Less may be more when it comes to infertility

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A less aggressive approach may make more sense when it comes to treating infertility. A recent randomized trial finds that mild ovarian stimulation with a single embryo transferred results in much the same number of live births as standard stimulation with two embryos transferred, but with a substantially reduced risk of multiple pregnancy, substantially less overall cost, and no difference in patient anxiety or discomfort.

Researchers from the Netherlands compared mild ovarian stimulation with gonadotropin-releasing hormone (GnRH) antagonist and single embryo transfer with stimu-lation with a GnRH agonist long-protocol and transfer of two embryos in women younger than 38 years of age.

After 1 year, they found that the proportion of cumulative pregnancies that resulted in term live births was 43.4% in the mild treatment group versus 44.7% in the standard treatment group. The small difference in success rates was accompanied by large differences in the proportion of multiple pregnancies (0.5% in the mild group vs. 13.1% in the standard group) and in mean total costs, which were about 22% higher for the standard group than for the mild group.

Heijnen EM, Eijkemans MJ, Deklerk C, et al. A mild treatment strategy for in-vitro fertilisation: a randomised non-inferiority trial. Lancet. 2007;369:743-749.

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raanan meyer, md
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