Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization

Reprod Biol Endocrinol. 2011 Feb 16:9:25. doi: 10.1186/1477-7827-9-25.

Abstract

In the last decades, several steps have been made aiming at rendering human IVF more successful on one side, more tolerable on the other side. The "mild" ovarian stimulation approach, in which a lower-than-average dose of exogenous gonadotropins is given and gonadotropin treatment is started from day 2 to 7 of the cycle, represents a significant step toward a more patient's friendly IVF. However, a clear view of its virtues and defects is still lacking, because only a few prospective randomized trials comparing "mild" vs. conventional stimulation exist, and they do not consider some important aspects, such as, e.g., thawing cycles. This review gives a complete panorama of the "mild" stimulation philosophy, showing its advantages vs. conventional ovarian stimulation, but also discussing its disadvantages. Both patients with a normal ovarian responsiveness to exogenous gonadotropins and women with a poor ovarian reserve are considered. Overall, we conclude that the level of evidence supporting the use of "mild" stimulation protocols is still rather poor, and further, properly powered prospective studies about "mild" treatment regimens are required.

Publication types

  • Review

MeSH terms

  • Female
  • Fertilization in Vitro / methods
  • Follicle Stimulating Hormone / administration & dosage*
  • Follicular Phase / drug effects
  • Gonadotropin-Releasing Hormone / administration & dosage
  • Gonadotropin-Releasing Hormone / agonists
  • Gonadotropin-Releasing Hormone / analogs & derivatives
  • Gonadotropin-Releasing Hormone / antagonists & inhibitors
  • Humans
  • Ovarian Follicle / drug effects
  • Ovulation Induction / methods*
  • Pregnancy
  • Pregnancy Rate
  • Randomized Controlled Trials as Topic
  • Triptorelin Pamoate / administration & dosage

Substances

  • Triptorelin Pamoate
  • Gonadotropin-Releasing Hormone
  • Follicle Stimulating Hormone
  • cetrorelix