Reluctance of medical professionals in adopting natural-cycle and minimal ovarian stimulation protocols in human clinical assisted reproduction

Abstract

Recent clinical evidence would suggest that natural cycle and minimal ovarian stimulation protocols in clinical assisted reproduction could be advantageous for younger women with indications for either male-partner or mild female-factor sub-fertility. The benefits include reduced medical fees associated with lower or nil dosages of recombinant gonadotrophins, a shorter treatment cycle and reduced risk of ovarian hyperstimulation syndrome. Additionally, there is also evidence to suggest improved quality of retrieved oocytes and better endometrial receptivity. Nevertheless, fertility clinics and doctors have conflicting interests that make them reluctant to incorporate natural-cycle and minimal stimulation protocols in their treatment programme. Firstly, the use of low or nil dosages of recombinant gonadotrophins would drastically cut profits from drug prescription sales to patients. Secondly, fertility clinics are also concerned by the apparent reduction in success rates for natural-cycle and minimal ovarian stimulation protocols. Moreover, refunding of medical bills by health insurance is usually based on a limited number of attempts, thereby hampering the introduction of natural-cycle and minimal stimulation protocols, which have lower efficacy on a per cycle basis. Lastly, the adoption of natural-cycle and minimal stimulation protocols would drastically reduce the numbers of surplus oocytes and embryos available for donation to other patients.