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Mini IVF — A Simpler In Vitro Fertilization

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a blog by Michael A. Feinman, M.D., HRC Fertility, January 14, 2011

Mini-IVF and natural cycle IVF are potential alternatives for women who do poorly with conventional stimulation protocols and might otherwise be directed to egg donation.

The value of using stimulated cycles for IVF is well-established. However, there are a number of women who prove to not benefit from the potent ovarian stimulation protocols that are commonly used. In particular, women with elevated FSH levels, especially after age 40, usually do not respond well.

For many years, it was accepted dogma that women over age 40 with FSH levels greater than 10 experience a zero pregnancy rate with IVF using their own eggs. However, over the past decade, a number of IVF programs, lead by physicians in Japan, have shown that some of these women can indeed conceive viable pregnancies through minimal-stimulation IVF or natural cycle IVF.

What Is Mini IVF?

The concept of minimal stimulation or natural cycle IVF is that nature is better at picking out a woman’s best egg each month. Retrieving these one or two eggs for IVF may prove better than exposing these women to high stimulation protocols to end up only retrieving a small number of eggs anyway.

As the names imply, minimal-stimulation IVF involves the use of oral drugs like Clomid and/or low doses of FSH injection, while natural cycle IVF relies on careful monitoring to allow retrieval of one egg without ovarian stimulation.

Who Can Benefit?

In addition to women with elevated FSH levels, other women who might benefit from these alternatives are those who despite normal FSH levels responded poorly in previous cycles and women with poor embryo quality in previous attempts. Some women with PCOS may have poor embryo quality, despite explosive responses to stimulation drugs.

These alternatives are especially attractive when women have blocked tubes or there is a significant male factor. In these cases, “one egg is better than none.”

Ultimately, egg donation represents a better option for most of these patients. However, minimal-stimulation IVF or natural cycle IVF offers women a small, but realistic, chance of conceiving with their own eggs before moving on to egg donation.

Success Rates

It is difficult to obtain pregnancy rate statistics for these alternatives. SART does not require reporting them, and the larger centers have not published their success rates.

Thus, in most cases, women are well-advised to attempt IVF with stimulated cycles before considering these alternatives.


Michael A. Feinman, M.D. graduated UCLA School of Medicine in 1980. He completed his residency in Obstetrics and Gynecology at the Sloane Hospital for Women, Columbia-Presbyterian Hospital of New York, in 1984 and his fellowship in REI at the University of Pennsylvania in 1986. Dr. Feinman went on to help establish the IVF program at the Albert Einstein College of Medicine in NY. His team performed the first vaginal ultrasound guided egg retrieval in New York and created on of the first successful egg donor programs in the world.

Dr. Feinman is an active member of an international organization called the Association of Private ART (A-PART). As part of his participation in this group, Dr. Feinman has had first-hand contact with many of the Japanese doctors who have popularized the concept of “Mini-IVF.”

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