Minimal in vitro fertilization (mini IVF) is a unique IVF protocol in which low-dose hormone stimulation is used to achieve excellent pregnancy rates without many of the side effects of traditional IVF. Many patients in the Los Angeles area have come to Dr. Mor for his expertise with the minimal IVF treatment.
Mini IVF, also known as “minimal stimulation IVF,” or “Micro IVF,” is a relatively new and advanced reproductive technology (ART) that offers a gentle alternative of ovarian stimulation to traditional in vitro fertilization (IVF). In Mini IVF the ovaries of a woman are minimally stimulated, using oral ovulation induction agents (Clomid, Tamoxifen, Letrozole…) and/or low doses of gonadotropins (follicle stimulating hormone and luteinizing hormone), in order to induce the growth of a small cohort of eggs. Once mature, the eggs are retrieved in a minor surgical procedure and fertilized in the IVF lab; the resulting embryos are transferred back into the woman’s uterus. The process is identical to traditional IVF, except that the goal is to create only a few but high-quality embryos for transfer. Mini IVF answers two major concerns for both patient and doctor — cost and overmedication. Recent trends in the fertility field prefer an ovulation induction that uses fewer medications and produces fewer but better quality embryos than an ovulation induction that uses significantly higher doses of medications. In other words, Mini-IVF is a useful method that can be used to help women get pregnant with minimal risks and low cost.
Mini IVF is an excellent ART tool which bridges the gap between Natural Cycle IVF and traditional IVF. While in Natural cycle IVF no ovarian stimulation is performed (no oral and/or injectable medications are taken), typically yielding only 1-2 naturally grown eggs and one embryo, in Mini IVF a “gentle” ovarian stimulation yields 3-4 eggs and 2-3 embryos, increasing the cycle efficiency significantly. Whereas in traditional IVF a high dose of gonadotropins is often used to maximize eggs/embryos from a single cycle, in Mini-IVF it is egg and embryo quality which is maximized rather than the number.
Couples who choose the Mini IVF treatment hope to obtain more eggs than in Natural Cycle IVF while avoiding some of the discomforts, risks, and costs which may be associated with traditional IVF. As such, patients undergoing Mini IVF may achieve the following benefits:
Mini IVF protocols may differ slightly from clinic to clinic but share a common goal: a gentle mild stimulation of the ovaries for the purpose of obtaining a small number of high-quality eggs and embryos. Most Mini IVF protocols begin with a short course of birth control pills (oral contraceptive pills=OCPs) followed by ovarian stimulation with oral ovulation induction agents (Clomid, Tamoxifen, Letrozole…). In patients older than 35 years of age, some protocols will forgo the use of OCPs and begin stimulation of the ovaries on day 2-3 of the menstrual cycle. Many Mini IVF protocols will involve the addition of low doses of injectable gonadotropins to orally ingested ovulation induction agents (often referred to as Micro IVF), while other protocols rely on low doses of gonadotropins only for ovarian stimulation. Monitoring is primarily by ultrasound exams with a minimal number of blood tests. 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) in cases where male factor infertility exists. Embryos may be transferred back into the uterus when they are 3, 4, 5 or 6 days old.
The main objectives are to create 2-3 good quality embryos and to make the procedure as simple as possible for the patient. The entire process takes place over about 7-10 days. The trade-off of possibly having to do more cycles to achieve pregnancy is compensated for by a lower cost and an easier experience.
The total cost for Mini IVF is typically more than half that of a traditional IVF cycle. Costs include medications, office monitoring visits, anesthesia costs, and IVF specific procedure and laboratory costs. Some patients will have some of these costs covered by their insurance.
The choice of Mini IVF depends on patient preference and specific medical conditions. In select groups of patients (under the age of 35, normal ovarian reserve) pregnancy success rates for Mini IVF treatment is excellent, if not higher than with traditional IVF. Women of all reproductive ages with reduced ovarian reserve often produce a lower number of eggs irrespective of the stimulation dose and may benefit from Mini-IVF as well. Some patients over 40 years of age may specifically benefit from Mini-IVF if traditional IVF had previously resulted in poor quality embryos since the gentler stimulation of Mini IVF may be less damaging to eggs and may yield better quality embryos.
At CCRH we specialize in Mini 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 Mini IVF.