What is IVF Minimal Stimulation?
In patients with low ovarian reserve (when the Antimullarian hormone (AMH) value of <1.0 ng/ml and few follicles are seen on the transvaginal ultrasound), the traditional IVF protocol may result few eggs with few embryos qualified for transfer. We have found that, in these cases, it is better to use a protocol that exposes the ovary to smaller doses of medications and leads to higher-quality embryos instead of bombarding the ovaries with maximal hormonal stimulation. With the Minimal Stimulation IVF, we like to accumulate at least five embryos over two or more cycles in order to select at least two good quality embryos for transfer, therefore increasing the chance of conception.
How Does Minimal Stimulation IVF Work?
What medications are used in Min Stimulation?
We usually use Clomiphene Citrate daily and then start gonadotropin injections (2-3 ampoules daily) on day 6 of stimulation. Vaginal ultrasounds are used to monitor the follicular growth, and the medication regimen continues until the follicles reach maturity. The medication we use is a fraction of the amount used typical IVF cycle.
How long is the Minimal Stimulation IVF process?
With the Minimal Stimulation IVF, we attempt to collect about five embryos. From these five embryos, we should be able to select at least two good quality embryos, which will hopefully lead to a successful pregnancy. This may require one to two cycles of stimulation.
Using Clomiphene Citrate will have a negative impact on the endometrium, so we prefer to freeze the embryos.
How does the embryo transfer occur?
Once we have accumulated about four or five embryos, we can prepare the patient for the embryo transfer. This will include evaluation of the uterine cavity by a process called a hysteroscopy and an endometrial biopsy. This procedure has been shown to improve embryo implantation by creating a new layer of endometrial cells.
The uterus lining is prepared and thickened by estrogen therapy, which lasts for about 14 days. The estrogen phase is followed by 4-6 days of progesterone. The embryos are then thawed and transferred.
How does the Min Stimulation IVF differ from the Natural Cycle IVF?
In a natural cycle IVF, we don’t typically use any medications to induce the growth of the follicle (egg). This makes the process much more problematic because it is difficult to pinpoint the exact time of follicle maturation and can result in cancellation of the egg retrieval. By using gonadotropins, we have more control over the growth of the follicle. Also, we can stimulate the growth of more than one follicle, which allows us to select the best ones.
Why Choose IVF Minimal Transfer?
In patients with low ovarian reserve, Antimullarian Hormone of (AMH)< 1.0 ng/mL, or less than four antral follicle counts (eggs in the ovary), the traditional IVF protocol would result in only one or two eggs and one or zero quality embryos for transfer. We now understand that in these cases, it is better to utilize a protocol that exposes the ovary to a smaller dose of gonadotropins instead of bombarding the ovary with an exaggerated amount of hormonal stimulation. In the Min Stimulation protocol, we can use less medication and accumulate more embryos over two or more cycles, which will in turn increase the chance of conception.