title: Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization.
abstract: In the last decades, several steps have been made aiming at rendering human IVF more successful on one side, more tolerable on the other side. The "mild" ovarian stimulation approach, in which a lower-than-average dose of exogenous gonadotropins is given and gonadotropin treatment is started from day 2 to 7 of the cycle, represents a significant step toward a more patient's friendly IVF. However, a clear view of its virtues and defects is still lacking, because only a few prospective randomized trials comparing "mild" vs. conventional stimulation exist, and they do not consider some important aspects, such as, e.g., thawing cycles. This review gives a complete panorama of the "mild" stimulation philosophy, showing its advantages vs. conventional ovarian stimulation, but also discussing its disadvantages. Both patients with a normal ovarian responsiveness to exogenous gonadotropins and women with a poor ovarian reserve are considered. Overall, we conclude that the level of evidence supporting the use of "mild" stimulation protocols is still rather poor, and further, properly powered prospective studies about "mild" treatment regimens are required.
authors.affiliation: Reproductive Medicine and IVF Unit, Department of Obstetrical and Gynecological Sciences, University of Torino, via Ventimiglia 3, 10126 Torino, Italy. fertisave@yahoo.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Revelli
authors.forename: Simona
authors.initials: S
authors.lastname: Casano
authors.forename: Francesca
authors.initials: F
authors.lastname: Salvagno
authors.forename: Luisa
authors.initials: L
authors.lastname: Delle Piane
mesh_terms: D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D005498:Follicular Phase / Q000187:drug effects; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000819:agonists / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors; D006801:Humans; D006080:Ovarian Follicle / Q000187:drug effects; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D017329:Triptorelin Pamoate / Q000008:administration & dosage
chemical_list: D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone; C062876:cetrorelix