Minimal stimulation IVF vs conventional IVF: a randomized controlled trial

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• 作者：John J. Zhang ; MD ; PhD^a ; ^{johnzhang98@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Zaher Merhi ; MD^b ; Mingxue Yang ; MD ; PhD^a ; Daniel Bodri ; MD ; PhD^a ; Alejandro Chavez-Badiola ; MD^a ; Sjoerd Repping ; PhD^c ; Madelon van Wely ; PhD^c
• 关键词：IVF ; mini-IVF ; clomiphene citrate ; OHSS ; multiple pregnancy
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：214
• 期：1
• 页码：96.e1-96.e8
• 全文大小：920 K

文摘

Minimal stimulation in vitro fertilization (mini–in vitro fertilization) is an alternative in vitro fertilization treatment protocol that may reduce ovarian hyperstimulation syndrome, multiple pregnancy rates, and cost while retaining high live birth rates.

Objective

We performed a randomized noninferiority controlled trial with a prespecified border of 10% that compared 1 cycle of mini–in vitro fertilization with single embryo transfer with 1 cycle of conventional in vitro fertilization with double embryo transfer.

Study Design

Five hundred sixty-four infertile women (<39 years old) who were undergoing their first in vitro fertilization cycle were allocated randomly to either mini–in vitro fertilization or conventional in vitro fertilization. The primary outcome was cumulative live birth rate per woman over a 6-month period. Secondary outcomes included ovarian hyperstimulation syndrome, multiple pregnancy rates, and gonadotropin use. The primary outcome was cumulative live birth per randomized woman within a time horizon of 6 months.

Results

Five hundred sixty-four couples were assigned randomly between February 2009 and August 2013 with 285 couples allocated to mini–in vitro fertilization and 279 couples allocated to conventional in vitro fertilization. The cumulative live birth rate was 49% (140/285) for mini–in vitro fertilization and 63% (176/279) for conventional in vitro fertilization (relative risk, 0.76; 95% confidence interval, 0.64-0.89). There were no cases of ovarian hyperstimulation syndrome after mini–in vitro fertilization compared with 16 moderate/severe ovarian hyperstimulation syndrome cases (5.7%) after conventional in vitro fertilization. The multiple pregnancy rates were 6.4% in mini–in vitro fertilization compared with 32% in conventional in vitro fertilization (relative risk, 0.25; 95% confidence interval, 0.14-0.46). Gonadotropin consumption was significantly lower with mini–in vitro fertilization compared with conventional in vitro fertilization (459 ± 131 vs 2079 ± 389 IU; P < .0001).

Conclusion

Compared with conventional in vitro fertilization with double embryo transfer, mini–in vitro fertilization with single embryo transfer lowers live birth rates, completely eliminates ovarian hyperstimulation syndrome, reduces multiple pregnancy rates, and reduces gonadotropin consumption.