Mild Ovarian Stimulation for in vitro Fertilization: Are We Ready to Change? A Meta-Analysis

Objective: To compare the efficacy of mild ovarian stimulation versus conventional stimulation in in vitro fertilization (IVF). Design: Meta-analysis. Search Strategy:A systemic literature search was carried out for prospective randomised clinical trials. We electronically searched using PubMed, Medline and Embase for all the studies published from 1990 to December 2011. Interventions: Mild ovarian stimulation IVF that uses lower doses and/or shorter duration of gonadotrophins in GnRH antagonist co-treated cycle compared with conventional stimulation IVF. Main Outcome Measures: Live birth rates per started cycle and ongoing pregnancy rates per started cycle of IVF. Results: On live birth rate, there was a significant difference in favour of the conventional stimulation [70/444(15.7%) mild vs. 78/325 (24%) conventional] (OR 0.59, Cl 0.41-0.85, p = 0.004). Similar findings were observed in the ongoing pregnancy data [140/696 (20%) mild vs. 144/547(26%) in favour of conventional stimulation] (OR 0.72, Cl 0.55-0.93, p = 0.01). The sub-analysis of two studies showed a statistically significant reduction of hyperstimulation syndrome in favour of the mild stimulation (OR 0.27, Cl 0.11-0.66). Conclusion: This analysis presents strong evidence in favour of conventional stimulation IVF, which therefore should currently be considered a treatment of choice for patients requiring IVF treatment. (C) 2013 S. Karger AG, Basel