The procedures utilized during therapy for mild IVF often referred to as micro, mini or minimal stimulation IVF, are similar to those used for conventional IVF. You receive monitoring during the cycle, egg retrieval, laboratory fertilization of the egg and sperm, and embryo transfer, just like with IVF.
The amount of medication used to induce the ovaries to produce eggs differs. Mild IVF uses weaker drugs or lower doses of medications to create only a few eggs, as opposed to standard IVF, which tries to develop numerous eggs for retrieval. It can also be carried out without the use of any ovarian stimulants. Less fertility medication is used, which lowers the cost per cycle and lowers the risk of ovarian hyperstimulation syndrome (OHSS).
What is Mild IVF?
Mild In vitro fertilization (IVF), also known as micro-IVF or gentle IVF, uses smaller doses of fertility drugs than typical IVF during the egg stimulation phase and sometimes during egg harvesting.
Mild IVF vs IUI Treatment
Mini-IVF is more expensive than IUI treatment. The danger of multiples is increased with intracytoplasmic injection (IUI), though. Only one embryo is transferred during mini-IVF. You have no control over how many eggs will fertilize with IUI. IUI also has lower success rates than mini-IVF.
Mild IVF Disadvantages
In the long run, the costs may even be higher if you are unable to conceive after a few cycles. If one cycle of normal IVF doesn't succeed, you often have several extra embryos to freeze. These can be applied during a frozen embryo transfer (FET). You are less likely to have any extra embryos for subsequent cycles using mini-IVF.
When using mini-IVF, there is also a higher chance of not having any eggs to fertilize. Not every egg produced will make it through the IVF procedure. For instance, with traditional IVF, only five of the retrieved Ten eggs may likely fertilize. Only three of those could mature into viable embryos for transfer.
You have lost the entire cycle if you only have two or three eggs to begin with and none of them fertilize or develop into embryos that can be transplanted. Additionally, mini-IVF is inappropriate if you require a high quantity of eggs. You must use additional fertility medications to develop more oocytes if you are freezing your eggs or using an egg donor's supply of eggs.
Mild IVF Candidates
Mild IVF would be a better choice if:
- You want to maintain your fertility before beginning cancer treatment, you are going to begin IVF, yet fertility medications could make your cancer worse.
- You lack the financial resources for more expensive conventional IVF.
- You don't like using needles. (Fewer injections due to fewer fertility medications)
- Your ovarian reserves are insufficient. High doses of fertility medications are unlikely to result in a high egg production rate in women with limited ovarian reserves. These medications may not have been worth the money.
- You have PCOS and are susceptible to OHSS.
If a couple wants to forgo the potential risk of multiples during IUI therapy, they can also opt for mild IVF. With IUI, the number of fertilized eggs cannot be predetermined by the doctor. You have the option to transfer one or two embryos using mild IVF. The fact that you can perform the treatment cycles back-to-back is another benefit of mini-IVF. No need to take a rest. If you need to get pregnant quickly for a specific reason, mini-IVF might be preferable to traditional IVF.
Reasons to Have Mild IVF
- Reduced or low ovarian reserve. Less medication use does not necessarily translate to fewer eggs because women with DOR may not respond effectively to the stimulating drugs. There would be no point in taking more drugs since you wouldn't be producing any more eggs. A mild IVF in this situation often entails a comparable quantity of eggs, less money, and a lower risk of hyperstimulation.
- Ovarian hyperstimulation risk is high. People who are at risk for OHSS, such as those with PCOS, may be suitable candidates for Mini IVF because by reducing the number of drugs used, one minimizes the danger of hyperstimulating the ovaries while still being able to produce adequate egg numbers.
- Cost. The cost of Mini IVF will be significantly lower for a single cycle because fewer drugs will be utilized (as medications make up a very significant part of the overall cost of IVF). However, be aware that fewer embryos may be produced if you use fewer drugs. This means that instead of using your remaining frozen embryos for a cost-effective FET (FETs within a year after your IVF cycle are only $650), you could have to undergo a second, more expensive IVF cycle. Because of this, mild IVF can end up costing more in the long term.
- Philosophy. Some believe that because this treatment regimen lessens the risk of ovarian hyperstimulation and the likelihood of having a significant number of remaining embryos after achieving a clinical pregnancy, it is more in keeping with their philosophical beliefs. Numerous people would prefer not to have to make this decision at all, even though there are many acceptable options for handling these remaining embryos, including preserving them for the future, destroying them, and embryo donation.
- Other reasons. Of course, mild IVF is a viable option for a variety of individuals and may be taken into consideration by the majority of individuals after failing other less invasive therapies like IUI or for those who have male or female fertility testing that suggests those lesser treatment choices are not recommended.
Mild IVF Medications
Instead of gonadotropins, Clomid may be administered during mini-IVF to stimulate the ovaries. Injectable drugs like Gonal-F, Follistim, and similar ones are examples of gonadotropins. Alternately, lesser gonadotropin doses could be employed to just ovulate a few eggs. Mini-IVF can also be performed on some women without the use of ovulation-inducing medications. This is also referred to as a natural cycle at times.
If there are any issues with ovulation that prevent conception, a natural mini-IVF cycle would not be appropriate, but it might be a viable option in cases of blocked fallopian tubes and some cases of male infertility. In addition to ovarian stimulation medications, you might also need to take a GnRH antagonist (such as Anatagon and Cetrotide), which delays ovulation. The eggs cannot be removed from the body and IVF cannot be performed if you ovulate too early.
Mild IVF Process
The follicular/egg development, egg and sperm retrieval and preparation, fertilization and embryo development, and embryo transfer still take place during a mild IVF cycle.
All women will take hormone-based drugs during ovarian stimulation for a brief IVF cycle, which promotes the ovaries to produce a modest number of high-quality eggs (as opposed to the natural egg that is produced each month).
The majority of women combine a little amount of injectable drugs like Gonal F, Follistim, or Menopur (for 10 days) with a minor amount of oral stimulation drugs like Letrozole (for 5 days).
On days 2-4 of the woman's cycle, the stimulation phase of a mild IVF cycle normally starts.
Beginning with a baseline appointment to assess hormonal and follicular baseline, the entire stimulation period will be meticulously monitored with follow-up appointments every few days to check uterine lining, follicular, and hormonal development.
Another medication will be administered after the follicles are the perfect size to promote the eggs' ultimate maturation and to time the egg retrieval appropriately.
Egg and Sperm Retrieval
The most important step in a small IVF cycle is egg retrieval. The developing eggs are removed from the woman's ovaries during a quick outpatient operation that takes place 35 hours following the trigger medication. The doctor extracts the eggs from the follicles using a small hollow needle that has suction capabilities.
The day before the egg retrieval, sperm can be obtained by ejaculating into a sterile cup, frozen at the office beforehand, frozen elsewhere and brought to the center, acquired from a donor, or obtained using more complex sperm retrieval techniques like a PESA, TESA, or TESE. The remaining motile concentrated sperm will be transported to the embryology laboratory for fertilization once the sperm has been treated.
Fertilization and Embryo Development
Similar to traditional IVF, there are two main ways to fertilize eggs. In conventional fertilization, the sperm are placed in a petri dish and allowed to naturally propel and penetrate the egg, resulting in fertilization.
ICSI Fertilization involves injecting a single sperm into an egg with the use of a small hollow needle. After fertilization, the resultant embryos will thrive for two to seven days in a nourishing medium that resembles the lining of a fallopian tube.
When an embryo reaches the blastocyst stage (often on day 5), it can be genetically examined, which is beneficial for people who want to choose the sex of their child, are at risk of aneuploidy (typically older mothers), have or are carriers of known genetic disorders.
One or two embryos are returned to the woman's uterus after undergoing early embryonic development to continue developing and hopefully implanting. A fairly straightforward procedure similar to an IUI, an embryo transfer involves loading embryos (not sperm) into a catheter, which is then gently pushed past the cervix and released into the uterus. There will be pregnancy if the embryo survives.
Any extra embryos that aren't transferred can be kept and used for additional frozen embryo transfers, though this is considerably less likely than with a typical IVF round.
Mild IVF Success Rate
Although mini-IVF has a lower success rate than traditional IVF, some couples may find it to be a better option.
Mini-IVF was compared to traditional IVF in a randomized control study. 564 women who were 39 or younger were included in the study. They were allocated at random to either the mini-IVF group or the traditional IVF group. They received treatment for over six months. Here are the study's findings:
- 49 percent of women who underwent mini-IVF became pregnant and delivered birth.
- 63% of those who underwent traditional IVF became pregnant and delivered birth.
- Those who underwent mini-IVF did not have ovarian hyperstimulation syndrome (OHSS).
- 5.7% of those who underwent traditional IVF experienced OHSS.
- The mini-IVF group used much fewer gonadotropins, resulting in a lower cycle cost overall.
According to the findings of this study, mini-IVF may be an excellent option for a woman who is at risk of having OHSS. Although the study only used single embryo transfers for the mini-IVF patients and double embryo transfers for the traditional IVF patients, it also discovered that the rate of twins was much lower with mini-IVF. The likelihood of having twins will increase if you transfer two embryos as opposed to one.
Additional research is required to compare the total cost per live birth for mini-IVF and traditional IVF and to ascertain whether the likelihood of multiple births is indeed any difference between the two techniques.
Mild IVF Cost
Mild in vitro fertilization is frequently described as being substantially more expensive than traditional IVF. While it is true that the overall cost of treatment for a single mini cycle is typically lower than the typical cost of IVF, it's crucial to keep two factors in mind:
- The fertility clinic typically charges the same amount for each procedure. The cost savings are reflected in the pharmacy bill and result from the altered pharmaceutical protocol.
- Even if a single mild IVF cycle is less expensive, there is evidence that it could not be as cost-effective in the long run. This is because regular IVF procedures frequently result in many embryos that can be frozen for a future FET, unlike mild IVF. Therefore, someone with remaining embryos can undertake a far more expensive FET rather than starting a brand-new cycle (which is frequently necessary if a transfer from a mild IVF round fails).
A mini-cycle costs $3,900 plus monitoring ($800-950) and drug costs (often under $2,000 for a mild IVF stimulation cycle).
After Failed IVF Cycle
The founder and medical director of New Hope Fertility Center, Dr. John Zhang, explains that whereas standard IVF aims for quantity, mini-IVF focuses on creating high-quality eggs. The attempt to create a lot of eggs can have negative effects on some women. Failure of a traditional IVF cycle does not ensure unsuccess with a mild IVF cycle.
According to Dr. Zhang, there are numerous causes for cycles to fail. Some factors include hormonal imbalances, stress, poor uterine conditions that prevent an egg from implanting, age-related poor egg quality, and more. When a standard cycle fails, a reduced stimulation regimen, such as mild IVF, can often generate eggs of greater quality, giving the person a better chance of success.
Dr. Zhang advised against assuming that just because one cycle failed, all subsequent treatments will also fail. According to studies, women can succeed more often over the course of several cycles with less stimulation. Most have had better results by using a different treatment.
Mini-IVF has reduced cycle expenses and a lower risk of ovarian hyperstimulation syndrome than conventional IVF. Mini-IVF does, however, often have lower success rates. Mini-IVF offers higher pregnancy success rates than IUI but is significantly more expensive. In comparison to IUI treatment, mini-IVF lowers your risk of multiple births.