Are You Thinking of Doing Mini-IVF?
We recently had a client ask us about whether or not we do “mini-IVF”. The question was about protocols and whether we use Clomid, Letrozole, injectables, or do we use just FSH or both FSH and LH?
What is Mini-IVF?
Mini-IVF is a term for and IVF cycle using minimal ovarian stimulation. In vitro Fertilization (IVF) was first started with no stimulation (natural cycle, 1 egg), and pregnancy rates were much lower per cycle. Over time, protocols were developed using gonadotropins, FSH (follicle stimulating hormone), LH, and medications like Pergonal, Repronex, Gonal-F, Follistim, Bravelle and Menopur . These are injectable medications that stimulate the ovaries to mature multiple eggs. On average, we are getting 6-10 eggs, which means more embryos. This means a higher chance of pregnancy.
By using minimal stimulation, either Clomid (a pill) which stimulates 1 or 2 eggs at a time, or Letrozole which is similar to Clomid but does not have the same anti-estrogenic effects (it is also not authorized by the manufacturer to be used this way, but many Reproductive Endocrinologists are using Letrozole), there is some success to be obtained by the 1 or 2 or 3 eggs that are retrieved. In a similar fashion, Clomid or Letrozole would be used day 3-7 of the cycle and then monitoring would happen between day 8 and day 10 of the cycle with ultrasound and blood testing. When the lead follicle is 18-22 mm in size with an endometrial lining of about 7 mm or greater, HCG 10000 units or Ovidrel 250 units is used to stimulate the release of the egg(s). Then 36 hours later egg retrieval is performed in our office.
Gonadotropins can also be added to the protocol, along with Cetrotide or Ganirelix, to prevent premature release of the eggs. Doing so may slightly improve the number of eggs without the same high-cost because the biggest issue is the expense of the gonadotropins and using mini-IVF (that’s low- dose gonadotropins, or Clomid/ Letrazole) you can reduce the cost significantly.
The Mini-IVF protocol is basically either low-dose gonadotropins with a natural cycle, and beginning on day 2 or 3 of the cycle with 37 to 75 units of gonadotropins with Cetrotide or Ganirelix beginning about day 5 to 7 of the cycle when the lead follicles are about 12 mm and ultrasound monitoring and blood testing so that when the eggs are 16 – 18 mm. HCG or Ovidrel is used to stimulate release and the egg retrieval is performed similar to the standard IVF.
Many people are interested in this type of IVF cycle because it reduces the strain on the body and can offer lower medication costs. While mini IVF is not our predominant protocol, CNY Fertility offers mini IVF, and it may be recommended based on your individual needs and medical history.
If you’re interested in learning more about IVF, Mini-IVF, or other fertility treatments or you have questions about your journey to fertility, please don’t hesitate to call us toll free at 800.539.9870, request a phone or in-office consultation or send us your questions here.
Dr. Rob Kiltz