Lower doses of IVF drugs?

There have been a number of articles about "mild" or "soft" IVF in the last few months, all suggesting that the higher doses of fertility drugs often used in the UK and USA during fertility treatment are potentially hazardous as they can lead to hyperstimulation. One recent piece described OHSS, or ovarian hyperstimulation syndrome, as a "little-known" side effect of treatment making it sound as if the condition had only just been discovered.   While it may well be little known to the journalist in question, it is hardly little known to anyone who knows much about infertility and treatment.

What's quite interesting about these articles is that they're all entirely one-sided, only quoting experts who happen to be great advocates of mild IVF and making it sound as if anyone who doesn't do this cannot possibly have their patients' best interests at heart.  Such articles would make far more credible reading if they also allowed space for those who don't use mild IVF to explain why.

While it's true that OHSS can be a very dangerous condition, it is also true that some women are at greater risk than others and that careful monitoring during treatment can reduce the chances of the condition developing.  Generally success rates are lower with mild IVF, which is why fertility specialists choose to stimulate the ovaries to produce more eggs in order to increase the chances of success.  Perhaps in the future we will be able to get excellent outcomes with far lower doses of drugs, but in the meantime it may be more prudent to continue to tailor the dose to the individual to increase the chances of success and reduce the risks.

Fresh or frozen?

An interesting new piece of research has looked at the effectiveness of freezing all the embryos created during an IVF cycle and then replacing them in a later cycle where no stimulation has been used.  It seems there are concerns that when you stimulate the ovaries, this may have an impact on how well the lining of the womb receives embryos. Not only this, but replacing frozen embryos in a later cycle also reduces the risk of hyperstimulation (OHSS).

The suggestion is that freezing embryos and transferring them later could actually increase pregnancy rates and also make IVF far safer for women by cutting the risk of hyperstimuation - although most women who get OHSS have fairly mild symptoms, it can be extremely dangerous.  Now, researchers from Spain have reviewed all the relevant studies in this area and analysed the results, coming to the conclusion that the chance of a pregnancy is as much as 30% higher if all the embryos are frozen for a later transfer rather than transferring them right away.

As is often the case with these rather interesting news stories, those responsible for the study have said that more research is needed to confirm their findings before making any changes to routine treatments for patients - but it will be reassuring for anyone who is having frozen embryos transferred. We often assume that this reduces the chances of success, but the evidence seems to suggest it could be quite the opposite.

IVM - is it for you ?

Anyone with an interest in fertility is likely to have heard the recent news about the first babies born in the UK after a new type of treatment called in vitro maturation, or IVM. The glowing newspaper reports on the subject suggested IVM was about to revolutionise fertility treatment. Cheaper than IVF, less invasive and less risky, it sounded the perfect solution and patients could be forgiven for rushing off to their clinics to demand it immediately. The reality is that IVM is not yet widely available, and is not suitable for everyone anyway.

IVM doesn't use drugs to get women to produce lots of eggs. Instead, it involves taking immature eggs straight from the ovaries, maturing them in the laboratory, and then injecting them with sperm. The technique relies on women having lots of immature eggs, and success rates are low for anyone with normal ovaries who is unlikely to have sufficient quantities to make it worthwhile. IVM is most suitable for younger women with polycystic ovaries because they tend to have an abundance of immature eggs, but even then, success rates are not particularly high at between 20 and 30%.

IVM is a relatively new technique, which has only produced 400 babies worldwide so far, and at the moment only one clinic in the UK is licensed to carry it out. It is cheaper than IVF because you're not using any drugs to stimulate the ovaries, so you save on the hefty drugs bill. It also cuts out the risk of hyperstimulation, which is a particular danger for women who have polycystic ovaries when they take the stimulating drugs.

IVM is undoubtedly an exciting step forward in reproductive medicine, but the revolution the news reports may have led us to expect is still some time away.