Controlled ovarian stimulation is a technique that uses ovulation-promoting drugs and adjuvant medications to control folliculogenesis and development with the goal of obtaining the desired number and quality of eggs, and is irreplaceable for assisted reproductive technology in the treatment of infertility. The most commonly used conventional ovarian stimulation regimen is the gonadotropin-releasing hormone agonist (GnRHa) long regimen. However, in its clinical application a decrease in egg embryo quality and altered endometrial tolerance can be observed, and the increased gonadotropin dosage (Gn) alters the hormonal environment in the body, increasing the incidence of complications such as ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies, which in turn affects patient compliance. Therefore, the choice of a safe, cost-effective and efficient ovarian stimulation protocol has become a primary issue in the application of clinical assisted reproductive technology. The term “microstimulation” refers to the relatively weak stimulation of the ovaries, as opposed to the conventional treatment protocols in IVF, in which the patient uses only a small amount of medication to reduce exogenous interference with follicular development, so that the few eggs obtained may be of better quality due to their “natural selection” during follicular development. “The few eggs that are obtained may be of better quality than those collected by traditional “hyperovulation” by reducing the interference with follicular development. Below we compare the advantages and disadvantages of the microstimulation protocol with the conventional long protocol. First, the microstimulation protocol has a higher safety profile than the conventional long protocol. 1) Embryonic: The embryo haplointegration rate is significantly higher with the microstimulation protocol than with the conventional long protocol. 2) Offspring: The estradiol (E2) levels are significantly lower in microstimulation patients than in long protocol patients, and the high E2 is thought to be associated with an increased incidence of low birth weight and small for gestational age infants. 3) Maternal. The incidence of OHSS was significantly lower in the microstimulation regimen, which is often difficult to accept as a medical condition that is “acquired” for couples seeking care for fertility purposes. On the other hand, severe OHSS leads to a low but serious incidence of near-term complications such as thrombosis, multiple organ damage, ovarian cyst torsion and even death, and an increased incidence of long-term complications such as gestational diabetes, placental abruption and low birth weight babies. Secondly, compared with the traditional long protocol for young patients with normal ovarian function, the microstimulation protocol has its own specific target groups: patients with low ovarian response, patients with ovarian overreaction such as polycystic ovary syndrome, patients with low ovarian reserve function, and patients with estrogen-dependent diseases. Moreover, according to statistics, the cumulative pregnancy rate of single embryo transfer with microstimulation protocol is similar to that of 2 embryo transfer with conventional protocol. That is, for some infertile patients, the effectiveness of the microstimulation regimen may be higher. Finally, patients’ compliance with the microstimulation protocol is better: 1) the egg retrieval procedure is simpler and less painful; 2) fewer medications are used and patients spend much less on medications, with a total cost of about $10,000 per treatment cycle, making a single cycle more cost-effective; 3) the frequency of blood draws, ultrasound follicle monitoring, and medication injections is reduced, and the number of patient visits is reduced, thus reducing patients’ stress The treatment is beneficial to pregnancy outcome and reduces the incidence of postpartum depression. In summary, the physician’s choice of treatment plan is a “tailor-made” one, based on age, ovarian function, and previous response to ovulation medications to select the most appropriate, successful, and safe plan for each patient. Treatment must be individualized. Microstimulation is a direction and trend in ovulation promotion, and its rational clinical application will definitely lead to more patients’ success.
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