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Natural Cycle IVF, Is it for You?

Considering Natural Cycle IVF

Dominion Fertility began performing Natural Cycle IVF in January 2007 and this Arlington, Virginia fertility clinic is the largest NCIVF center in the United States currently performing more than 800 cycles of NCIVF per year. So of course they’ll have the NCIVF answers you’re looking for, especially to that big question you’ve been asking yourself: Is Natural Cycle IVF for me?

Dominion Fertility’s Medical Director Dr. Michael DiMattina discussed the ins and outs of this assisted reproductive technology that requires no fertility drugs to produce multiple eggs in an effort to help you make the fertility treatment choice that is best for you.

What types of patients request Natural Cycle IVF treatment?

NCIVF can be used to treat any type of infertility problem so long as the patient has regular menstrual cycles. With NCIVF, there are no ovarian stimulation drugs, so many patients wish to first try NCIVF prior to undergoing treatment using stimulated IVF. Furthermore, ovarian stimulation drugs are expensive costing roughly $6,000 - $8,000 per treatment cycle, whereas the costs of a single NCIVF cycle is about $5,000 dollars.

Others prefer the simplicity of NCIVF compared with stimulated IVF. Many patients with decreased ovarian reserve or who have failed stimulated IVF try NCIVF prior to proceeding with ova donor IVF or adoption, as many will be successful. Patients with low AMH or elevated FSH levels are good candidates for NCIVF so long as they have regular menstrual cycles. Many studies have shown much success using NCIVF for patients having poor ovarian reserve.

Who is the ideal Natural Cycle IVF candidate?

Any patient who is a candidate for stimulated IVF is a candidate for NCIVF as long as she has regular menstrual cycles.

As with any infertility treatment, success rates are age dependent. Patients less than 35 years old have a better likelihood for success compared with those over 35. However, we treated a 47 year old patient with NCIVF and she became pregnant after her first embryo transfer and she delivered a healthy baby at age 48 years old. She had failed 4 treatments of stimulated IVF when she was 42-43 years old and her doctor told that her that her only options were egg donor IVF or adoption. She was not interested in either of those treatments but at age 47 she learned about NCIVF and decided to give it a try. In addition to her age, her serum FSH level was 20 with a very low AMH level too.

The only reproductive reason that would prevent a patient from undergoing NCIVF is that her menstrual cycles are completely irregular or that her uterus is abnormal. Patients are not rejected because of elevations in their serum FSH, low AMH or previous IVF failures. Other medical conditions may also be relevant but that would be true for any other infertility treatment.

What are the 3 top advantages of NCIVF?

There are many advantages of NCIVF. Simplicity, relatively low costs and NCIVF is often successful when other treatments have failed. In my opinion, it’s a great first step for patients who wish to do IVF but who want to keep it simple and not take ovarian stimulation drugs. It’s also a great treatment for the cost especially if it works on the first or second attempt. Our experience shows that over 80% of our patients who get pregnant with NCIVF do so after only one or two embryo transfers. And finally, NCIVF can be used for patients who have poor ovarian reserve or who have failed stimulated IVF and provide hope before moving on to egg donor IVF or adoption.

What are the drawbacks of Natural Cycle IVF?

Because there are no drugs used for Natural Cycle IVF, cycle cancellation is high. About 50% of patients who begin a cycle will complete a cycle and have an embryo transfer. Cycle cancellation may be due to an LH surge (12-15% of cycles), no egg (8-10%), no fertilization (5-8%) or embryo arrest (20-25%). With stimulated IVF, many eggs and embryos are usually produced, so the likelihood for embryo transfer is high and the drugs can control and prevent the LH surge for most patients.

The good news is that most of the pregnancies that occur using NCIVF occur within the first or second embryo transfer.

What percentage of your patients opt for Natural Cycle IVF?

In our practice, about 75% of our total IVF cycles are NCIVF.

What are the top 3 reasons they opt for Natural Cycle IVF over any other treatment?

Many patients don’t have IVF insurance coverage, so they want to try the lesser expensive NCIVF first. Others just don’t want to use ovarian stimulation drugs for a variety of reasons. Many of our patients are older with poor ovarian reserve and they know that they will produce few eggs with stimulated IVF or they have already failed stimulated IVF, so they wish to try NCIVF before pursuing egg donation or adoption. After performing NCIVF for 7 years now, our data shows that the success rates with NCIVF are equal for patients who have normal or poor ovarian reserve regardless of their levels of FSH or AMH. So, we really don’t care what a patients’ FSH or AMH level is when we perform NCIVF.

How do the success rates of NCIVF compare to other treatments?

There are no randomized prospective controlled studies that answer that question. However, our data has been presented at the Annual Meeting of the American Society of Reproductive Medicine showing that the implantation rates with NCIVF are similar to stimulated IVF for patients less than 35 years old but superior in patients 35-42 years old regardless of the level of their serum FSH and AMH. This data has been submitted for publication.

We recently analyzed the data from the SART database for all IVF centers in the United States for 2006-07 and found that the pregnancy and live birth rates per initiated cycle were 19.2 and 15.2% for NCIVF and stimulated IVF, respectively, in patients less than 35 years old. This was published in Fertility Sterility in 2013.

What is the price range for Natural Cycle IVF and what does that price cover?

The total costs for a cycle of NCIVF at Dominion Fertility is $4,400 plus anesthesia (additional $450). The costs are pro rated if an embryo transfer does not occur. This covers the monitoring, oocyte retrieval, embryo transfer and ICSI. We perform ICSI in most patients as there is only one egg.

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