# In Vitro Fertilization in Africa: Mild Versus Conventional Antagonist Ovarian Stimulation Protocols in Expected Normal Responders Undergoing IVF/ICSI: A Cohort Study From Ethiopia

## TL;DR

A study in Ethiopia compared mild and conventional IVF protocols and found mild stimulation had higher biochemical pregnancy rates with fewer complications.

## Contribution

The study evaluates mild versus conventional GnRH antagonist protocols in IVF for normal responders in an African context.

## Key findings

- Mild stimulation IVF had a higher biochemical pregnancy rate (35.3%) compared to conventional (28.6%).
- Mild stimulation required a lower total dose of gonadotrophin (1274 vs. 2776 units).
- No significant difference in clinical pregnancy rates or OHSS between the two protocols.

## Abstract

Though infertility remains a global public health problem, it stands as a unique challenge in Sub‐Saharan Africa, with either no or limited in vitro fertilization (IVF) service in most countries located in it. This study aimed to compare the efficacy of mild stimulation with conventional GnRH antagonist ovarian stimulation in patients with expected normal responders at a public IVF center in Ethiopia.

A retrospective cohort study was conducted at Center for Fertility and Reproductive Medicine in Ethiopia. The primary outcomes were biochemical pregnancy rate, clinical pregnancy rate, and mature (M2) oocyte retrieval rate. Data were collected retrospectively by reviewing medical records of patients. SPSS version 26 was used to analyze the data. Mann–Whitney U test and chi‐squared/exact were performed as appropriate. p value less than 0.05 was used to present the results significance.

Five hundred infertile women (age ≤39) undergoing their first IVF cycle. A total of 150 women exposed to mild stimulation group and 350 women exposed to conventional or antagonist IVF‐group). The biochemical pregnancy was higher in MS‐IVF, which is 35.3% and 28.6% in conventional (antagonist) IVF group, p value = 0.04. Clinical pregnancy rate (35.4% in the MS‐IVF vs. 25.8% in the antagonist arm, p value = 0.2) and early abortion (8.8% in the MS‐IVF group vs. 3.7% in the antagonist group, p value = 0.3) were not statistically different between the groups. There was no difference in the rate of ovarian hyperstimulation syndrome (OHSS) between the groups. The total dose of gonadotrophin used for stimulation was lower in MS group (1274 ± 546 in MS group vs. 2776 ± 719 in the antagonist group, p < 0.001).

Compared to conventional antagonist IVF, MS‐IVF has a higher biochemical pregnancy and lower risk of multiple pregnancy with comparative rates of clinical pregnancy, OHSS, and mature oocyte (M2).

A cohort study was conducted on IVF outcomes using different IVF protocols: 150 women exposed to mild stimulation (MS) IVF protocol were compared to matching 350 women exposed to conventional or antagonist IVF protocol. We found MS‐IVF has higher biochemical pregnancy and lower risk of complications compared to conventional IVF.