Current status of subfertility care: time to rationalize treatment options.

Assisted conception treatment has been widely available throughout the world for more than two decades, but the success rate of this technology in terms of rates of live births per cycle is still low. Conventional in-vitro fertilization (IVF) usually involves the use of ovarian stimulation. Stimulated IVF is currently popular because initial studies showed that this treatment resulted in improved success rates. It is perhaps only during the past few years that the negative aspects of stimulated IVF have been recognized. The effect of ovarian stimulation on short-term (ovarian hyperstimulation syndrome) [1] and long-term (cancer risk) [2] health of women, on chromosomal abnormalities in oocytes and embryos [3,4], and on endometrial status [5] have been recognized. IVF with ovarian stimulation is also associated with increased incidence of multiple pregnancy and premature birth [6], which has ®nancial repercussions. It is time to reconsider the need for extensive ovarian stimulation in IVF cycles. In view of the long-term effects of ovarian stimulation on the health of women, research and clinical practice should surely be directed towards using less ovarian stimulation or even none at all.