Strength of stimulation and number of eggs are not equivalent

8 September 2023
By Sophie Sulehria

“Strength of stimulation and number of eggs are not equivalent” says Professor Geeta Nargund

I was interested to hear from Prof Geeta Nargund that mild or natural IVF would, in her opinion, be a viable option for women with low ovarian reserve.  Being that I have POI myself, I was always advised not to go for this option because I would produce so few eggs. Prof Nargund is indeed a pioneer in the field of Natural and Mild IVF. 

So when talking to her for the first in our series of lunchtime “Let’s all Talk Fertility” webinars this week, she was keen to explain that mild and natural IVF was a good option for anyone.   Be that normal, moderate or low egg reserve.

For context, Mild and Natural IVF differ to conventional IVF.  As the names suggest, less drugs, with the focus on the quality rather than quantity of eggs.  Mild IVF is different to Natural IVF again, with mild stimulation meaning you receive a lower dose of fertility drugs over a shorter period of time than with standard IVF. Then a natural cycle involves no fertility drugs at all. The one egg you release as part of your normal monthly cycle is taken and mixed with sperm as with conventional IVF. 

The mild and natural approach have always divided clinics, as many experts believe that conventional stimulation should remain the gold standard.  At ESHRE’s annual meeting this year, Prof Nargund debated her theory during a head-to-head debate on mild vs conventional IVF. 

Her stance being that mild stimulation is synonymous with quality – the fewer the oocytes (cells in the ovary) the better the eggs and embryos, and the chance of a live birth.

To combat this idea was Ernesto Bosh from IVIRMA Valencia.  Pro conventional stimulation, he pushed for this to remain the gold standard, arguing that research shows “the more oocytes, the more embryos, the more blastocysts” and that stimulating the ovary softly is not necessarily going to give us the best eggs. Indeed, recent data shows that the more eggs collected, the higher the live birth rate per retrieval.

Yet when it came to this webinar, Geeta remained stedfast in her view that higher stimulation does not equal more follicles. 

“When you have been told you have low reserve, high stimulation is not going to help” she said “it’s not going to make new follicles, so therefore it’s worth exploring what you can achieve with less drugs.”

In the end, the audience at ESHRE finally voted largely in favour of conventional IVF. However, for someone with such low ovarian reserve, who hasn’t responded particularly well to conventional IVF, with the regular amount of drugs, this view is interesting to me. As Geeta said, “patients with extremely low ovarian reserve can opt for Natural IVF, as the focus shifts from needing more stimulating drugs, to collecting the best of those that are remaining.” If this is another approach for people to consider, before they explore other options, then why not.

For further information about mild and natural IVF, with Prof Nargund and her team at Create Fertility, head HERE

Coming up on the 20th September at 1pm, I shall be talking with Fertility Expert Anya Sizer, about “How to choose the right clinic”.  To register for this free lunchtime event, and ask any questions you may have, head HERE.

Details of how to subscribe to the full on-demand library coming soon.

Written by Sophie Sulehria, Sept 2023.