Our Mini-stim IVF™ Results for Younger Women
Our pregnancy rates with Mini-stim IVF are not included as part of IVF in the SART/CDC data reporting for IVF programs. Mini-stim IVF (or Mini-IVF) is not recognized as a different procedure than conventional IVF and is done by relatively few programs in the United States. However, mixing this data decreases the value of it for understanding how either IVF or Mini-IVF is done in this program.
Mini-IVF results for women under age 38 from 2010 through 2013
Mini-IVF uses the powerful laboratory techniques of conventional IVF together with a gentle medical stimulation of the ovaries. Many women will get pregnant using Mini-stim IVF at a much lower cost and with a patient friendlier experience. With Mini-stim IVF, our target has been to produce one or two embryos each cycle, in contrast to trying to produce 12 or more embryos with conventional IVF. Patients with good quality eggs and infertility problems like male factor or tubal factor do particularly well with Mini-IVF. However, in this age group, fewer embryos lead to a lower pregnancy rates than with conventional IVF. The Teramoto series from Japan suggests a pregnancy rate of half to two-thirds of conventional IVF.
An emerging trend in some programs offering minimal stimulation IVF is to freeze all embryos until an adequate number of embryos are collected and then transfer the best embryos. The thinking behind this is that women get discouraged if a cycle doesn't work and if you combine several stimulations, you get a higher pregnancy rate per transfer (which also appears more competitive to conventional IVF in the SART registry). We do not use this approach since it adds cost and complexity to a cycle that we offer in part because of its simplicity for patients. It is well established that the most effective way to enhance the take-home baby rate per patient is to encourage patients to do more cycles. Most women stop trying with IVF too early. (Cost is a major, but not the only reason for this.)
What follows is a summary of our experience with Mini-stim IVF for women under age 38. For women above 37, we find no essentially difference in pregnancy rates between Mini-stim IVF and conventional IVF. Those results are summarized elsewhere.
With simplified IVF cycles, we are always concerned about the cancellation rate. Cycles may be cancelled before the eggs are taken out (before an aspiration) or after the eggs are taken out. Cancellations before eggs are taken out are disappointing, but are similar to a failed IUI cycle with relatively low costs incurred. Cancellation after aspiration involves more costs (laboratory) and an unnecessary invasive procedure (egg aspiration). Our experience with cycle cancellation due to not being able to obtain eggs has been very low.
Singleton delivered (or ongoing) pregnancies are the objective with any type of IVF. A biochemical pregnancy is a positive pregnancy test. It may or may not continue development. A clinical pregnancy means that a pregnancy has been visualized in some manner (usually ultrasound). The loss of a clinical pregnancy is a miscarriage.
Women Under age 35 for 2010-2013
Delivered pregnancy per transfer- 7/31 = 22.6%
(One set of twins- multiple birth rate- 3.2%)
Clinical pregnancies per transfer- 9/27 = 33.3% Miscarriages- 2/9 = 22.2%
Women aged 35, 36 or 37 for 2010-2013
Delivered pregnancy per transfer- 5/27 = 18.5%
(Multiple birth rate- 0%)
Clinical pregnancies per transfer- 5/27 = 18.5% Miscarriages- 0%
We believe that we have now had enough patients that we have a good understanding of what variations of our approach mean for different patients. In our program we view mini-IVF as an established technique. We are attempting to promote it to other programs though our publications and talks. We believe that mini-IVF should be a preferred approach for most patients prior to conventional IVF and lament that it is not more available in most communities.