Many patients looking into fertility treatment are exploring their options and trying to find the best possible option for them. This can mean a lot of things to different patients. Some are looking for the best possible success rate for their personal situation, an option that is more affordable, an option that is easier on your body, or a combination of any of those three and more. For those looking for an option that reduces the amount of medication involved in your cycle, ‘natural cycle IVF’ can appear very appealing.
“Natural cycle IVF” treatment is comparable to traditional in vitro fertilization which we’ll refer to as ‘stimulated IVF,’ but without the medication used to stimulate the ovaries and produce multiple eggs. NCIVF still requires the other elements of an IVF cycle, including frequent appointments, ovulation trigger injection, egg retrieval, developing embryos in the lab, and embryo transfer. For patients, NCIVF reduces some of the medications administered in comparison to stimulated IVF; however, it can still be almost as costly if more than one cycle is needed for success.
At Dominion Fertility, we’re committed to providing our patients the best possible fertility care, including expert guidance on which treatment will give them the highest likelihood of reaching their family-building goals. This has meant removing NCIVF from our service line as we found that it was not a viable option when all factors, including success, costs, and risks, are considered. Through this article, we share the differences between stimulated IVF, low-stimulation IVF (often referred to as mini-IVF), and ‘natural cycle IVF’ so patients can better understand the facts behind these alternatives and how they compare to traditional IVF.
What’s the Difference Between IVF, Natural Cycle IVF, and Low-Stimulation IVF?
In a stimulated IVF cycle, we administer ovarian stimulation medications for 9 to 12 days to encourage all of the eggs in the ovaries to grow equally. The medications also ensure that one egg does not become dominant. We allow all the eggs to grow leading up to the retrieval process, even those that would have died away in a regular menstrual cycle. During this time, patients are monitored frequently to track follicle growth.
In all IVF cycles, physicians will perform an egg retrieval with an ultrasound-guided needle under sedation to remove the eggs. The eggs are then fertilized in the lab and grown to the blastocyst stage, where embryologists will test them to help identify the chromosomally normal embryos for transfer. Not all eggs will survive and develop into viable embryos, and the remaining viable embryos can be frozen and stored for subsequent IVF cycles.
During low-stimulation IVF, less stimulation medication is used; therefore, fewer eggs develop concurrently. On average, a stimulated IVF cycle results in 8-14 eggs, and a low-stimulation IVF cycle results in 3-6 eggs. Although, it is essential to note that quantity is only one factor to consider, as one high-quality egg is more likely to yield a pregnancy than a dozen low-quality eggs. Due to the attrition rate from egg to viable embryo to a successful pregnancy, patients should consider they may need more than a single egg to realize their family-building dreams.
Because natural cycle IVF does not utilize any ovarian stimulating hormone medications, only one egg matures during these cycles. Patients are still required to come in for monitoring appointments and surgical egg retrieval. If retrieved, the embryologist fertilizes the egg, and the embryo hopefully develops into a “normal” blastocyst that can be prepared for transfer with the goal of achieving a successful pregnancy. Of course, many factors play a role in each step, and a significant portion of patients will hit setbacks along the way, sending them back to start again. For instance, an egg is not retrieved in approximately a quarter of natural IVF cycles. In another 25% of NCIVF cycles, the egg is not fertilized and isn’t able to develop into a viable embryo. Because of this attrition rate throughout the process, often, it can take three natural IVF cycles to achieve a successful pregnancy.
The timeline for IVF cycles, whether stimulated, natural, or low stimulation is all reasonably comparable. The main difference between these types of IVF cycles is the number of medications used to stimulate egg development prior to retrieval.
Medications and Risks
You may be wondering about the medications we utilize for the egg maturation process. Often, women feel wary about taking hormones, wondering if it will make them moody or cause unnecessary stress on their bodies. The medications we administer are similar to the hormones the body produces naturally, and we individualize the dose and monitor patients’ progress with ultrasound and blood hormone levels.
When being administered ovarian stimulation medications, there is a risk to consider: Ovarian Hyperstimulation Syndrome (OHSS). OHSS occurs when a woman’s body over responds to the stimulation medication, which can result in the ovaries and abdomen swelling and sometimes a buildup of fluid in the abdomen. According to ASRM (American Society for Reproductive Medicine), approximately one-third of patients experience mild symptoms of OHSS. Those with polycystic ovary syndrome (PCOS) have an increased risk of OHSS and can benefit from lower doses of stimulation medication. Common symptoms of OHSS can include soreness, fluid buildup, and weight gain.
At Dominion Fertility, patients are monitored closely for signs of possible OHSS, and medications can be adjusted as needed by the physician. We use medication protocols for stimulated IVF that reduce the complication of OHSS for our patients.
Success rates are an important factor to consider, and we encourage all our patients to comb through the data and ensure they understand what is being presented. Often, fertility practices present success rates in ways that make it difficult for patients to discern the best treatment for their situation. The most important thing at the end of the day is bringing home a healthy baby, so look at SART and CDC data for live birth rates for each treatment.
Stimulated IVF pregnancy and live birth rates are significantly higher than natural cycle IVF or low-stimulation IVF. Achieving a successful pregnancy can take up to three natural IVF cycles. Setbacks include patients prematurely ovulating, unsuccessful egg retrieval, fertilization doesn’t occur, etc. Because of this attrition rate, natural cycle IVF has a higher likelihood of cycles being canceled at an earlier stage resulting in much lower live birth rates per initiated cycle.
At Dominion Fertility, patients under age 38 who transfer a single high-quality blastocyst embryo have a pregnancy rate of about 60%. Much of this success can be partially attributed to the retrieval of multiple eggs. With multiple eggs being retrieved, there is a much higher chance of high-quality embryos developing.
Your Family Building Plans
When deciding what treatment is best for you, it’s essential to consider your family-building plans. If you’re hoping to have multiple children, you may want the ability to freeze extra embryos for subsequent IVF cycles. For those pursuing natural cycle IVF, freezing embryos is not an option. For those utilizing traditional or stimulated IVF, about 50% will end up with remaining healthy embryos that can be frozen for future use.
Frozen embryos have a higher pregnancy rate than a fresh transfer, and these subsequent cycles do not require ovarian stimulation medications or the retrieval process, resulting in a more affordable cycle. These frozen embryos provide patients the opportunities for a second or even third pregnancy. Frozen embryos allow you to continue to grow your family with viable embryos that were created when you were younger. If you’re starting your family as you approach 30 or 35, this could be a critical factor in your decision, as aging has a negative impact on fertility.
Many patients are attracted to natural cycle IVF or low-stimulation IVF because of their cost savings compared to stimulated IVF. A single cycle of natural cycle IVF or low-stimulation IVF does have less of an initial investment because there are fewer medications to pay for. Still, we advise patients to look at the cost compared to the value of the result. Comparing only the costs of these treatments is like comparing apples and oranges. To best make your decision, you should look at the likelihood of your chances of pregnancy and a resulting healthy baby.
Some tout that the reduced cost of natural cycle IVF could be up to 30 – 50% compared to a stimulated IVF cycle. However, if the odds are that you will need to utilize up to three natural IVF cycles before finding success, these costs can quickly add up and exceed the cost of a stimulated IVF cycle.
Although the cost of a stimulated IVF cycle is higher, your chances of achieving a successful pregnancy and live birth are far greater than that of up to three cycles of natural cycle IVF. As for low-stimulation IVF, you are reducing costs through fewer medications and potentially reducing your chance of success by a third.
Further, many higher costs associated with IVF are due to the monitoring appointments, egg retrieval, and embryology laboratory costs. All of which are present with natural cycle IVF, low-stimulation, and stimulated IVF cycles.
Emotional Stress of IVF
Proponents of natural cycle IVF often proclaim that cycles are less stressful. While it may be true that fewer medications could result in less overall stress, our experience in working with patients throughout a decade of natural IVF cycles is that the stress is quite comparable to other types of IVF cycles. There’s no doubt that pursuing any fertility treatment is an arduous process. The appointment schedule is demanding, it’s an emotional process, and there is a financial burden. Because of the likelihood of additional natural IVF cycles needed to achieve success, we have found that all those stressors remain present whether you’re pursuing a natural cycle, low-stimulation, or stimulated IVF.
To help our patients manage the stress of fertility treatment, we provide personalized care, resources, and support throughout the process.
Alternate Options for Religious Beliefs
We understand that some patients have religious beliefs that prevent them from pursuing the development of more than one embryo at a time. We have developed protocols that have higher chances of success than Natural IVF but do not retrieve as many eggs as a traditional IVF cycle. With this protocol, we can fertilize one egg at a time until we develop a healthy embryo that can be transferred.
This allows us to provide an option that respects these beliefs and desires while offering expert medical care designed to give the best possible chance of bringing home a baby.
We’re here to help you have the best possible chance of having the family of your dreams.
We encourage our patients to consider all the factors when exploring their treatment options. Be sure to review pregnancy and live birth success rates and cost information compared to the value those treatments provide.
Throughout our expert physicians’ decade-long experience with natural cycle IVF, we have found that it is not a viable option to recommend for most patients. Compared to natural cycle IVF, IVF cycles with an ovarian stimulation medication protocol are the better option for a time-sensitive, cost-effective method of bringing home a healthy baby.
Contact us today to learn more about your IVF treatment options.