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"Gentle" IVF offer

IVM

Mini-stim IVF

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What does “gentle” IVF have going for it?

(other than cost)?

Less ovarian stimulation

IVM uses about 10% of the injectible medications used in a conventional IVF cycle.  Mini-stim IVF uses about 20% of the injectible medications used in a conventional IVF cycle. 

Less to no risk of ovarian hyperstimulation

Severe ovarian hyperstimulation is the primary established health risk of IVF.  Mild to moderate ovarian hyperstimulation occurs frequently and at minimum is uncomfortable.  With IVM, ovarian hyperstimulation never occurs.  With Mini-stim IVF, mild ovarian hyperstimulation is uncommon and moderate ovarian hyperstimulation is rare.

No exposure to abnormally high levels of ovarian hormones

Quite reasonably, no woman wishes to be exposed to high levels of estrogen.  Fortunately, a detrimental health impact due to the high levels of ovarian hormones produced in a conventional IVF cycle has NOT been demonstrated.  However, theoretic concerns remain about a possible contribution to non-malignant ovarian cancer and to breast cancer.  Given that safety can never be completely proven, why take a theoretical risk if you don’t have to?

Much quicker cycle than IVF

These cycles take half as long as conventional IVF using an antagonist and less than 25% as long if a Lupron “long” protocol is used. 

Fewer office visits

The number of office visits required to monitor ovarian development is about half of what is typically required with conventional IVF.  For many women, the time missed from work is a significant problem with conventional IVF.

Fewer tests (blood or vaginal ultrasound)

For both IVM and Mini-stim IVF about half as many vaginal ultrasounds are required.  IVM essentially requires no blood tests for monitoring.

Produces better (on average) embryos

A randomized study comparing low dose stimulation to higher dose stimulation showed that high dose stimulation produced more eggs and more embryos, but the same number of chromosomally normal embryos.   This is consistent basic science studies and with other clinical studies that have looked at this less directly.

Less risk of high order multiple births than with IUIs

Current practice rarely results in high order (more than 2) multiple births with IVF since it is rare that more than two embryos are placed into the uterus.  Most triplets and above occur with IUIs.  This is because there is no control and some uncertainty about the number of eggs that ovulate and the number of embryos produced. “Gentle” IVF procedures are closer in price to IUIs than to conventional IVF and multiple gestation less commonly than does IUI.

Less risk of twins than routine IVF (without extra interventions)

It is uncommon for “gentle” IVF to produce more than two embryos worthy of transfer.  The idea of "single embryo transfer" is growing more popular in conventional IVF programs, but often involves adding procedures that greatly increase costs and the complexity of the cycle.

Less production of excess quality embryos

With Mini-stim IVF, our objective is to produce only one or two embryos.  There are seldom good left over embryos.  With IVF, most programs retrieve about 12 eggs from an average patient, but some patients produce 30 or more.   IVM is generally also a procedure that produces only small numbers of good quality embryos.

Rare need for embryo cryopreservation

We cryopreserve embryos from about 5% of patients undergoing “gentle” IVF.  This compares to cryopreservation in greater than 50% of patients undergoing conventional IVF because of the large number of embryos produced.  Some view this as an opportunity to save money, but the cost of cryopreservation, storage, embryo defrost and transfer is in the same range as a fresh cycle of “gentle” IVF.