In Vitro Fertilization in Africa: Mild Versus Conventional Antagonist Ovarian Stimulation Protocols in Expected...

Though infertility remains a global public health problem, it stands as a unique challenge in Sub-Saharan Africa, with either no or limited in vitro fertilization (IVF) service in most countries located in it. This study aimed to compare the efficacy of mild stimulation with conventional GnRH antagonist ovarian stimulation in patients with expected normal responders at a public IVF center in Ethiopia.

A retrospective cohort study was conducted at Center for Fertility and Reproductive Medicine in Ethiopia. The primary outcomes were biochemical pregnancy rate, clinical pregnancy rate, and mature (M2) oocyte retrieval rate. Data were collected retrospectively by reviewing medical records of patients. SPSS version 26 was used to analyze the data. Mann-Whitney U test and chi-squared/exact were performed as appropriate. p value less than 0.05 was used to present the results significance.

Five hundred infertile women (age ≤39) undergoing their first IVF cycle. A total of 150 women exposed to mild stimulation group and 350 women exposed to conventional or antagonist IVF-group). The biochemical pregnancy was higher in MS-IVF, which is 35.3% and 28.6% in conventional (antagonist) IVF group, p value = 0.04. Clinical pregnancy rate (35.4% in the MS-IVF vs. 25.8% in the antagonist arm, p value = 0.2) and early abortion (8.8% in the MS-IVF group vs. 3.7% in the antagonist group, p value = 0.3) were not statistically different between the groups. There was no difference in the rate of ovarian hyperstimulation syndrome (OHSS) between the groups. The total dose of gonadotrophin used for stimulation was lower in MS group (1274 ± 546 in MS group vs. 2776 ± 719 in the antagonist group, p < 0.001).

Compared to conventional antagonist IVF, MS-IVF has a higher biochemical pregnancy and lower risk of multiple pregnancy with comparative rates of clinical pregnancy, OHSS, and mature oocyte (M2).