Minimal stimulation IVF, referred to often as, “Mini IVF”, “Soft IVF”, or “Micro IVF,” is a relatively new Advanced Reproductive Technology (ART) technique in the United States that offers a gentler version of ovarian stimulation compared to traditional In Vitro Fertilization. It has been used successfully in Japan for some time with good success. In Minimal IVF a woman uses less medication during the course of her IVF cycle. These drugs can be oral ovulation agents such as Clomid, and may be combined with low doses of gonadotropins.
Once matured, the eggs are retrieved from the ovary in a minor out-patient surgical procedure typically without the use of intravenous sedation. The eggs are then fertilized in the IVF laboratory and the embryos are transferred back into the woman’s uterus. The laboratory process is very similar to traditional IVF. However, unlike traditional IVF which can produce multiple eggs (typically > 8), Minimal IVF usually results in the production of only a few eggs and only a few embryos (1-6) that will hopefully be of high quality. This means that few patients doing a Minimal IVF cycle will have embryos available for freezing for a second cycle.
Minimal IVF can address two major concerns for both patients and doctors: cost and overstimulation. Recent trends in the fertility field prefer an ovulation induction protocol that uses fewer medications and produces fewer, but hopefully better quality, embryos than an ovulation induction that uses significantly higher doses of medications. In other words, Minimal IVF is a useful method that can help women get pregnant with fewer medication-associated risks at a lower cost.
Minimal IVF can be an excellent ART procedure to bridge the gap between Natural Cycle IVF and traditional IVF. In a Natural IVF cycle no ovarian stimulation is performed (no medications are taken), and the typical yield is 1-2 eggs which may or may not result in an embryo after fertilization. Minimal IVF stimulation will yield, on average, 3-6 eggs and can produce 1-4 embryos, increasing the chances for at least one healthy embryo for transplantation. Traditional IVF uses a high dose of gonadotropins to assure that there are as many eggs retrieved as possible.
The goals for utilizing Minimal IVF are the following:
- Minimize exposure to medications during ovarian stimulation
- Reduce health risks of Ovarian HyperStimulation Syndrome (OHSS),
- Reduce costs associated with the medications used
- Reduce the time between cycles
How is Minimal IVF done?
Minimal IVF protocols differ from clinic to clinic. Any patient interested in this technique should talk to their clinic about their experience with Minimal IVF and determine what their protocols are for stimulation and what their particular success rate is.
Minimal IVF protocols may begin with a natural cycle or after short course of birth control pills (oral contraceptive pills or OCPs) or a course of estrogen preparation to regulate the cycle. This is then followed by ovarian stimulation with oral or injectable ovulation induction agents. For patients who are older than 35 years of age, some protocols will forgo use of OCPs and begin stimulation of the ovaries after suppression of follicle recruitment by using estrogen in the luteal phase (period after ovulation in a natural cycle or on day 2-3 of the natural menstrual cycle.. Monitoring is primarily by ultrasound exams with a limited number of blood tests to monitor the hormone levels. The egg retrieval procedure is identical to that done in traditional IVF, except that some patients will prefer to avoid intravenous sedation (anesthesia) since only a small number of eggs are harvested, and choose to undergo the procedure with oral analgesia (pain medications) only. Eggs are fertilized in the IVF lab with either standard insemination (mixing of sperm with eggs) when no male factor exists, or with intracytoplasmic sperm injection (ICSI). Embryos will be transferred back into the uterus when they are based upon their growth and quality somewhere between two and five days after fertilization.
How much does Minimal IVF cost?
The cost of Minimal Stimulation IVF varies slightly depending on the individual patient’s needs due to the medication cost involved and whether additional procedures such as ICSI or embryo freezing is used during the cycle. In all cases Minimal IVF will cost significantly less than traditional IVF ($5-7,000 as compared to $10-15,000.) Some patients will have some of these costs covered by their insurance.
Who should consider Minimal IVF?
The choice of Minimal IVF depends on patient preference and specific medical conditions as well as hormone levels. In select groups of patients (under the age of 35, normal ovarian reserve) pregnancy success rates for Minimal IVF treatment are excellent. Women of all reproductive ages with reduced ovarian reserve often produce lower number of eggs irrespective of the stimulation dose and may benefit from Minimal IVF as well. Some patients over 40 years of age have benefitted from Minimal IVF if traditional IVF had previously resulted in poor quality embryos.
What are the major disadvantages to a Minimal IVF cycle?
The major risks associated with a Minimal IVF cycle are the following:
- The chance of having no eggs retrieved is significantly higher.
- The chance of having no embryos available for transfer is significantly higher.
- There is minimal opportunity to use any type of genetic analysis to determine the chromosomal health of the embryo or the sex of the embryos.
- It may take several cycles to achieve a pregnancy.
At Laurel Fertility Care we specialize in Minimal IVF protocols that are safe, proven, effective, and highly affordable. A comprehensive consultation with us will help determine if you are a good candidate for Minimal IVF and or what other courses of action may lead you on your path to a successful pregnancy. Contact us on line for more information on IVF Procedures and In Vitro Fertilization doctors.