Why ovarian stimulation should be aimed to maximize oocyte yield.

Area of Science:

• Reproductive Endocrinology
• Assisted Reproductive Technology (ART)

Background:

• Assisted reproductive technology (ART) success is measured by cumulative live birth rate (CLBR) per ovarian stimulation cycle.
• While mild stimulation is promoted for safety and cost-effectiveness, it may not maximize oocyte yield.
• Risks associated with ovarian stimulation, such as OHSS and adverse outcomes, are concerns, but preventive strategies and vitrification have evolved.

Purpose of the Study:

• To evaluate the optimal strategy for ovarian stimulation in ART.
• To challenge the notion that mild stimulation is superior to maximizing oocyte yield.
• To demonstrate that maximizing oocyte yield is the most effective approach for improving CLBR.

Main Methods:

• This paper uses a proof by contradiction approach.
• It analyzes the impact of ovarian stimulation intensity on oocyte yield and ART outcomes.
• It considers the role of oocyte vitrification and cycle segmentation in mitigating risks.

Main Results:

• Accumulating data suggest ovarian stimulation does not adversely affect oocyte quality or obstetric/neonatal outcomes.
• Vitrification allows for cycle segmentation, minimizing OHSS risk and impaired endometrial receptivity.
• Maximizing oocyte yield per cycle, facilitated by vitrification, enhances CLBR and potentially reduces overall treatment costs.

Conclusions:

• Ovarian stimulation should aim to maximize oocyte yield to improve cumulative live birth rates (CLBR) in ART.
• The benefits of maximizing oocytes collected, especially with vitrification, outweigh the perceived advantages of mild stimulation.
• This strategy offers a more cost-effective pathway to live birth by reducing the need for repeat cycles and procedures.