A mild treatment strategy for in-vitro fertilisation: a randomised non-inferiority trial

Mild ovarian stimulation for in vitro fertilization: one perspective from the USA

“…However, there was no difference between the mild and conventional stimulation groups with respect to anxiety, depression, physical discomfort or sleep disturbances in a randomized trial, perhaps because only a slight higher mean number of oocytes was retrieved with standard treatment compared with mild treatment (8.5 vs 6.9) [7]. But in this same trial, the rate of drop-out was significantly lower with mild treatment [8].…”

“…In a randomized controlled trial of over 400 patients with a mean age of approximately 33 years, a mild stimulation protocol utilizing low doses of FSH, a GnRH antagonist and transfer of one embryo had a lower live birth rate per cycle compared to conventional stimulation and transfer of two embryos [7]. The live birth rate per initiated cycle was of 15.8 % vs 24.0 %.…”

“…Some patients may wish to avoid the high numbers of injections associated with conventional ovarian stimulation protocols for IVF. Mild stimulation protocols are typically simpler for patients because they involve fewer injections per day and lower total number of days of ovarian stimulation [7]. On the other hand, mild stimulation cycles without the use of pre-treatment oral contraceptives may be more difficult to program, an inconvenience that may an issue for both IVF centers and some patients.…”

“…Some authors have used the term "total reproductive potential" to describe the chance of live birth from a single fresh IVF cycle, including all fresh and frozen embryo transfers which utilized eggs from one fresh cycle [26]. In the randomized trial just described [7], the mean number of embryos cryopreserved per cycle was under 1 (0.9 for mild treatment, 0.6 for standard treatment), despite a mean age of under 33 years. This low number of embryos available for cryopreservation is an important consideration.…”

“…The cost per fresh IVF cycle is lower with minimal stimulation [7]. However, when all fresh and frozen embryo transfers associated with one oocyte retrieval are considered, it is not clear that mild stimulation IVF is costeffective in the United States.…”