The Mini IVF protocol gives women with minimal egg reserve a chance to conceive their own biological children.
For patients with low ovarian reserve, the traditional IVF strategy has been to use aggressive stimulation to collect as many eggs as safely possible in one cycle. However, for patients whose ovaries can only produce a few eggs per cycle (those with AMH < 0.3 ng/ml or antral follicle count <5), there comes a point when maximum stimulation is no longer cost effective. For these patients, a gentler stimulation protocol that combines the body’s natural reserve of FSH (Follicle Stimulating Hormone) with a lighter dose of medications can give the same stimulating effect and thus may be more productive. Instead of wasting money in high doses of medications that are unlikely to be effective, the resources can be channeled into a couple of Mini IVF cycles to accumulate more embryos in order to improve the chance of success.
As an analogy, imagine driving a car with an engine that can only allow a top speed of 30 miles/hr. Pressing the gas pedal aggressively would only waste fuel without making the car going any faster. A better approach would be to nudge the accelerator just enough to allow it to go at 30 miles/hr and use the saved gas to travel a longer distance.
At IVFMD, we use a combination of clomiphene and low dose injectable stimulation medications to allow maturation of multiple follicles. By inducing the release of FSH from the pituitary with clomiphene, we can significantly reduce the amount of FSH from medications to achieve the same stimulating effect of an aggressive IVF protocol.
Our Mini IVF program is consisted of 2 phases:
- Embryo Accumulation Phase: Patients use a combination of clomiphene and low dose injectable medications to stimulate the ovaries, have monitoring with sonograms and blood works, and undergo egg retrieval. All matured eggs are injected with sperm (ICSI), and the resulting embryos are cultured to day 3 and then cryopreserved by the new vitrification method. Based on our experience, most patients require 2 rounds of Mini IVF to accumulate at least 3 embryos for future transfer. After each Mini IVF cycle, a break of 1 cycle is recommended to allow the ovaries to return to their normal state before the next stimulation cycle.
- Embryo Transfer Phase: Once at least 3 embryos are available for transfer, patients can proceed to the frozen embryo transfer cycle. For about 2 weeks, estrogen is used to grow the uterine lining before vaginal progesterone is added to mature the endometrium. By avoiding exposure to high hormone levels seen in the stimulation phase, the endometrium can grow and mature closer to the conditions of a natural cycle, thus making it more receptive to the embryos. On the transfer date, the embryos are thawed and prepared for transfer. Laser drilling of the zona is also performed to facilitate embryo hatching and promote implantation.
The main disadvantage of the Mini IVF program lies in its length. Whereas a typical IVF cycle lasts about 6 weeks (from the start of birth control pill to the day of pregnancy test), the Mini IVF program can last 3-6 months before the outcome is known. A break cycle is usually necessary between Mini IVF cycles to allow the ovaries to return to their resting state before the next stimulation.
In addition, the total cost of treatment is about the same for the Mini IVF program when compared to that of the conventional aggressive IVF protocol. The savings in medication cost is just diverted to cover a second Mini IVF cycle in order to produce more embryos. Lastly, while the Mini IVF program can help to produce more embryos, it cannot change the greatest challenge faced by many patients with diminished ovarian reserve, low egg quality. However, by creating a greater number of embryos than possible with a single cycle, the chance of having a normal embryo can be increased.
In summary, for most patients undergoing IVF treatment, the standard approach of high stimulation to obtain more eggs can improve their chance to conceive. However, in women with extremely low ovarian reserve, a better choice may be to use the gentler stimulation of the Mini IVF protocol in order to accumulate embryos that can later be transferred into a more receptive uterine environment of the frozen cycle. For these women, less stimulation can mean more embryos and a better chance of success.