Minimal Stimulat ion In Vitro Fertilization

success-for-lessBy: Danielle E. Lane, MD

have we found SUCCESS for Less?

The term in vitro fertilization conjures up many feelings. For many women it is a process that reflects excess hormones, tremendous cost, financial debates with their spouse and no guarantee of pregnancy. Yet in many cases, it’s been the best and only option that we have.

What if you could have the benefits of identifying the egg, seeing that fertilization had occurred, and replacing an embryo with less? Less hormone, less cost, and fewer visits. This is the concept behind minimal stimulation IVF.

In this treatment protocol, lower stimulation of hormones are used. Some studies have looked at using clomid alone, but the best success rates have been with the combined use of clomid and low dose injectable hormones. Using this combination anywhere from 1-5 eggs can be obtained through an egg retrieval. In addition, there are fewer laboratory techniques applied to the eggs/embryos. Typically, this does not involve intracytoplasmic sperm injection (IC SI), embryo biopsy for genetic analysis or assisted hatching.

Instead the eggs are inseminated and allowed to fertilize on their own. Then they are cultured in the laboratory for three to five days. Currently, the highest pregnancy rates are achieved when the embryos are initially vitrified (frozen) and the lining is allowed to recover. Finally, after a preparation period, one or two embryos are transferred back to the uterus.

Potential-Candidatespregnant-purple-dressThis protocol is a tremendous option for women who meet several criteria (see box). Typically women who do not meet these criteria are less likely to succeed and may benefit from a more standard IVF approach.

So what are the advantages? Because the stimulation is lower, the cost of medications is less ($500-$1500 compared with $4000-$6000). The laboratory also has less to do when handling these embryos and thus the procedural fees are lower. There are fewer ultrasounds because of the lower stimulation. This translates to less time in your physician’s office. Because embryos are created, there is still the opportunity to make safe decisions about how many embryos to replace. This is important when patients are trying to minimize twins and triplets.

So with pregnancy rates that can be anywhere from 20-40% in studies, why would anyone not try this? First, the lower number of eggs produced makes this protocol less ideal as women age. There is less opportunity to get to the correct egg. Therefore, assessing the biochemical markers such as anti-mullerian hormone (AMH),follicle stimulating hormone (FSH), and antral follicle count (AFC) are critical. Second, a semen analysis with a level of sperm that does not require individual injections into each egg is important.Third, the female anatomy needs to be normal.And finally, more than two failed cycles is likely to be an indication that this may not be the right treatment choice.

Minimal stimulation IVF shows great potential for providing success for less. Ultimately, patients and physicians alike may find that this option provides a solution for a large group of women who otherwise are not accessing appropriate care for their fertility challenges. Ask your physician whether this treatment may be right for you.