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Letter| Volume 44, ISSUE 5, P951, May 2022

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Is mild stimulation the way forward?

  • P. Drakopoulos
    Affiliations
    Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels 101-1090, Belgium
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  • F. Di Guardo
    Correspondence
    Corresponding author.
    Affiliations
    Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels 101-1090, Belgium

    Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, Catania 95125, Italy
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  • N.P. Polyzos
    Affiliations
    Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona 08028, Spain
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Published:February 28, 2022DOI:https://doi.org/10.1016/j.rbmo.2022.02.019
Is mild stimulation the way forward?
Previous ArticleWhy fertility preservation rates of transgender men are much lower than those of transgender women
Next ArticleResponse to: Is mild stimulation the way forward?
      We read with interest the study by
      • Datta A.K.
      • Campbell S.
      • Felix N.
      • Singh J.S.H.
      • Nargund G.
      Oocyte or embryo number needed to optimize live birth and cumulative live birth rates in mild stimulation IVF cycles.
      Reprod. Biomed. Online. 2021; 43: 223-232https://doi.org/10.1016/j.rbmo.2021.02.010
      suggesting that an oocyte yield of 9 and 12 following mild stimulation IVF (MS-IVF) in patients with uncompromised ovarian reserve could optimize fresh and cumulative live birth rate, respectively. However, these findings are in contrast with the inherent aim (or even definition) of mild stimulation, indicating a 'procedure in which the ovaries are stimulated with gonadotropins and/or other pharmacological compounds, with an intention of limiting the number of oocytes obtained for IVF to fewer than 8′ (
      • Nargund G.
      • Fauser B.C.J.M.
      • Macklon N.S.
      • Ombelet W.
      • Nygren K.
      • Frydman R.
      The ISMAAR proposal on terminology for ovarian stimulation for IVF.
      Hum. Reprod. 2007; https://doi.org/10.1093/humrep/dem285
      ;
      • Zegers-Hochschild F.
      • Adamson G.D.
      • De Mouzon J.
      • Ishihara O.
      • Mansour R.
      • Nygren K.
      • Sullivan E.
      • Van Der Poel S.
      The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009.
      Hum. Reprod. 2009; 24: 2683-2687https://doi.org/10.1093/humrep/dep343
      ).
      Interestingly, the number of patients who had MS-IVF and achieved this number of oocytes retrieved (and therefore had the best outcome) is not reported by the authors. This information would be helpful to understand firstly the percentage of patients treated with MS-IVF that achieve its goal (2–7 oocytes retrieved) and secondly whether mild stimulation is in the end as efficient as conventional stimulation which aims for an oocyte yield >8 oocytes (
      • Nargund G.
      • Fauser B.C.J.M.
      • Macklon N.S.
      • Ombelet W.
      • Nygren K.
      • Frydman R.
      The ISMAAR proposal on terminology for ovarian stimulation for IVF.
      Hum. Reprod. 2007; https://doi.org/10.1093/humrep/dem285
      ).
      Data interpretation is crucial for a personalized strategy in IVF counselling and caution is warranted. MS-IVF may be an option for some patients (e.g. expected poor ovarian responders) (
      • Drakopoulos P.
      • Romito A.
      • Errázuriz J.
      • Santos-Ribeiro S.
      • Popovic-Todorovic B.
      • Racca A.
      • Tournaye H.
      • De Vos M.
      • Blockeel C.
      Modified natural cycle IVF versus conventional stimulation in advanced-age Bologna poor responders.
      Reprod. Biomed. Online. 2019; 39: 698-703https://doi.org/10.1016/j.rbmo.2019.05.009
      ), while conventional stimulation should be preferred in normal responders, representing a more effective approach to fulfill the ultimate goal of IVF, which is undeniably the birth of a healthy full-term baby (
      • Drakopoulos P.
      • Blockeel C.
      • Stoop D.
      • Camus M.
      • De Vos M.
      • Tournaye H.
      • Polyzos N.P.
      Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos?.
      Hum. Reprod. 2016; 31: 370-376https://doi.org/10.1093/humrep/dev316
      ;
      • Law Y.J.
      • Zhang N.
      • Kolibianakis E.M.
      • Costello M.F.
      • Keller E.
      • Chambers G.M.
      • Venetis C.A.
      Is there an optimal number of oocytes retrieved at which live birth rates or cumulative live birth rates per aspiration are maximized after ART? A systematic review.
      Reprod. Biomed. Online. 2021; https://doi.org/10.1016/j.rbmo.2020.10.008
      ;
      • Polyzos N.P.
      • Drakopoulos P.
      • Parra J.
      • Pellicer A.
      • Santos-Ribeiro S.
      • Tournaye H.
      • Bosch E.
      • Garcia-Velasco J.
      Cumulative live birth rates according to the number of oocytes retrieved after the first ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection: a multicenter multinational analysis including ∼15,000 women.
      Fertil. Steril. 2018; 110 (e1): 661-670https://doi.org/10.1016/j.fertnstert.2018.04.039
      ).

      References

        • Datta A.K.
        • Campbell S.
        • Felix N.
        • Singh J.S.H.
        • Nargund G.
        Oocyte or embryo number needed to optimize live birth and cumulative live birth rates in mild stimulation IVF cycles.
        Reprod. Biomed. Online. 2021; 43: 223-232https://doi.org/10.1016/j.rbmo.2021.02.010
        View in Article
        • Drakopoulos P.
        • Blockeel C.
        • Stoop D.
        • Camus M.
        • De Vos M.
        • Tournaye H.
        • Polyzos N.P.
        Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos?.
        Hum. Reprod. 2016; 31: 370-376https://doi.org/10.1093/humrep/dev316
        View in Article
        • Drakopoulos P.
        • Romito A.
        • Errázuriz J.
        • Santos-Ribeiro S.
        • Popovic-Todorovic B.
        • Racca A.
        • Tournaye H.
        • De Vos M.
        • Blockeel C.
        Modified natural cycle IVF versus conventional stimulation in advanced-age Bologna poor responders.
        Reprod. Biomed. Online. 2019; 39: 698-703https://doi.org/10.1016/j.rbmo.2019.05.009
        View in Article
        • Law Y.J.
        • Zhang N.
        • Kolibianakis E.M.
        • Costello M.F.
        • Keller E.
        • Chambers G.M.
        • Venetis C.A.
        Is there an optimal number of oocytes retrieved at which live birth rates or cumulative live birth rates per aspiration are maximized after ART? A systematic review.
        Reprod. Biomed. Online. 2021; https://doi.org/10.1016/j.rbmo.2020.10.008
        View in Article
        • Nargund G.
        • Fauser B.C.J.M.
        • Macklon N.S.
        • Ombelet W.
        • Nygren K.
        • Frydman R.
        The ISMAAR proposal on terminology for ovarian stimulation for IVF.
        Hum. Reprod. 2007; https://doi.org/10.1093/humrep/dem285
        View in Article
        • Polyzos N.P.
        • Drakopoulos P.
        • Parra J.
        • Pellicer A.
        • Santos-Ribeiro S.
        • Tournaye H.
        • Bosch E.
        • Garcia-Velasco J.
        Cumulative live birth rates according to the number of oocytes retrieved after the first ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection: a multicenter multinational analysis including ∼15,000 women.
        Fertil. Steril. 2018; 110 (e1): 661-670https://doi.org/10.1016/j.fertnstert.2018.04.039
        View in Article
        • Zegers-Hochschild F.
        • Adamson G.D.
        • De Mouzon J.
        • Ishihara O.
        • Mansour R.
        • Nygren K.
        • Sullivan E.
        • Van Der Poel S.
        The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009.
        Hum. Reprod. 2009; 24: 2683-2687https://doi.org/10.1093/humrep/dep343
        View in Article

      Article info

      Publication history

      Published online: February 28, 2022
      Accepted: February 4, 2022
      Received: October 26, 2021

      Identification

      DOI: https://doi.org/10.1016/j.rbmo.2022.02.019

      Copyright

      © 2022 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

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