Hi this is Dr. Rob Kiltz, founder and director of CNY Fertility Center with locations in Syracuse, Rochester and Albany, NY. We recently had a client ask us about whether or not we do “mini-IVF”. The question was about the protocols and whether we use Clomid, Letrozole, injectables, or do we use just FSH, or both FSH and LH. Many people may be interested in this type of IVF cycle so we wanted to share the information to all, on our website. If 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.
Mini-IVF is a term of minimal stimulation. Invitro Fertilization (IVF) was 1st started with no stimulation (natural cycle, 1 egg) and the 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 & Menopur . These are injectable medications that stimulate the ovary to mature multiple eggs. On average we are getting 6-10 eggs which means more embryos. This means a higher chance of pregnancy but at the same time a higher chance of multiples.
By using minimal stimulation, so 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 and an endometrial lining of about 7mm or greater, HCG 10000 units or Ovidrel 250 units is used to stimulate the release of the egg, then 36 hours later egg retrieval is performed in the office.
Now gonadotropins can also be added to that, along with Cetrotide or Ganirelix, to prevent premature release of the eggs. And this may have a slightly improved 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 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.
These are all performed at CNY Fertility Centers, yet they are not our predominant protocols, but all are possible and based on your individual needs and can be utilized in the process.
Dr. Rob Kiltz