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The Benefits of Mini-IVF: Should You Consider it?
February 15, 2013
Aggressive fertility treatment protocols, like in vitro fertilization (IVF) with high dose gonadotropins, can result in a condition called Ovarian Hyperstimulation Syndrome (OHSS). Most cases of OHSS are mild and consist of bloating and enlarged ovaries. However, about 2% of cases can result in severe complications, fluid in the abdomen, difficulty breathing, hospitalization, or even death. OHSS is relative to the number of eggs retrieved during an IVF cycle, and symptoms can occur with as few as 15 eggs retrieved. The greater the number of eggs retrieved, the greater a woman’s risk of OHSS.
Suheil J. Muasher, M.D., of Duke Fertility Center in Durham, NC, says OHSS is one of the worst complications with IVF, but is actually the most avoidable side effect. “If you look at the SART data, 30% of patients have fifteen or more eggs retrieved [which increases a patient's risk of OHSS]. This syndrome should be completely preventable. To decrease incidence, we can give the patient low dose gonadotropin medications (injectable fertility drugs). Minimal stimulation IVF (mini-IVF) can be offered to patients at risk,” he says.
A minimal stimulation IVF, or mini-IVF, cycle consists of lower dose fertility drugs and fewer days of stimulation. Patients are prescribed Clomid for five days, which is supplemented with low dose follicle stimulating hormone (FSH) injections. Dr. Muasher says the average IVF patient expends between 40-50 vials of gonadotropin fertility drugs, but mini-IVF patients use only eight to ten vials. “The drawback is that you get a lower number of eggs, maybe six or seven in a good responder, but the pregnancy rate is almost as good as traditional IVF and having fewer eggs addresses some of the moral or ethical and financial concerns a patient might have with freezing a higher number of embryos,” Muasher explains. Benefits of minimal stimulation IVF include eliminating the risk of OHSS, having an easier protocol, reducing the costs to the patient, addressing a patient’s concern of creating embryos they may not use, and also reducing the harmful effects of fertility drugs on the uterine lining which can hinder implantation.
Dr. Muasher advises that mini-IVF is a good option for all fertility patients, but specifically those at risk of OHSS, like patients with PCOS, or fertility patients known to respond poorly to an aggressive fertility drug protocol. For poor responders who typically have two to six eggs retrieved even in the most aggressive fertility drug protocols, mini-IVF provides cost savings since high doses of fertility drugs are not necessary to achieve the same results and less frequent monitoring is required. Overall, mini-IVF is a safe and cost-effective treatment for fertility patients known to have less desirable effects from a traditional IVF cycle.