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Successful Outcomes with Natural Cycle IVF
Dominion Fertility began offering Natural Cycle IVF (NCIVF) in January, 2007, and to date we have performed more than 3,000 cycles of NCIVF, the largest experience in the United States and one of the largest NCIVF programs in the world.
This week, the Journal of Reproductive Medicine published our experience describing critical parameters necessary in order to optimize a successful treatment outcome using NCIVF (J Reprod Med 2014;59:267-273). This data will assist other IVF centers interested in starting a NCIVF program or enhance the results in centers that already offer NCIVF.
We described certain critical parameters in estrogen levels and follicle sizes that resulted in better pregnancy rates in 422 patients who underwent 821 cycles of NCIVF from 2007-2010. Furthermore, we found that FSH and antimullerian hormone (AMH) levels were irrelevant in predicting NCIVF success. In other words, the pregnancy rates were not diminished in patients who's FSH levels were greater than 10 or in those patients with low AMH levels. Poor ovarian reserve did not lower the success rates in patients treated with NCIVF.
In this group of patients we found the clinical success rates for NCIVF were similar on day 3 or 5 embryo transfer. In stimulated IVF, it is well established that a day 5 embryo transfer is superior to a day 3 transfer. Because there is no ovarian stimulation in NCIVF, the endometrium is spared the well-demonstrated adverse effects of ovarian stimulation drugs on the endometrium, and that is why we believe we observed no differences in day 3 or 5 embryo transfer using NCIVF.
Most importantly, our live birth rates or ongoing pregnancies per transfer rate were 49%, 24%, 27% and 13% for patients under 30, 31-34, 35-39, 40-42 years old, respectively, again unaffected by the level of the patients' FSH or AMH level. In fact, about one third of these patients had poor ovarian reserve.
In 2009, we began offering NCIVF to all patients with regular menstrual cycles regardless of their FSH or AMH levels or their history of previous failures using stimulated IVF. Anecdotally, we had a 48 year old nulliparous patient deliver a healthy infant following her first embryo transfer using NCIVF with her own egg. This patient's FSH was 20 and her AMH 0.6.
For many years NCIVF was considered of historical interest only. The concern with NCIVF has focused on the lower success rates and the need for multiple treatment cycles to achieve the same pregnancy rates as a single treatment cycle of stimulated IVF. This concern seems less relevant today with modern IVF techniques such as careful ultrasound and estradiol assessments to determine follicular competence and maturity. Indeed, in this study, 84% of our pregnancies occurred within the first 2 embryo transfers, so most did not require more than 2 embryo transfers.
We believe that NCIVF if an effective and well-received therapy for any infertile patient with regular menstrual cycles regardless of their ovarian reserve. I look forward to sharing with you more information on our next article coming out this month further describing another 1,200 cycles of NCIVF at Dominion Fertility that directly compares the success rates of NCIVF to that of stimulated IVF. Stay tuned! Dr. Michael DiMattina