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Ovarian stimulation in ART - Unwinding pressing issues.

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Conventional controlled ovarian stimulation (cCOS) can cause discomfort and ovarian hyperstimulation syndrome (OHSS). Alternative methods like non-conventional controlled ovarian stimulation (non-cCOS) aim to reduce burden, but classic cCOS with single embryo transfer and embryo freezing optimizes IVF outcomes.

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Area of Science:

  • Reproductive Endocrinology and Infertility
  • Assisted Reproductive Technologies (ART)
  • In Vitro Fertilization (IVF)

Background:

  • Conventional controlled ovarian stimulation (cCOS) can lead to significant patient discomfort and risks like ovarian hyperstimulation syndrome (OHSS).
  • Alternative strategies, including non-conventional controlled ovarian stimulation (non-cCOS) and non-controlled ovarian stimulation (non-COS) therapies, aim to mitigate these issues.
  • The optimal approach balances cycle efficiency, patient burden, and successful pregnancy outcomes.

Purpose of the Study:

  • To evaluate the effectiveness and patient impact of various controlled ovarian stimulation protocols in IVF.
  • To compare the outcomes of conventional stimulation versus milder or non-controlled approaches.
  • To identify strategies that minimize OHSS risk and maximize the chance of a healthy birth per cycle.

Main Methods:

  • Review and comparison of different ovarian stimulation protocols: cCOS, non-cCOS (mild, mini, low-dose IVF), and non-COS (natural cycle IVF, modified natural IVF).
  • Analysis of outcomes including pregnancy rates, OHSS incidence, patient burden (physical, emotional, financial), and cost-effectiveness.
  • Consideration of advanced techniques like GnRH agonist long protocol, single embryo transfer (SET) at blastocyst stage, embryo vitrification, and accumulation cycles (AC) with preimplantation genetic screening (PGS).

Main Results:

  • Non-conventional and non-controlled methods may reduce physical and financial burdens but can increase the overall cost per baby due to more cycles required.
  • Classic cCOS, when optimized with GnRH agonist long protocol, SET, and embryo vitrification, can minimize OHSS risks and inconvenience.
  • Accumulation cycles (AC) with preimplantation genetic screening (PGS) show promise for specific patient groups like low responders and those with advanced maternal age (AMA).

Conclusions:

  • Optimized conventional controlled ovarian stimulation (cCOS) with single embryo transfer and embryo freezing offers a high probability of achieving multiple viable embryos from a single cycle.
  • While alternative methods aim to reduce patient burden, they may not always be more cost-effective per live birth.
  • Strategies like accumulation cycles (AC) combined with preimplantation genetic screening (PGS) present a promising future for specific patient populations in IVF.