Historically, the sole desired outcome of IVF is that of a pregnancy. The worlds first successful IVF pregnancy was Louise Brown who was born in 1978. Over the last 34 years IVF has changed immeasurably, not only in becoming significantly more successful, but also that the desired outcome is now not just a pregnancy, but that of a healthy pregnancy both for mother and baby. Unusually in medicine, most patients requiring IVF are otherwise healthy, and therefore the notion of primum non nocere or first do no harm, is even more important than with most patients who are by definition unwell. A lot of the advances endocrinologically over the last ten years have been to try and make the cycle safer for the female patient by trying to individualise the dose of FSH used, to ensure the safest protocols for IVF are used and that the resultant baby has the healthiest and best possible start in life. More accurate methods of assessing ovarian reserve such as antral follicle count and AMH levels now allow us to individualise, more accurately, stimulation regimes. This has allowed us to reduce the proportion of patients who are under stimulated and also over stimulated. This not only improves pregnancy outcomes, but also safety. We know one of the biggest risks of IVF is ovarian hyperstimulation syndrome, and it has been well recognised that certain groups of patients, such as those suffering from PCOS, are at higher risk of developing this life threatening complication. By not only individualising the dose, but optimising the protocol and using more antagonist protocols, then the risk of severe OHHS can be significantly reduced. Concurrent use of medication such as metformin can also reduce the ovarian hyperstimulation rates.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.