title: Minimal stimulation IVF vs conventional IVF: a randomized controlled trial.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Reproductive Endocrinology and Infertility, New Hope Fertility Center, New York, NY. Electronic address: johnzhang98@yahoo.com.
authors.forename: John J
authors.initials: JJ
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Biology, New York University School of Medicine, New York, NY.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Merhi
authors.affiliation: Department of Reproductive Endocrinology and Infertility, New Hope Fertility Center, New York, NY.
authors.forename: Mingxue
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Reproductive Endocrinology and Infertility, New Hope Fertility Center, New York, NY.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bodri
authors.affiliation: Department of Reproductive Endocrinology and Infertility, New Hope Fertility Center, New York, NY.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Chavez-Badiola
authors.affiliation: Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Repping
authors.affiliation: Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Madelon
authors.initials: M
authors.lastname: van Wely
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000379:methods*; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D007248:Infertility, Male / Q000628:therapy*; D050498:Live Birth; D008297:Male; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology; D011247:Pregnancy; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple; D056826:Single Embryo Transfer
chemical_list: D006062:Gonadotropins
keywords: IVF; OHSS; clomiphene citrate; mini-IVF; multiple pregnancy