Clinical and economical effectiveness of mild ovarian stimulation using clomiphene citrate and mid-follicular gonadotropin for ART

Abstract

The conventional ovarian stimulation is expensive, and associated with significant morbidity and stress. Interest and demand for patient-friendly stimulation protocols is increasing. Effectiveness of mild ovarian stimulation was studied. Retrospective analysis of ART clinical data at a single institution. Clinical and laboratory data of 41 conventional GnRH antagonist cycles (c-ANT) commencing gonadotropin at early follicular phase before 2011 and 63 mild-stimulation GnRH antagonist cycles (m-ANT) combining early follicular clomiphene citrate and mid follicular gonadotropin after 2011 were analyzed. GnRH antagonist was flexibly used in both groups. The patients were under 40 years old in either group. The clinical and laboratory outcomes were summarized in the table.Tabled 1Conventional versus mild ovarian stimulationProtocolFemale ageAMH (pMol)Total gonadotropin dose (unit)**Retrieved eggs**Cleaving embryos**G1-2 embryos*G1-2/cleaving ratio (%)*c-ANT (n=41)36.2±3.221.7±16.31161±5067.3±5.24.5±2.92.1±1.945.7±33.5m-ANT (n=63)35.7±3.420.5±17.4501±1973.5±2.52.1±1.51.3±1.263.2±39.1±:S.D., *:p<0.05, **:p<0.005. Open table in a new tab Comparing c-ANT and m-ANT group, number of transferred embryos(average 1.2 vs. 1.0) was similar and linical pregnancy rate (18.8 vs. 29.2%), embryo implantation rate (17.9 vs. 29.2%) showed higher trend in m-ANT group. Clinical pregnancy per retrieval was not statistically different (39.0 vs. 44.4%, p=0.64). No significant morbidity was reported in the both groups. ±:S.D., *:p<0.05, **:p<0.005. Compared to conventional antagonist protocol, our mild protocol reduced cost of ovarian stimulation and did not compromised clinical outcomes of ART. Mild stimulation yielded significantly higher fraction of good quality embryos. This approach can be the first choice of ovarian stimulation for patients with good ovarian reserve.