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Budget IVF Using Clomiphene, hMG, and Antagonists

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Minimal Stimulation and Natural Cycle In Vitro Fertilization

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Abstract

Over the last three decades, several different ovarian stimulation protocols for in vitro fertilization (IVF) have been proposed and tried. The most commonly used gonadotropin-releasing hormone (GnRH) agonist long protocol has several advantages like good predictability, easier cycle management, lower cancellation rates, a higher number of oocytes and embryos, and better pregnancy rates. However, its use has been plagued with unpredictable multiple births and morbidity of ovarian hyperstimulation syndrome (OHSS). In addition to being physically and emotional stressful, it is costly and is unaffordable to a significant number of patients.

In the mild stimulation protocols, the mean number of days of stimulation and the total amount of gonadotropins used is reduced, and the mean number of oocytes retrieved is lower but the proportion of high quality embryos is higher. The per cycle success rates maybe lower, but cumulative pregnancy rates are comparable to conventional IVF. The fewer side effects, better patient tolerability, and reduced costs decrease the stress and burden associated with IVF, decreasing the dropout rates and encouraging couples to perform more attempts, thereby improving cumulative pregnancy rates.

There are a spectrum of protocols for mild IVF varying from the use of Clomiphene citrate (CC) alone, gonadotropins alone, or Clomiphene followed by gonadotropins, with or without GnRH antagonist. The CC/gonadotropin/GnRH antagonist protocol takes advantage of the synergistic effect of CC and gonadotropins on follicular growth. The gonadotropins also counteract the antiestrogenic effect of CC on the endometrium, and the antagonist started in the mid-follicular phase effectively prevents the luteinizing hormone (LH) surge.

The implementation of mild ovarian stimulation for IVF in clinical practice is definitely justified and is worth pursuing.

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Abbreviations

ART:

Assisted reproductive technology

CC:

Clomiphene citrate

COH:

Controlled ovarian hyperstimulation

FSH:

Follicle-stimulating hormone

GnRH:

Gonadotropin-releasing hormone

hCG:

Human chorionic gonadotropin

hMG:

Human menopausal gonadotropin

ISMAAR:

International Society for Mild Approaches in Assisted Reproduction

IU:

International units

IVF:

In vitro fertilization

LH:

Luteinizing hormone

OHSS:

Ovarian hyperstimulation syndrome

rFSH:

Recombinant FSH

rLH:

Recombinant LH

uFSH:

Urinary FSH

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Authors and Affiliations

  1. Consultant Reproductive Medicine, Nova IVI Fertility, Mumbai, Maharashtra, 400 088, India

    Sneha Sathe MS (Obstetrics and Gynecology)

  2. Department of Assisted Reproduction, Rotunda – The Center for Human Reproduction, 36, Turner Road, B-Wing, 101, Bandra W, Mumbai, Maharashtra, 400 050, India

    Goral Gandhi MSc & Gautam N. Allahbadia MD, DNB, FNAMS, FCPS, DGO, DFP

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  1. Sneha Sathe MS (Obstetrics and Gynecology)
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  2. Goral Gandhi MSc
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  3. Gautam N. Allahbadia MD, DNB, FNAMS, FCPS, DGO, DFP
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Correspondence to Sneha Sathe MS (Obstetrics and Gynecology) .

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  1. 1st floor, Rotunda-CHR 36, Mumbai, India

    Gautam N. Allahbadia

  2. Department of Assisted Reproduction, Obstetrics and Gynecology, ICI – Instituto Canario de Infertilidad , Las Palmas de Gran Canaria, Spain

    Markus Nitzschke

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Sathe, S., Gandhi, G., Allahbadia, G.N. (2015). Budget IVF Using Clomiphene, hMG, and Antagonists. In: Allahbadia, G., Nitzschke, M. (eds) Minimal Stimulation and Natural Cycle In Vitro Fertilization. Springer, New Delhi. https://doi.org/10.1007/978-81-322-1118-1_10

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