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Conventional ovarian stimulation protocols intend to yield as many oocytes and embryos as possible to try to maximize the success of an in vitro fertilization (IVF) program. In reality, however, a series of studies over the last few years observed that live birth rates (LBRs) do not increase after a certain number of retrieved oocytes [1–3]; some studies even found a decline in LBRs when the number of oocytes was in excess of 18  or blastocyst numbers above 5 . Although the cumulative LBR keeps rising over and above the number of oocytes/embryos that maximizes per cycle live birth, the incidence of ovarian hyperstimulation syndrome (OHSS) and venous thromboembolism (VTE) also escalate in a parallel fashion [2;3;6]. A recent study, by restricting the stimulation dose to 150 IU/day, found only nine oocytes or four embryos optimizing the fresh cycle LBR .
This chapter explores the concerns with conventional ovarian stimulation regimens, which have provoked a need to develop alternative strategies. Natural and modified natural cycles for in vitro fertilization (IVF) are briefly discussed. Elective single embryo transfer correlates well with the NHS funding policy. However, as long as couples pay for IVF treatments themselves, many of them will opt for double embryo transfer because it can result in a higher chance of success in older women. Clomiphene citrate (CC) acts antagonistically on the estradiol receptor at the hypothalamic level, inhibiting negative as well as positive feedback, and resulting in ovarian stimulation and suppression of the luteinizing hormone (LH) surge. To improve effectiveness, natural cycle IVF could be offered as a series of treatment cycles, since it is safer and less stressful compared with conventional stimulation. Mild ovarian stimulation aims at reducing the psychological burden of IVF treatment.
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