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Hum. Reprod. Advance Access originally published online on May 14, 2008
Human Reproduction 2008 23(8):1808-1814; doi:10.1093/humrep/den155
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Cumulative pregnancy rates after sequential treatment with modified natural cycle IVF followed by IVF with controlled ovarian stimulation

M.J. Pelinck1,3, H.M. Knol1, N.E.A. Vogel1, E.G.J.M. Arts1, A.H.M. Simons1, M.J. Heineman1,2 and A. Hoek1

1 Section of Reproductive Medicine, Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands 2 Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands

3 Correspondence address. E-mail: pelinck{at}hotmail.com

BACKGROUND: In modified natural cycle IVF (MNC-IVF), treatment is aimed at using the one follicle that spontaneously develops to dominance, using a GnRH-antagonist together with gonadotrophins in the late follicular phase only. The MNC-IVF is of interest because of its low-risk and patient-friendly profile. The effect of application of MNC-IVF preceding standard IVF with ovarian stimulation on overall results is unknown.

METHODS: This single-center cohort study provides follow-up of an earlier study in which nine cycles of MNC-IVF were offered to 268 patients. Ongoing pregnancy rates and live birth rates, as well as time-to-pregnancy after controlled ovarian stimulation-IVF (COS-IVF) following MNC-IVF, were evaluated.

RESULTS: Actual observed cumulative ongoing pregnancy rates and live birth rates after sequential treatment with MNC-IVF followed by COS-IVF were 51.5 (95% CI: 45.4–57.6) and 50.0% (95% CI: 43.9–56.1) per patient, of which 8.0 and 6.7% were twins. Median time to ongoing pregnancy was 28.8 weeks. Including treatment-independent pregnancies, cumulative ongoing pregnancy rate was 56.7% (95% CI: 50.7–62.8).

CONCLUSIONS: Sequential treatment with MNC-IVF followed by COS-IVF does not appear to compromise overall success rates, while twin pregnancy rate is low. Because of its patient-friendly and low-risk profile, it seems appropriate to perform MNC-IVF preceding COS-IVF.

Key words: natural cycle/assisted reproduction/ovarian stimulation/cumulative pregnancy rate/BESST

Submitted on November 22, 2007; resubmitted on February 9, 2008; accepted on March 14, 2008.


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