Natural IVF and Mini IVF

Natural Cycle IVF

In vitro fertilization (IVF) refers to the process of joining an egg and sperm within the laboratory (as opposed to within a woman’s body).  The vast majority of IVF procedures in this country are performed after a patient has taken 8-12 days of ovarian stimulation medication to induce the ovaries to produce multiple eggs.  It is generally believed that the IVF process is more efficient if multiple eggs are available.

Natural cycle IVF still involves joining an egg and sperm in the laboratory; however, it is performed without the use ovarian stimulation medication, and thus relies on the single egg naturally produced by the ovary.

Both natural and stimulated IVF cycles culminate in an egg retrieval procedure.  This is a short surgical process performed under ultrasound guidance to remove the egg(s) from the ovary. Once the egg(s) are retrieved, all of the variations associated with IVF, such as ICSI, PGS, PGD, assisted hatching, gender identification, cryopreservation (freezing) and embryo transfer are available.

Steps Involved with Natural IVF

The timing involved with natural IVF is somewhat less predictable than traditional IVF.  Because the patient’s body dictates the process, each successive step depends on the one before it. For this reason, certain factors affecting the success of the treatment will be carefully weighed. In general, a natural cycle IVF proceeds as follows:

1. Call the office when menses begins
2. Cycle day 3 ultrasound and possible blood work
3. Cycle day 7-11 ultrasound and possible blood work
4. Cycle day 9-15 trigger shot
5. Cycle day 11-17 egg retrieval procedure

Variations of Natural IVF

One of the advantages of natural IVF is the inherent flexibility and adaptability of the process.  Depending on the patient and the cycle, there is the opportunity to add a small amount of stimulation medication to the process. By adding stimulation medication, the cycle is converted to a “mini” cycle.  Further, in some cycles, medication to prevent premature ovulation is used. Most cycles utilize a “trigger shot” to induce ovulation at the appropriate time.

Several types of patients may choose to pursue natural cycle IVF.

1. Low responders – Women whose ovaries do not respond to ovarian stimulation medication. For these patients, the use of medication is inefficient and expensive.  If a natural cycle produces essentially the same number of eggs as a stimulated cycle, then there is no reason to use a stimulated cycle.
2. Religious/Ideological opposition – Many people have strong religious or personal beliefs which find multiple egg (and eventually embryo) production unacceptable. The single egg associated with natural cycle presents an acceptable alternative for these patients.
3. Medical reasons – For patients with specific medical conditions, avoidance of fertility medication is important for their overall health. While the medical literature supports that fertility medicine is generally very safe for the vast majority of patients, some individuals with specific cancers or clotting disorders may be better served by natural cycles.
4. Out of the box treatment – Couples who have not been successful with traditional fertility treatment may opt for natural cycle as an alternative approach.
5. Cost- The cost of natural cycle IVF is significantly lower than stimulated IVF. While this is very attractive to many patients, we do not recommend natural IVF simply as a way to save money.  The reason is that even though the upfront cost is lower, the success rates are also lower and the cost per egg is higher.  Therefore, if a patient is a good candidate for traditional IVF, we work with them to afford IVF rather than trying natural IVF.

Mini IVF

Mini IVF is a middle road approach between natural and traditional IVF.  Mini IVF utilizes small doses of medication, including oral medication such as Clomid, to gently encourage a few eggs to grow and mature. The medication may be started at the beginning of the cycle, as with traditional IVF, or later in the cycle near day 7-9. As with natural IVF, the ultrasound monitoring schedule depends on the individual development of eggs and can range from once a week to every other day.  Once the eggs are ready, the retrieval and fertilization proves proceeds just as with traditional IVF. The biggest advantage of min-IVF is the opportunity to retrieve more than one egg with minimal medication.

At Los Angeles Reproductive Center we respect your choices and will create a treatment plan individualized to your needs. We understand that each patient is unique and that the best outcomes result from personalized care.  Do natural cycle or mini IVF represent the right choice for you? To find out, schedule a consultation with reproductive endocrinologists Dr. Marc Kalan or Dr. Nurit Winkler at Los Angeles Reproductive Center. They can help you weigh the benefits of traditional vs. mini IVF and explain all of your treatment options.