#114 : Is Mild Stimulation IVF Better for Women with Previous Poor Outcome Following Conventional High-Dose Stimulation?

Abstract

Background and Aims: With the aim of yielding higher number of oocytes, high gonadotrophin doses are often used in ovarian stimulation protocols which may have a detrimental impact on oocyte and subsequently embryo quality. Alternatively, mild stimulation (MS) protocols mimic physiological folliculogenesis with a low dosage of gonadotropins and aims to produce better-quality oocytes with a reduced aneuploidy rate. This study investigates the clinical outcome of patients who had multiple attempts of IVF cycles with both MS and high-dose conventional stimulation (HS) protocol. Method: A retrospective analysis was carried out on 26 patients who had a total of 108 IVF cycles from 2017-2022. The MS protocol involves administration of Letrozole/Clomiphene from Day 2 for 5 days followed by highly purified menotrophin (150-225IU) on alternate days starting after Day 3 whereas in HS protocol, [Formula: see text]300IU of daily dose of gonadotrophins were given. ICSI was performed for all mature oocytes and the resulting embryos were cultured to blastocyst stage for preimplantation genetic testing for aneuploidy (PGT-A). Clinical outcomes such as the rate of fertilisation, degeneration, blastocyst utilisation, aneuploidy, clinical pregnancy, and live birth were analysed with Chi-square and Fisher’s exact test. Results: The fertilisation rate (p=0.00140) and blastocyst utilisation rate (p=0.00966) are significantly higher with MS compared to the HS protocol. The degeneration rate did not differ among the treatments (p=0.50248). The pregnancy and live birth rates are higher following MS compared to HS but this is not statistically significant due to low number of patients. Aneuploidy rate is shown to be significantly higher in HS compared to MS (p=0.00975). On average, 3 cycles of MS are required to produce a live birth. Conclusion: Patients with poor outcome to conventional hyperstimulation cycles may benefit from MS protocols. MS is cost-effective with lower treatment burden and has been shown in this small study to produce better clinical outcomes.