Geoffrey Sher MD & Drew Tortoriello MD
Mini-IVF is a procedure that involves ovarian stimulation with oral fertility drugs such as clomiphene or letrozole to promote the development of follicles, for egg extraction. This is on the pretext that Mini-IVF, involves the administration of oral low-dosage medication, cuts down on cost, reduces the need for intensive monitoring and is highly successful.
Natural-cycle (NC)- IVF is an extension of the same concept. It relies on the development of follicles during natural ovulatory cycles, sufficient to permit extraction of one (and sometimes more) eggs, while completely avoiding the need for any of fertility drugs.
EZ-IVF: Sher Fertility Solutions (SFS)-NY is proud to announce the introduction of EZ-IVF, a low-cost, low risk, and highly successful alternative to Mini/NC-IVF . EZ-IVF is well suited to women under 40Y of age who have adequate ovarian reserve (AMH=>1.5ng/ml or > 10pmol/L). The process involves the use of very low dosage gonadotropin stimulation (administered every other day), thereby virtually eliminating the risk of complications. The process also requires minimal monitoring. It does all this at virtually the same low cost as Mini-IVF while offering a much higher potential for success and a greater likelihood that there will be left-over embryos for cryopreservation with a view to later use.
With regard to the argument given that both Mini and NC-IVF will yield comparable success rates to “conventional IVF”, please consider the following:
1. Use of fewer drugs translates into lower cost. This would be true, were it not for the fact that success rates with mini-IVF across the board are much lower than with conventional ovarian stimulation. More important is the fact that the cost of IVF should be expressed in terms of “the cost of having a baby” rather than “cost per cycle of treatment”. When this is taken into account the cost associated with mini-IVF will be significantly higher than conventional IVF. Then there is the additional emotional cost associated with a much higher IVF failure rate with mini-IVF.
2. Absent or milder stimulation using oral agents such as clomiphene, letrozole reduces stress on the ovaries and overall risk associated with IVF. This argument, while perhaps having some merit when applied to mini-IVF conducted in younger women who usually have normal ovarian reserve, does not hold water when it comes to older women and those with diminished ovarian reserve (DOR).. Furthermore, there is good body of evidence to show that both clomiphene and letrozole increase the release of LH-by the pituitary gland which so increases ovarian testosterone as to potentially further compromise egg development and maturation. .
3. Women with DOR will respond better to “milder stimulation” and egg quality will so be enhanced. This assertion is totally flawed. It is like saying that applying less force to a heavier object will increase the likelihood of moving it”. That is simply not how FSH stimulates follicle development.
4. Mini-IVF is less technology driven, less stressful and easier to execute. There is some merit to this assertion although all IVF cycles require careful monitoring and the same involvement of the embryology laboratory.
There can be little doubt that aside from a woman’s age, the method used for ovarian stimulation represents the most important determinant of egg/embryo quality and thus of IVF outcome. There is no single stimulation protocol that is suitable for all IVF patients. It must be individualized…. especially when it comes to women who, regardless of their age have DOR and for women over >35y of age for whom the use of clomiphene for ovarian stimulation is not optimal.
So, what about younger women with normal or increased ovarian reserve? If mini-IVF has any role at all, it could be in such cases. I do not not advocate aggressively stimulating the ovaries of younger women who have normal or increased ovarian reserve (as assessed by basal FSH& AMH) simply to try and access more eggs. In fact, such an approach is neither safe nor acceptable. In such women it is often wiser to use lower dosage stimulation to try and prevent the development of severe ovarian hyperstimulation syndrome (OHSS) which aside from putting the woman at severe risk , can also compromise egg/embryo quality. This is where EZ-IVF comes in! For the reasons state above, it offers a rational alternative to “conventional” IVF as well las to Mini-IVF and NC-IVF.
I invite you to contact us at Sher Fertility Solutions (SFS) if you are interested in learning more about this exciting development, called EZ-IVF.
PH: 702-533-2691 & 646-792-747