Natural IVF, Mini IVF, Mild IVF, what does it all mean?

Last week we received this email from a reader, who like so many, are conscious about the  expensive cost of IVF.

“I hope you can help me. I am in the early stages of researching fertility treatment options but I am starting to get really confused! Firstly, I should start by saying that I have been diagnosed with PCOS and have been told I will need help conceiving.

I do not have an enormous budget though, so I was immediately drawn to something I read about “natural” IVF, being much cheaper than “standard” IVF.

Would you be able to offer me some clarity? I only ever thought there was one type of IVF and now I am reading about ‘natural’, ‘mild’, ‘mini’, and ‘natural modified’ IVF, and I am so confused! Please can you help me differentiate?”

We turned to Dimitris Kavakas from Redia, to explain the cost, and Dr Maria Arque MD, PhD, Gynecologist, REI Specialist, International Medical Director, from Fertty International clinic, Barcelona Spain to answer our readers questions

What is natural IVF and how does the process work?

Natural cycle IVF does not use medications to stimulate the ovaries. Therefore, the cycle can only produce up to one mature egg at a time. Patients are monitored with ultrasounds and bloodwork to track the development of the single follicle so that it is not released (ovulated) by the body before it can be retrieved.

The patient then undergoes the same type of egg retrieval that is done in a stimulated IVF cycle to retrieve the egg from the single follicle. If the egg retrieval is successful, an attempt is made to fertilize the egg in the laboratory. If a viable embryo develops, it will be transfered  back to the uterus.

What is the difference between natural IVF and standard IVF?

The main difference between the natural and stimulated IVF cycle is that there is no medication used to stimulate the growth of follicles in the ovaries with the natural IVF cycle, and therefore, only one mature egg can grow. With the stimulated cycle, medication is given to the patient to stimulate the growth of several follicles at the same time

Natural IVF cycle and a traditional IVF cycle look very similar in terms of the timeline and the procedures followed. The difference is just that the patient does not use medications to stimulate multiple egg development in a natural IVF cycle.

How successful is natural IVF?

Pregnancy and live birth rates for traditional IVF cycles are higher than natural IVF cycle . In fact, one may have to undergo several natural cycles in order to achieve a successful pregnancy—compared to one stimulated IVF cycle. One important element that influences this success rate is the retrieval of multiple mature eggs.

The main reason success rates for natural  IVF cycle  are low is that, without the use of medications, there is a much higher chance of a cycle being cancelled at each stage. Some patients will prematurely ovulate, or an egg cannot be retrieved at the time of egg retrieval. And others will have a cycle that doesn’t result in fertilization, and therefore, no embryo will be available for transfer. The resultant delivery rate per initiated cycle for women 37 or under is low (15%), and very low for women over 40 (5-10%).  The rate of pregnancy is about the same as intrauterine insemination (IUI).  However, IUI is much less costly and doesn’t require a surgical procedure. In general, IUI success rates are approximately 15 percent for women 37 and under and 5 to 10 percent in women older than 40.

Who is natural IVF for? Would it work for me (with my PCOS)?

The ideal candidate for a natural IVF cycle would be a woman who is under 37 years old (as most likely her egg quality will still be good), who has very low ovarian reserve or that has already done several attempts of conventional IVF with very low ovarian response (which means that she does not benefit of conventional IVF).

Natural IVF would not be the ideal treatment option indicated for patients with PCOS, who usually have a very high ovarian reserve and don’t ovulate naturally.  PCOS patients would benefit from ovulation induction or IUI if they are young, they have short infertility history and both tubal and male factor have been rule out. Otherwise, PCOS patients would benefit more from a conventional stimulated IVF cycle, using the appropriate protocol to minimise the risk of OHSS. (low dose stimulation drugs, GnRH antagonist protocol with GnRH analogue trigger  and defered embryo transfer (freeze all embryos)).

What is the different in cost?

Natural cycle IVF costs less than a standard IVF cycle because it uses fewer medications.  What’s critical to understand when comparing costs is that, from a value perspective, the choice is clear. For the cost of doing a traditional IVF cycle, chances of pregnancy and live birth are far greater than with natural IVF cycle (except for those specific cases mentioned above, as women with very low ovarian reserve or previous cycles with very poor ovarian response). In fact, for most patients, chances are better with one stimulated IVF cycle than with  several natural IVF cycles.  Furthermore, with the stimulated IVF cycle there is a possibility of having frozen embryos available for future use.

What is natural modified IVF?

One of the main limitations of natural IVF cycle is the risk of a premature LH surge and spontaneous ovulation before undergoing the egg collection.  To minimise this risk, with the natural modified IVF cycle, a GnRH antagonist is given to the patient once the leading follicle is greater than 15mm and the endometrial thickness greater than 6 mm. Once the follicle measures 18-20 mm, hCG is given to the patient to achieve final follicular maturation and the egg collection is planned between 34-36 hours after it’s administration.

What is natural and mild IVF?

Mild and natural IVF are different from conventional IVF in their approach.

With Mild IVF and Natural IVF, there are fewer drugs  used and therefore less side effects than with conventional IVF. With the natural IVF cycle no drugs are given to stimulate the growth of follicles in the ovaries, and therefore, only one follicle will develop and provide a mature egg.  With mild stimulation, a low dose of drugs is given and several follicles will develop, but not as many as with a conventional IVF cycle.

What is mini IVF?

While terms  low dose, « mini » IVF or « gentle » IVF  don’t have exact, industry-standardized definitions, they have general uses. Those terms typically describe a cycle that uses lower doses of the injectable medications used in conventional IVF, or uses less powerful oral medications such as Clomid. A typical low-dose cycle may result in 1–4 eggs being matured and retrieved.

Huge thanks to Dimitris Kavakas and Dr Maria Arque for answering our reader’s questions. If you have any questions about anything fertility related, please do drop us a line at info@ivfbabble.com

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