Mild approaches in assisted reproduction Better for the future

Authors:
René Frydman, M.D., Ph.D., Geeta Nargund, M.D.

Volume 102, Issue 6, Pages 1540–1541

Abstract:
Current approaches for in vitro fertilization (IVF) in the majority of assisted conception units throughout the world are aggressive, unphysiological, and expensive. Is this really necessary? There is a widespread belief among practitioners that for a woman the only consideration is a high success rate, and that the current practice of down-regulation, high-dose stimulation, and retrieval of a large number of oocytes yields a higher success rate per cycle and better outcomes. Incidentally, it also results in a higher income for the clinic, so surely, the argument goes, this is a win-win situation for both patient and practitioner.

  • This article is of great interest, as it challenges the current practice of IVF on a large scale. The authors propose a “milder” approach to stimulation than currently practiced (“conventional IVF”), using less aggressive stimulation, and less ICSI. This “light” version of IVF they are proposing also would include better pretreatment preparation, with more focus on general physical and mental wellbeing. Questions arising from this article are: Would a (multi-center) randomized controlled trial be feasible, to compare the conventional aggressive method with their “mild” approach? Are there plans for such a trial? It would be great to see the hypotheses presented backed up by more evidence. Additionally, the article presents the options as polar opposites, but is it possible that the best approach is somewhere in between, integrating “mild” and “aggressive” components for optimal IVF outcomes?

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