Mild in-vitro fertilisation* (IVF) can achieve the same chance of a pregnancy resulting in term livebirth as standard IVF**, but can also reduce patients' discomfort, multiple pregnancies, and costs, according to an Article published in this week's issue of The Lancet.
IVF is a complex treatment for infertility that entails costly regimes for ovarian stimulation, serious discomfort to patients, and substantial risks of complications. Strategies with shorter ovarian stimulation protocols—such as gonadotropin-releasing hormone (GnRH) antagonist cotreatment—and transfer of a single embryo could allow more IVF cycles in the same period as conventional treatment, and produce a similar proportion of livebirths. Moreover, such mild strategies could reduce patients' discomfort and diminish the costs associated with multiple pregnancies.
Bart Fauser (University Medical Centre, Utrecht, Netherlands) and colleagues did a randomised trial to compare mild IVF treatment with standard IVF treatment in 404 patients. The 1-year cumulative proportion of pregnancies leading to livebirths was much the same with a mild strategy of IVF (43.4%) as with the standard IVF strategy (44.7%). The proportion of couples with multiple pregnancy outcomes was 0.5% with mild treatment versus 13.1% with standard treatment, and mean costs were €8333 and €10745 respectively. There were no significant differences between the groups in the anxiety, depression, physical discomfort, or sleep quality of the mother.
The authors conclude: "Our findings should encourage more widespread use of mild ovarian stimulation and single embryo transfer in clinical practice. However, adoption of our mild IVF treatment strategy would need to be supported by counselling both patients and health-care providers to redefine IVF success and explain the risks associated with multiple pregnancies, and by institution of reimbursement systems that encourage, rather than penalise, the practice of single embryo transfer."
In an accompanying Comment, William Ledger (University of Sheffield, UK) states: "While 75% of IVF treatment in the UK continues to be paid for by patients themselves…many couples will opt for double embryo transfer because it is much less costly. Governments should recognise the long-term benefits to patients, to neonatal and postnatal care, and to the public purse of implementing a policy of single embryo transfer, and encouraging adoption of policy with increased funding for such treatments."
Comment
Professor William Ledger, University of Sheffield, UK.
T) +44 (0)114 226 8317 w.ledger@sheffield.ac.uk
Notes to Editors
*Mild IVF—mild ovarian stimulation with GnRH antagonist cotreatment combined with single embryo transfer.
**Standard IVF—stimulation with GnRH agonist long-protocol and transfer of two embryos.
Journal
The Lancet