: January 2009
Identifiers
Local EPrints ID: 150723
URI: http://eprints.soton.ac.uk/id/eprint/150723
ISSN: 1355-4786
PURE UUID: e9e57284-6245-4e41-9b45-915eb799e87f
Catalogue record
Date deposited: 06 May 2010 12:25
Last modified: 14 Mar 2024 01:18
Export record
Altmetrics
Contributors
Author:
M.F.G. Verberg
Author:
Nicholas S. Macklon
Author:
G. Nargund
Author:
R. Frydman
Author:
P. Devroey
Author:
F.J. Broekmans
Author:
B.C.J.M. Fauser
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics