Less Aggressive IVF Treats Infertility
Live Birth Rate Similar Over Time With 1 Embryo Transfer, With Fewer Multiple Births
March 1, 2007 -- A less aggressive approach to in vitro fertilization is
easier on the patient, carries far less risk of multiple births, and is
virtually as effective over time as the approach favored in the U.S., a study
from Holland reports.
In the study, 92 of the 205 women undergoing a so-called "mild IVF"
gave birth; vs. 102 of the 199 women who had more aggressive IVF treatment.
The women who had what researchers termed “mild IVF” were treated with lower
doses of hormones than women who had aggressive ovarian stimulation, using high
doses of hormones. They also had one embryo transferred per IVF cycle instead
Over the course of a year, the two approaches resulted in a strikingly
similar number of pregnancies leading to live births.
The women who had the less aggressive treatment did end up undergoing more
IVF cycles during the year-long trial -- an average of three attempts instead
of two, according to the researchers.
But they did not report more discomfort or anxiety as a result of the extra
And less than 1% had multiple births, compared to 13% of the women in the
traditional treatment group.
“We showed that outcomes can be the same with this more gentle approach,
where not so much is riding on a single treatment cycle,” study researcher Nick
S. Macklon, MD, PhD, tells WebMD. “The all-or-nothing approach is more
stressful for the patient and it results in more multiple births.”
The Dutch study included 199 women treated with standard IVF, which included
aggressive ovarian stimulation and two embryo transfers per cycle.
Another 205 women got the less aggressive IVF, which included mild ovarian
stimulation with lower hormone doses and a single embryo transfer per
A year after entering the trial, conducted by Macklon, Bart Fauser, MD, and
colleagues from Holland’s University Medical Centre, Utrecht, a total 444 IVF
cycles had been performed in the mild IVF group, compared to 325 cycles in the
aggressive treatment group.
A total of 43.4% of the pregnancies that resulted from the less aggressive
treatment led to live births, compared to 44.7% of pregnancies resulting from
Only one multiple birth occurred among the 92 women who delivered after
getting the milder version of IVF, compared to 26 multiple births among 102
women who gave birth after traditional IVF.
The findings about the per cycle success rate with single-embryo, less
aggressive treatment has been reported in previous studies.
But the researchers argue that the similar success rate over time, coupled
with a dramatically reduced risk of multiple births, and lower overall costs
due to fewer multiple pregnancies, makes the less aggressive approach the
better option for infertile women with a good chance of achieving a live birth
The study is reported in the March 3 issue of the The Lancet.
“Our findings should encourage more widespread use of mild ovarian
stimulation and single embryo transfer in clinical practice,” the researchers
“However, adoption of our mild IVF treatment strategy would need to be
supported by counseling of both patients and health care providers to redefine
IVF success and explain the risks associated with multiple pregnancies, and by
[supporting payment plans] that encourage, rather than penalize, the practice
of single embryo transfer,” the researchers say.