Minimal Stimulation IVF (Mini IVF)

Minimal stimulation IVF, sometimes referred to as mini IVF or gentle IVF, uses lower doses of fertility medication than traditional in vitro fertilization (IVF) during the egg stimulation process and sometimes at egg retrieval. During a traditional IVF cycle, patients use gonadotropin hormone injections to produce a number of eggs within the ovaries.

But unlike a typical IVF cycle’s injections, mini IVF primarily uses an oral medication (Clomid) to induce ovulation prior to an egg retrieval. This greatly reduces the number and dose of hormone injections.

Benefits of minimal stimulation IVF

There are many benefits to mini IVF, most notably the reduction in medication use and the resulting reduction in cost. Additional advantages of the mini IVF include the following.

• Fewer side effects and less discomfort from fertility medication. Specifically this involves reduced injection site pain and exposure to gonadotropin medications, which may cause symptoms like abdominal discomfort, bloating and mood swings.
• Decreased likelihood of complications such as ovarian hyperstimulation syndrome (OHSS), a situation where the body overreacts to the hormones stimulating egg production. This causes the ovaries to swell and potential symptoms like abdominal pain, nausea and vomiting.
• Gives people who do not respond well to injection protocols in conventional IVF a similar option.
• Requires fewer injections, fewer blood draws and less monitoring, reducing the number of office visits and further lowering costs.

Additionally, minimal stimulation IVF mitigates the risk of needing to cryopreserve a significant number of embryos, as can be the case with standard IVF. Since fewer eggs are produced via mini IVF, fewer embryos are developed in the lab.

The presence of remaining embryos can pose a moral and financial conundrum for couples who are satisfied with the size of their family after IVF. In that regard, mini IVF may be advantageous for religious and ethical reasons, because it limits the number of embryos created.

Who should consider mini IVF?

Individuals and couples who want to reduce the cost associated with IVF, avoid higher doses of medication, or who are looking to reduce the time commitment associated with IVF might consider using minimal stimulation in place of standard IVF.

Good candidates for IVF include:

• Women under the age of 35.
• Patients with tubal factor infertility.
• Couples who are not experiencing male factor infertility.
• Individuals at greater risk of complications from injections used during conventional IVF.
• Individuals with diminished ovarian reserve who have responded poorly to injections previously.

The process

Each minimal stimulation IVF cycle follows a very similar process to a conventional IVF cycle. Patients take oral contraceptives until ovulation induction is initiated. Rather than using injectable medications to spur ovulation, the patient will begin taking lower dose oral medications.

During the ovulation induction phase, the patient will undergo monitoring and ultrasounds to confirm that the follicles within the ovaries are maturing into eggs. Patients opting for mini-IVF will still need to administer injections, but will require them less frequently and take lower doses than patients undergoing regular IVF. Injections of follicle stimulating hormone (FSH) and human chorionic gonadotropin (hCG), sometimes referred to as a trigger shot, will be administered prior to egg retrieval.

Once the eggs have been retrieved, they will be fertilized by the partner’s or donor’s sperm, develop as embryos in the lab, and transferred to the uterus.

How does mini IVF compare to other procedures?

Minimal stimulation bears similarities to medicated intrauterine insemination (IUI) in regard to the early stages of the process, specifically the uses of oral medications to encourage eggs to develop in the ovaries. A single mini IVF cycle has a higher success rate than a single IUI.

Mini stimulation IVF is often described as the bridge between natural cycle IVF and traditional IVF. Natural IVF follows the egg retrieval process of conventional IVF without any medications. This means patients don’t undergo any sort of ovarian stimulation outside of natural ovulation.

Natural IVF cycles typically yield 1-2 eggs, which may or may not result in an embryo. Due to the absence of medication, natural IVF is relatively low cost in comparison to conventional IVF with injectable hormones.

Mini IVF produces more eggs and often more embryos than natural IVF, increasing the likelihood of achieving pregnancy without the high cost of conventional IVF. A typical mini stimulation cycle produces an average of 3-6 eggs, resulting in 1-4 embryos. This limits the number of embryos that need to be stored, donated or destroyed.

Disadvantages of mini IVF

While having fewer resulting embryos may be an advantage for some, it may be considered a disadvantage of mini IVF for patients with different family goals. Since mini IVF results in fewer eggs and embryos, it is statistically less successful than standard IVF. Another disadvantage is that multiple mini-IVF cycles may be required to achieve pregnancy, resulting in an additional cost to the patient for each attempt.