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Natural Cycle IVF Effective for Older Patients and Decreased Ovarian Reserve
Hi everyone! Dr. DiMattina here to provide you with the latest information regarding Natural Cycle IVF (NCIVF) compared with stimulated cycle IVF. New evidence shows Natural Cycle IVF is an effective treatment especially in older patients and those patients with decreased ovarian reserve.
In 2013, our practice published a report in Fertility and Sterility titled, “Utilization and success rates of unstimulated in vitro fertilization in the United States: an analysis of the Society for Assisted Reproductive Technology database” (Gordon et al) in which we compared the pregnancy and live birth rates of Natural Cycle IVF to all stimulated IVF performed in the United States from 2006 to 2007.
The results of this study were remarkable, showing that the implantation rates for both types of IVF were similar in patients less than 35 years old (NCIVF 35.9% vs Stim IVF 31.7 %) but NCIVF had a statistically higher implantation rate for all patients 35 to 42 years old compared with stimulated IVF. The NCIVF implantation rates across all age groups (
So, Dominion Fertility decided to analyze our NCIVF data on 615 patients undergoing 1,288 cycles of NCIVF from 2007 to 2011 compared with patients who underwent stimulated IVF in the entire United States as reported to SART. It is well known that Dominion Fertility has the largest NCIVF program in the United States. The results again showed that the implantation rates were similar in patients
|SART Stim IVF live birth/ET%||31.4%||27.3%||21.5%|
|NCIVF singleton live birth/ET %||34.2%||30.3%||23.5%|
Importantly, the data also showed that the implantation rates for NCIVF were independent of serum antimullerian hormone (AMH) levels. In other words, the NCIVF implantation rate was unaltered if the patient’s AMH level was normal (>1.0) or very low (
Most recently, a study by Wolff et al titled, “Gonadotropin stimulation for in vitro fertilization significantly alters the hormone milieu in follicular fluid: a comparative study between natural cycle IVF and conventional IVF” (Human Reprod, 2014), suggested lower oocyte quality in stimulated IVF compared to NCIVF.
What does all of the above mean? First, NCIVF has similar implantation rates in patients less than 35 years old compared with stimulated IVF but superior implantation rates in patients over 34 years old. Second, pregnancy rates for NCIVF are independent of serum AMH, so patients with poor ovarian reserve have the same success rates as patients with normal ovarian reserve. This is not true for stimulated IVF. Recent evidence suggests that the naturally produced oocyte may be superior to the stimulated oocyte. We find many of our patients with poor ovarian reserve who have failed stimulated IVF to be successful using NCIVF and many of our patients choose to undergo NCIVF before moving on to egg donor IVF or adoption. Additionally, many patients attempt NCIVF as a first step before considering stimulated IVF. As I have always stated, both types of IVF are excellent treatment options and one is not superior to the other. Deciding which type of IVF is best for the patient depends upon each individual couples’ situation.
This month we are presenting preliminary data at the annual meeting of the American Society of Reproductive Medicine using our NCIVF data that was analyzed by the Yale University Reproductive group. Their analysis showed significantly fewer preterm births in pregnancies conceived using NCIVF as compared with stimulated IVF. Apparently the same is true in the animal IVF world and the Yale University group wished to see if this was also true in human IVF. More on this later for sure.
I sincerely hope that this newer information about NCIVF and stimulated IVF will be helpful to our patients. Best wishes always!
1. Gordon JD, DiMattina M et al. Fertil Steril 2013;100:392-95
2. DiMattina M, Gordon JD et al. J of Reprod Med 2014; Sept 03
3. DiMattina M, Gordon JD et al. IVF Lite 2014; 1:81-7
4. Wolff M, Kollmann Z et al. Human Repro 2014; vol 29,no.5, 1049-57