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Articles

IVF in Minimal Stimulation Protocol

Minimal-stimulation in IVF is an unique in vitro fertilization protocol. Like any Natural Cycle IVF, it is a holistic approach to fertility care and seeks to offer a gentle alternative to Conventional IVF. It differs from Natural Cycle IVF in its use of a minimal amount of oral medication which stimulates your ovaries so that they are able to produce the maximum number of "quality" eggs in a single cycle. Fertility experts know only 3-5 high quality eggs can be likely to develop into a healthy baby, even if more are to be produced through hyper-stimulation. When more aggressive IVF drug treatments are used (like with conventional IVF), although more eggs are produced, those beyond 3-5 are typically not viable and are either discarded prior to implantation or are prone to failing in a later natural miscarriage. Minimal-stimulation in IVF is a less invasive IVF protocol than conventional IVF and is an appropriate alternative for certain patient groups. Our medical team is highly respected in the field of reproductive medicine, and has expertise and many years of experience in all aspects and types of IVF.

Minimal-stimulation in IVF involves a series of steps:
Step 1: Stimulation of the ovaries with medications to allow multiple eggs to develop
Step 2: Retrieval of the eggs from the ovaries (“egg retrieval” or “harvesting”)
Step 3: Fertilization of the eggs with sperm and culturing of the embryos in incubators
Step 4: Transferring one or more embryos to the uterus

Both conventional and minimal-stimulation IVF are essentially identical in steps 2, 3 and 4. The protocols differ in Step 1, ovarian stimulation. In conventional IVF, varying doses of hormones are injected daily for several days in order to yield multiple follicles and eggs. In Minimal-stimulation IVF, physicians use oral medications or a mixture of oral medications and low doses of injectable hormones.

During the early years of IVF, ovarian stimulation medications were administered orally or not at all. Pregnancy rates were significantly lower than current rates for a variety of reasons, including suboptimal laboratory materials and equipment, the relative lack of expertise of physicians and embryologists, and low egg yields. The stimulation protocols used resulted in high rates of premature ovulation and frequently no eggs available at retrieval. Over time, reproductive endocrinologists began to conduct ovarian stimulation with injectable hormone medications in order to better regulate the cycles and induce development of multiple eggs. The rationale for allowing multiple eggs to develop is that many eggs are abnormal and might lead to poor pregnancy and high miscarriage rates. With multiple eggs developing, there is an increased chance that at least one will result in a normal embryo and thus enhance the chances for a successful pregnancy.

At the present time, the chances of achieving a pregnancy with conventional stimulation methods is higher than with minimal-stimulation IVF. However, the use of new medications to minimize the risk of premature ovulation has allowed the success rates from Minimal-stimulation IVF to improve significantly. Whether MS-IVF can yield pregnancy rates comparable to conventional IVF remains to be determined. Minimal-stimulation IVF does, however, have several advantages over conventional IVF and may be a reasonable and appropriate choice for selected patients and couples.

Minimal-stimulation IVF involves the use of fewer medications, and lower doses of medication, than conventional IVF. Patients doing conventional IVF protocols are typically required to be monitored with blood-hormone tests and vaginal sonograms every 24 to 72 hours. These tests allow the IVF team to modify the patient’s medication dosing and time when the egg retrieval should be performed. With Minimal-stimulation in IVF, fewer monitoring visits are required, thus reducing patients’ inconvenience and stress. In addition, patients are required to inject themselves less frequently than with conventional IVF, limiting the level of discomfort common with fertility medications.

The use of fewer medications, and lower doses of these medications, often results in a significant cost savings for patients, amounting to hundreds or thousands of dollars per cycle. As many patients do not have insurance coverage for medications, this savings can be the sole factor that determines if a patient can undergo IVF or must forego this option. What has not yet been determined is whether the cost savings per cycle for MS-IVF translates into a cost savings per pregnancy achieved. As Minimal-stimulation in IVF appears to result in a lower pregnancy rate per cycle than conventional IVF, more cycles of Minimal-stimulation in IVF are required to achieve a pregnancy than with conventional IVF. Further studies are needed to adequately compare the total cost expenditures for minimal stimulation as compared to conventional IVF.

In general, medication for the Minimal-stimulation in IVF treatment includes one Clomid pill consumed daily, no more than one to three injections of Menopur, and a simple nasal spray of Synarel or an equivalent medicine administered 36 hours prior to egg retrieval. Synarel avoids the need for repeated progesterone injections, which are typically used after the transfer step in conventional IVF. However, because we customize protocols to each individual patient, these vary substantially from case to case.

Women who choose the Minimal-stimulation in IVF treatment hope to minimize the amount of chemicals and drugs in their lives. Minimal-stimulation IVF treatment can be preferable to a natural cycle IVF because it tends to yield more quality eggs each cycle, increasing the chances of pregnancy and providing surplus embryos to freeze for a later cycle.

Additionally, women will choose Minimal-stimulation in IVF over conventional IVF to reduce health risks and discomfort caused by ovarian hyper-stimulation (OHSS), to eliminate the pain of daily drug injections (which can be 20-60 per cycle), to reduce the high cost of drugs in conventional IVF protocols, to avoid the wait time of two to three months between cycles, and to minimize the potential risk of ovarian and endometrial cancer from prolonged use of high-dose IVF drugs.

Pahlajani Test Tube Baby Center promotes a single-embryo strategy (unless otherwise requested by the patient) to avoid the health risks of twins and multiple pregnancies and the pregnancy success rates for our Mini-IVF treatment is competitive with the success rate produced with conventional IVF, where usually 2-3 embryos are transferred in each IVF cycle. You may refer to the chart below which compares what you can expect from Conventional and Minimal-stimulation IVF treatments.

Pahlajani Test Tube Baby Center's Minimal-stimulation IVF protocols are gentle, affordable, and successful and our clinic is recognized globally as leading experts in this treatment.