Minimal Stimulation IVF or Natural Cycle IVF

Replies to This Discussion

Permalink Reply by Dr. Andrea Reh on February 9, 2012 at 4:33pm

Hi George.  Welcome to Fertile Grounds.  Thanks for sharing your question, it's a good one.  Without knowing more about your exact situation it is difficult to say why that treatment was recommended for you.  Minimal stimulation has been touted as a less expensive alternative to "full" stimulated IVF because typically lower doses of costly fertility injections or even oral fertility drugs like Clomid are utilized to stimulate the ovaries, and typically fewer eggs are retrieved than would be from a "full" stimulated cycle.  Natural cycle, on the other hand, uses no fertility drugs and allows your body to choose the best egg.  If it is anticipated that very few eggs are going to be retrieved, one could make the argument that allowing your body to choose an egg under natural hormone conditions are superior conditions to manipulating the body with hormones, although that is just an opinion. 

• ▶ Reply

Permalink Reply by Anonymous on February 9, 2012 at 5:01pm

I can't see why minimal stim IVF would be better than regular IVF, but we will be doing NCIVF which avoids the multiple medications which for me seems like the best option.

• ▶ Reply

Permalink Reply by George on February 9, 2012 at 5:49pm

Thanks, Dr. Reh.  The doctor we spoke cited two things in his recommendation - cost and likelihood of response to fertility medication.  At my age (38) and since I had an FSH of 10 on day 3 (estradiol at 55) and 15.4 on day 10 after the Clomid Challenge Test, the doctor said I have poor ovarian reserve and would not be likely to produce many more viable eggs on an increased dosage of fertility medications.  I have also read articles discussing the drugs and dosages that should be used in a stimulated cycle for a poor responder.  It's all very confusing on what type of IVF one should choose.  I suppose there is an element of experience one gains in practice.

• ▶ Reply

Permalink Reply by Dr. Andrea Reh on February 10, 2012 at 11:28am

Measuring the ovarian reserve is difficult, and FSH levels at the beginning of the menstrual cycle are known to fluctuate.  A level of 10 can be normal or slightly elevated depending upon the laboratory reference values, but certainly is a common (even if it is not "normal") value that we see here at DF.  Most 38 year women will have some element of decreased ovarian reserve, even if their "numbers" are normal.  Other tests to estimate the egg reserve include a newer test called "AMH", which stands for anti-mullerian hormone.  AMH doesn't seem to fluctuate as much as FSH and is helpful in determining the dosage of drugs used for IVF.  Other factors include ultrasound assessments such as counting the number of resting eggs in the ovary ("antral follicle count") or measuring the volume of the ovary.  You're right - interpreting these values does take some experience.  But it is important to remember that these numbers are not good predictors of pregnancy, but rather how many eggs could be retrieved in a given IVF cycle.  More is not always better!

• ▶ Reply