Fertility Treatments & Services Minimal Stimulation IVF (Mini IVF)

Definition: What is Mini IVF?

“Mini IVF”, also known as “minimal stimulation in vitro fertilization” or “Min Stim IVF”, is similar to conventional IVF, but differs in the amount of medications used to stimulate the ovaries. The goal of Mini IVF is to help produce fewer but higher quality eggs with fewer medications and injections. This reduces the overall treatment cost and avoids possible over-stimulation of patients. In this select group of people, it is imperative to optimize all aspects of care in order to yield the greatest benefits.

Min Stim IVF is designed to recruit the highest quality eggs that are naturally selected by the body’s own hormonal pathways. Through the sequential use of oral medications and injectables, this natural pathway is gently augmented in order to keep those eggs growing rather than letting a single dominant egg be selected.

Mini IVF may be an option for women who meet certain criteria to help fulfill the dream of having children using their own eggs versus using donor eggs.

Contact us at 323.525.3377 to schedule a consultation to see if Minimal Stimulation IVF is a good fit for you.

Who is a Good Candidate for Mini IVF?

There are several reasons to consider Mini IVF techniques beyond the lower cost advantage. For certain women, mini IVF is a good option because the success rates may be significantly improved for their specific patient profile and history.

Good candidates for Mini Stim IVF include women whom are “low responders” to traditional IVF medications demonstrated in previous cycles, had failed IVF cycles, had low egg yields, suffer from PCOS, are of advanced maternal age, or test low in their ovarian reserve or AMH levels for their age category. Some patients may also be interested in Mini IVF because they do not want to freeze embryos or want to limit the number of eggs to be fertilized due to personal values.

Dr Berger Mini IVF Process Consultation Couple

Comparing Mini IVF vs. Conventional IVF

The biggest difference between conventional, or regular, in vitro fertilization and Mini IVF is that Mini IVF takes advantage of the body’s natural FSH elevation that occurs following the use of certain oral agents. This simplified protocol involves using either Clomid or Femara to cause the body to increase its own production of FSH by at least 50% to 60%.

This is followed by low dose injectable medication that then keeps the FSH levels elevated until it is time for egg retrieval. By using this protocol, we strive for smaller numbers of better quality eggs. Instead of using maximal dosages of injectable and expensive hormones, hoping to gain maybe one or two more eggs that are of questionable quality, it is believed that this process more naturally allows for the selection of better quality eggs.

Often times, especially in older patients or otherwise “low responder” patients, there is no difference in the number of eggs retrieved between the two IVF protocols. In younger patients, there can be a benefit because there are no symptoms of huge hormonal swings or hyper-stimulation. It is easier on the patient and much cheaper than conventional IVF.

The risks of hyper-stimulation, and injection site reactions are reduced, and the number of total injections are reduced so the overall cost is dramatically reduced in terms of medication cost. Because a lower number of eggs are usually retrieved, there are also reduced costs associated with lab and processing fees.

In many patients whom used conventional IVF stimulation protocols and obtained very poor quality embryos, Min Stim protocols were able to give them a chance with improved embryo quality, even in previously hopeless cases.

What is the Mini IVF Protocol/Process?

As with any IVF treatment, Min Stim IVF involves being monitored throughout the cycle, completing an egg retrieval, having the eggs fertilized with sperm in the lab, and then transferring the embryo back into the womb.

Mini IVF Process:
1. Stimulation & Cycle Monitoring
2. Egg Retrieval
3. Sperm collection
4. Fertilization
5. Culture & Selection
6. Embryo Transfer & Implantation

The process begins on Day 2 and 3 of the menstrual cycle (Day 1 is the first day of your period). The patient starts taking oral ovulation induction agents Clomid or Femara and continues for 5 days. Then on medication day 6, you start injectable medications with gonadotropins Gonal-F or Follistim tailored for you. With this simple protocol, the tried and true oral ovulation induction agents can be used with the injectable gonadotropins to foster a more natural selection of the best eggs for retrieval.

Another advantage of the minimal stimulation protocol is that you do not have to go on Lupron first to suppress the pituitary, so more injections are avoided. Once the eggs have demonstrated adequate growth, and the estrogen levels have risen appropriately, you then start another medication called an antagonist (either Ganarelix or Cetrotide) to prevent premature ovulation.

At the right time, as determined by the rate of growth and rate of rise in estrogen, ovulation is then actually triggered in order to cause the inner machinery of the eggs to activate and allow for final maturation of the egg. Thirty-six hours after initiating ovulation, the eggs are retrieved under conscious sedation administered by a board-certified anesthesiologist in our fully licensed ambulatory surgery center.

After retrieval, the eggs are taken from the operating room directly to our in house embryology lab to be evaluated for quality by our world famous senior embryologist, Laboratory Director Simon Hong, PhD, HCLD and his staff. They then begin the process of fertilization with sperm provided by your partner or donor. The fertilized egg grows into a blastocyst, where on Day 5 or 6 after fertilization, a biopsy can be performed for genetic testing, if elected.

Because both Clomid and Femara can have a slightly negative effect on the growth of the lining of the uterus that is desired for pregnancy, we do not transfer the embryo that same cycle. Also, we want to make sure that the embryos are genetically normal prior to transferring back into the patient. Therefore, the carefully evaluated embryos are graded on a quality scale and are then vitrified, or flash frozen, until ready for transfer in a subsequent cycle. Successful thaw rates are over 98% and are not affected by the length of time the embryo was frozen. So, patients can actually freeze embryos and have them transferred many years later.

Usually about a month or two later, we then start a protocol that prepares the lining of your uterus to accept the normal embryo. This process is meant to mimic a natural cycle where embryo implantation will happen approximately 6 days following fertilization. The frozen embryo is thawed on the day of transfer. Once the uterus is prepared, the events can take place in a coordinated manner that mimics nature and is appropriate for embryo implantation and growth, i.e. pregnancy!

Contact us at 323.525.3377 to schedule a consultation to start your full evaluation for a customized treatment plan.

Pros and Cons of Minimal Stimulation IVF

The idea of Mini IVF is to limit the total costs of medications for less than a regular cycle, avoid the emotional burden, and work on collecting all the healthy eggs without trying to get huge response or pushing the ovaries too hard and have a better outcome per cycle.

Pros of Mini IVF include:

  • Fewer medications used and fewer injections needed
  • Decreased costs (patients pay for relatively inexpensive oral fertility drugs & only three injections per treatment cycle, lower laboratory expenses due to fewer eggs/embryos to process)
  • Lower side effects (significantly reduces the risk of ovarian hyperstimulation syndrome (OHSS))
  • Less emotional burden (patent is prepared for low numbers to increase quality)

Cons of Mini IVF include:

  • Not meant for all patients (few eggs harvested so chance that none will fertilize or survive the IVF process for entire lost cycle)
  • New treatment option (lack of data or long term studies are not available on success rates)

Mini IVF Success Rates

The success rates for Mini IVF are comparable with conventional IVF when looking at the number and quality of embryos that are produced. Theoretically, Minimal Stimulation IVF success rates could be better than conventional IVF for older women, women with low ovarian reserve, low medication responders, hyper responders and women who suffer from PCOS. The success of this protocol relies on the positive outcome of the hormones stimulating your body.

The protocol strives to collect a smaller amount but better quality eggs without over-stimulating the ovaries, which can be hard on the reproductive system for older patients who would normally have less of a response to regular IVF. Our natural approach to minimal stimulation allows us to retrieve quality eggs with less cost passed on to the patient than conventional stimulation. We have found that embryos created with Mini IVF result in a decreased likelihood of miscarriage. There is also a reduction in the emotional burden if there is a failed cycle, because the financial burden is not nearly as great. All of this adds up to better success rates and far less cost to aggravate the patient unnecessarily.

Mini IVF Cost

The cost of Mini IVF will be less than that of a conventional IVF cycle due to the reduction of medications. Also, at our center, we decrease the lab fees because the number of eggs and embryos to be processed is expected to be fewer in these situations.

We have various packages available, all patient-centered. It is the mission of our clinic and that of CHA Fertility Centers founder, Dr. Kwang Yul Cha, to strive for the most affordable care for everyone while maintaining the highest laboratory and medical standards. If you have had previous testing done at other fertility clinics, we will not repeat them just to run up the bill. When we can, we are happy to use allowable outside testing and medical information as long as they are current and meet current standards.

Contact us at 323.525.3377 to schedule a consultation to start customizing your treatment plan and pricing.

Resources:

American Society for Reproductive Medicine (ASRM)

Medication List

Testimonials

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