Less Aggressive IVF Treats Infertility

Live Birth Rate Similar Over Time With 1 Embryo Transfer, With Fewer Multiple Births

Medically Reviewed by Louise Chang, MD on March 01, 2007
From the WebMD Archives

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 of two.

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 procedures.

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.”

IVF Lite

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 cycle.

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 traditional IVF.

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 with treatment.

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 write.

“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.

Patient Resistance

In the U.S., only a handful of states mandate coverage for infertility treatment, meaning the vast majority of infertile couples pay for such treatments out-of-pocket.

Because per cycle costs are so steep, infertile couples seeking treatment have traditionally been willing to accept the risk of multiple births in order to maximize their chances of success in one try.

The American Society for Reproductive Medicine (ASRM) recommends that no more than two embryos be transferred per cycle in women who are 37 or younger with a good chance of achieving success with IVF.

ASRM president Steven Ory, MD, tells WebMD that single-embryo transfers are increasingly being performed, but there is still far to go.

Ory says whether patients are footing the bill or not, they tend to believe that their chance of success is strongly tied to the number of embryos transferred.

“The biggest complication of IVF is the high multiple pregnancy rate, and we are working very, very hard to get that down,” he says. “We regard single-embryo transfer as the ideal for women with a good chance of achieving a pregnancy.”

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SOURCES: Heijnen, E. The Lancet, March 3, 2007; vol 369: pp 743-749. Nick Macklon, MD, PhD, University Medical Centre, Utrecht, the Netherlands. Steven Ory, MD, president, American Society for Reproductive Medicine.

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