title: Can we modify assisted reproductive technology practice to broaden reproductive care access?
abstract: One of the barriers to access to fertility care is the relative complexity of fertility treatments. If these can be simplified, more patients may be able to take advantage of these treatments. In this overview, we review the potential benefits of simplifying ovarian stimulation by the means of four distinct methods: 1) using mild stimulation for IVF cycles; 2) using in vitro maturation to allow for the retrieval of oocytes that are not yet fully mature yet have the potential to result in live births; 3) conducting IVF in modified natural cycles which use no exogenous FSH stimulation; and 4) allowing embryo culture to take place in a novel intravaginal incubation system. These methods are considered to be somewhat unconventional, yet they have all been shown to lead to live births. In the era of individualized patient care, these techniques present viable alternatives to standard treatment. As experience and outcome data accumulate, they may prove to be not just alternatives to standard treatment, but potentially first-line treatment choices.
authors.affiliation: USC Fertility, University of Southern California, Los Angeles, California. Electronic address: rpaulson@usc.edu.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Paulson
authors.affiliation: Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Bart C J M
authors.initials: BCJM
authors.lastname: Fauser
authors.affiliation: Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
authors.forename: Lan T N
authors.initials: LTN
authors.lastname: Vuong
authors.affiliation: Center for Assisted Reproduction, Bedford, Texas.
authors.forename: Kevin
authors.initials: K
authors.lastname: Doody
mesh_terms: D005260:Female; D006297:Health Services Accessibility / Q000639:trends; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology / Q000628:therapy*; D050498:Live Birth / Q000453:epidemiology; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000639:trends
keywords: ART; IVM; Mild stimulation; intravaginal culture; natural cycle IVF