Everything You've Wanted To Know About Minimal Stimulation IVF: A Milder IVF Stimulation Process

Sep 07, 2017

What is Minimal Stimulation IVF?

Minimal stimulation IVF, also known as Mini IVF or Mild IVF or low-intensity IVF is rapidly gaining popularity. With Minimal stimulation IVF, a milder and more natural ovarian stimulation is used in place of the standard IVF stimulation.

In Minimal stimulation IVF, oral medications such as Clomiphene Citrate are used to stimulate the ovaries in place of the usual gonadotropin injections. Nevertheless, on occasion mixed protocols with oral medications and gonadotropins are used, but the total amount of gonadotropins used is a fraction of what is normally used in a standard IVF cycle. Also the woman receives these medication for a shorter period than with conventional IVF. The intent usually is to produce and collect fewer eggs to be used for IVF.

Who can opt for Minimal Stimulation IVF?

• Minimal Stimulation IVF is also an option for women with diminished ovarian reserve. These women usually have a poor response to aggressive gonadotropin stimulation during conventional IVF and anyway produce fewer eggs. These women may benefit from a Minimal Stimulation IVF as they will still produce the same number of eggs with milder stimulation without having to spend as much on medication.

• Patients at high risk of OHSS (Ovarian Hyper Stimulation Syndrome) i.e., a dangerous over-reaction to fertility drugs.

• Those with a particular concern about possible adverse reactions or previous bad experience with hormonal stimulation.

• Candidates for intrauterine insemination seeking a more effective treatment.

• Couples with religious, moral or personal beliefs who want to limit the number of embryos created and don’t desire embryo or egg cryopreservation. Since with Minimal Stimulation IVF a small number of egg are collected and fewer embryos are created, this could be a good alternative for them.

How does Minimal Stimulation IVF work?

Minimal Stimulation IVF is similar to conventional IVF but with a few variations. A lower dose of fertility drugs is taken for a shorter period of time, hence your natural cycle is not suppressed, unlike in conventional IVF. Daily injections of standard IVF cycle are avoided making it more comfortable for you.

At the first consultation, we will assess your situation and devise a personalized treatment plan. You will then be requested to call up on the first day of your period in order to book your first scan. This will be scheduled for the second or third day of your cycle. If everything looks healthy, you may be prescribed fertility drugs like clomiphene citrate to boost egg growth. You will need 3-4 scans during the first 10-14 days of your cycle. You will then receive an injection of human chorionic gonadotropin (hCG) to mature your follicles. The egg collection which is carried out under a short acting anaesthetic is usually performed on around day 13. As lower doses of drugs are used, fewer eggs may be available for collection. This is followed by the embryo transfer a few days later. Any embryos of suitable quality that are not used in treatment may be frozen and stored for your future use.

What is my chance of having a baby with Minimal Stimulation IVF?

Minimal Stimulation IVF may be more likely to result in pregnancy than Natural Cycle IVF, which uses no fertility medications at all.

However since fewer eggs are available in Minimal Stimulation IVF, its success rates are often lower than conventional IVF success rates

What are the advantages of Minimal Stimulation IVF?

• Minimal Stimulation IVF results in a much shorter and safer procedure. Since only a few eggs are collected, the procedure time is very short. In addition, only a very short anesthesia is used for egg collection. Therefore, the anaesthetic risks are minimized too. Patients recover soon after the procedure.

• As smaller doses of fertility medication are used for a shorter duration, it reduces the chances of side effects or complications, such as Ovarian Hyper-Stimulation Syndrome (OHSS).

• More importantly, Minimal Stimulation IVF reduces the stress and discomfort of daily injections required for conventional IVF.

• It requires much less frequent monitoring. Most patients only need three to four visits during Minimal Stimulation IVF, compared to six to seven with conventional IVF.

• Minimal Stimulation IVF can be done for any woman who wants to use her own eggs and is still ovulating. Many women with a poor hormonal profile, low ovarian reserve or poor response to fertility drugs are recommended treatment with donor egg instead of conventional IVF with their own eggs. In this scenario, instead of using donor eggs, the woman can opt for Minimal Stimulation IVF, giving her the best chance of having a baby with her own egg.

• Low dose ovarian stimulation protocols in Minimal Stimulation IVF, have been considered to yield eggs and embryos of higher quality.

• Minimal Stimulation IVF can be repeated in consecutive cycles to collect multiple eggs and freeze all embryos for future frozen embryo transfers.

What are the risks/limitations of Minimal Stimulation IVF?

• The risks with mild stimulation IVF are similar to those with conventional IVF but are significantly reduced because smaller quantities of fertility drugs are used.

• Minimal Stimulation IVF has a lower risk of side effects to fertility drugs like Ovarian Hyper-Stimulation Syndrome (OHSS).

• Compared to conventional IVF, Minimal Stimulation IVF has a higher cycle cancellation rate because of lower ovarian response to less medications, increased risk of spontaneous ovulation or fewer or no eggs retrieved.

• Fewer eggs are available for fertilization and as a result fewer embryos available for transfer than with conventional IVF. Sometimes these eggs may not fertilize to form healthy embryos leading to cancellation of the cycle.

• As usually fewer eggs are collected, we do not have the luxury of extra embryos to choose from for transfer or storing extra embryos by freezing. However, if a patient wishes to have multiple embryos stored, we can freeze the embryos from the first few cycles of egg collection before we start embryo transfer.

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