Mild ovarian stimulation

These protocols are more patient-friendly, with shorter duration, lower cost and fewer complications. Recent studies have indicated that these protocols are associated with better egg quality, embryos and endometrium, while pregnancy rates seem to be similar to those of traditional protocols.

The protocols used in ART are usually longer and are characterized by a higher cost, higher doses of administered gonadotropins and in some cases, increased chance for the development of complications, such as the Polycystic ovarian Hyperstimulation Syndrome.

Mild stimulation protocols are mainly combined with the use of GnRH antagonist, while the limited evidence that exists regarding the use of the GnRH agonist, haven’t demonstrated its effectiveness in mild stimulation.

According to the revised terminology of the International Society for Mild Approaches in Assisted Reproduction (ISMAAR), mild stimulation protocols include a) the natural cycle, b) the modified natural cycle and c) mild protocols.

Natural Cycle

Fertility treatment occurs during a natural menstrual cycle, without the administration of drugs.

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Modified Natural cycle

Towards the end of the modified natural cycle (MNC) we administer the antagonist and a minimum dose of gonadotropins. We thus avoid oocyte loss, in case of premature ovulation.

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Mild protocols

Mild ovarian stimulation involves the administration of a low dose of the gonadotrophin FSH (up to 150 IU/day) for a shorter duration, aiming at the development of fewer follicles and the collection of up to 7 oocytes. Mild stimulation protocols mainly use GnRH antagonists, hCG administration for final oocyte maturation, as well as exogenous progesterone and estradiol administration for corpus luteum support.

However, the use of mild stimulation protocols remains limited, mainly because they require a sound knowledge of the GnRH antagonist protocol and optimal laboratory conditions. In addition, the lower number of oocytes collected and thus lower number of embryos generated, create concerns for more frequent cycle cancellations.

At Eugonia we successfully use mild protocols for ovarian stimulation with specific criteria, taking into account the history and needs of each individual couple.