Strategies for Risk Reduction and Improving Success in Women with Medical Comorbidities

Women with medical comorbidities embarking on IVF are at increased risk of complications and efforts must be made to ensure that these are kept to a minimum. Essentially this involves manipulating the IVF cycle in such a way so as to reduce the risk of ovarian hyperstimulation syndrome and multiple pregnancy. The safest way of conducting an IVF cycle in women with medical comorbidities therefore is to utilize an antagonist stimulation protocol with a relatively low dose of FSH, use a GnRH agonist trigger, cryopreserve all embryos and then electively transfer a single embryo as part of a frozen embryo replacement cycle. Although this segmented approach may detract from the overall success rates, compromising any element of this strategy will incorporate an unacceptable and unnecessary risk to women with medical comorbidities.