IVF Choices

In the USA, most patients undergoing fertility treatment are familiar with “Conventional IVF” since it is the only type of IVF that is readily available in most states. At our IVF center, we also offer “Mild IVF” that consists of both Natural Cycle IVF and Minimal Stimulation IVF. Mild IVF was primarily developed in Japan at the Kato Ladies Clinic, where they currently perform greater than 20,000 cycles of mild IVF a year. Mild IVF is the most common type of IVF performed throughout Europe, Asia and South America.

To decide which type of IVF should be considered for you, we have broken down the following issues that should be addressed per IVF type available.

(1) Patient’s Age

Natural Cycle IVF is suitable for any woman that regularly ovulates REGARDLESS of her AGE. This includes women over 40 years old, women with decreased ovarian reserve, women with prior poor response to ovarian stimulation medication, and women who have been unsuccessful with previous conventional IVF.

Minimal Stimulation IVF is also suitable for any woman that regularly ovulates REGARDLESS of her AGE. This includes women over 40 years old, women with decreased ovarian reserve, women with prior poor response to ovarian stimulation medication, and women who have been unsuccessful with previous conventional IVF.

Conventional IVF is most suited for young women under 36 years old with a good ovarian reserve and a good response to ovarian stimulation medication.

(2) Ideal Candidates

Natural Cycle IVF is ideal for women who want NO OVARIAN STIMULATION medication. This may include women with decreased ovarian reserve or women with a history of poor response to ovarian stimulation medication. This also may include women who have a strong interest in holistic approaches to medicine, women who desire a less artificial & less medically aggressive approach for their fertility treatment, women with a medical condition or family history that contraindicates ovarian stimulation with reproductive hormones (eg., certain cancers especially if they are estrogen or progesterone receptor positive), and women who want to use their own eggs but have been rejected from conventional IVF programs unless they accept donor eggs. This approach is fine for women with tubal factor infertility, male factor infertility and couples with unexplained infertility. This is also a good option for same sex female couples who have failed donor sperm IUI and are looking for a reasonable treatment option that is cost considerate.

Minimal Stimulation IVF is best for women who want to LIMIT the amount of OVARIAN STIMULATION MEDICATION used. This may include women with decreased ovarian reserve or women with a history of poor response to ovarian stimulation medication. This also may include women who have an interest in holistic approaches to medicine, women who would like a more natural & less aggressive approach for their fertility treatment, and women who want to use their own eggs but have been rejected from conventional IVF programs unless they accept donor eggs. This approach is fine for women with tubal factor infertility, male factor infertility and couples with unexplained infertility.

Conventional IVF is best for women who want to become pregnant as quickly as possible, women who do not care how much hormonal medication they use during the cycle, women who will accept donor egg IVF if they do not respond well to ovarian stimulation medication, and women who can easily afford (or have medical insurance benefits that covers) the additional expense of conventional IVF and the thousands of dollars of medication that is used. This approach is also fine for women with tubal factor infertility, male factor infertility and couples with unexplained infertility.

(3) Specific Benefits

In Natural Cycle IVF there is no exposure to ovarian stimulation medications. A woman’s natural process for egg development is allowed to proceed normally and in many cases it is thought that a better egg is retrievable under these circumstances than when her reproductive system is overridden by ovarian stimulation hormones. There is a very low risk of multiple pregnancies and no risk of ovarian hyperstimulation syndrome. Natural cycle IVF has good success rates for women who regularly ovulate and are under the age of 35 years old.

In Minimal Stimulation IVF there is exposure to ovarian stimulation medication but in far lower amounts than what is used during conventional IVF. The attempt is to supplement the woman’s natural process of egg development without completely overriding this process, and in many cases it appears that better eggs are retrievable in these circumstances when compared to the eggs retrieved at conventional IVF. There is a low risk of multiple pregnancies and a low risk of ovarian hyperstimulation syndrome (much lower than with conventional IVF). Minimal Stimulation IVF has very good success rates for women who regularly ovulate and have a good ovarian reserve, and a reasonable success rate for women with decreased ovarian reserve when using their own eggs.

In Conventional IVF there is exposure to extreme amounts of ovarian stimulation medication and the goal usually is to retrieve as many eggs as possible so that the best embryos (fertilized eggs) can be selected. There is a common belief that most women can only produce 4-5 good quality eggs per IVF cycle regardless of the number of eggs that are retrieved, so that conventional IVF often involves discarding many eggs and embryos that are not capable of reproductive success. Minimal Stimulation IVF attempts to retrieve these same 4-5 high quality eggs but uses a more natural process and much less medication. Conventional IVF has a high success rate per egg retrieval, possibly due largely to the very careful selection of patients with the greatest likelihood of success.

(4) Specific Risks

In Natural Cycle IVF there is usually only one mature egg that develops (that may be retrieved), there is a chance of premature ovulation (ovulation before we can retrieve the egg from the ovarian follicle), and there is a chance that no eggs are retrieved despite the appearance of a mature egg in a follicle at egg retrieval. Consequently, it may take several cycles to achieve a pregnancy (there is a relatively low pregnancy rate per egg retrieval procedure). If genetic testing is desired, it may take several cycles to accumulate enough embryos.

In Minimal Stimulation IVF couples with a good prognosis for Conventional IVF may require more cycles to achieve a pregnancy when compared to Conventional IVF. These same patients do have a much lower risk of complications from ovarian stimulation medication, including multiple pregnancies and ovarian hyperstimulation syndrome, compared to Conventional IVF.

In Conventional IVF there appears to be greater emotional stress related to the cycle, there is much more office monitoring which can be very inconvenient, side effects from the medications due to extreme doses may occur (cramps, hot flashes, mood swings, heavy flows, insomnia, breast tenderness, headaches, weight gain, dizziness), and there is a greater chance of developing ovarian hyperstimulation syndrome (which can result in rapid weight gain, dehydration, shortness of breath, nausea and vomiting and possibly hospitalization for 1-2 weeks).

(5) Medication Used

For Natural Cycle IVF, no ovarian stimulation medication is used and generally Lupron or HCG is used to trigger ovulation. Oral contraceptive pills may be used to minimize pre-cycle egg maturation if this appears to be an issue for the patient. Nonsteroidal anti-inflammatory medication (such as Ibuprofen) may be used to inhibit premature ovulation.

For Minimal Stimulation IVF, birth control pills may be used to minimize pre-cycle egg maturation, ovarian stimulation medications may include pills (Clomiphene citrate, Letrozole) and/or injectables (Follistim, Gonal F, Menopur, possibly along with a GnRH antagonist) and generally ovulation is triggered with Lupron or HCG.

For conventional IVF, oral contraceptive use is common mostly to regulate cycle start times, Lupron or GnRH antagonist is used to override and incapacitate the patient’s ability to produce an LH surge (trigger ovulation), Clomiphene citrate or Letrozole use is uncommon, large amounts of injectable medications (Follistim, Gonal F, Menopur) is common, HCG or Lupron is used to trigger ovulation.

(6) Financial Cost at The NJ Center for Mild IVF
(costs are approximate and do not take into account available insurance or available discounts that you may qualify for)

Natural Cycle IVF: $6,000 per cycle. This excludes medication, which can cost $50-$200 dollars. This includes the IVF cycle monitoring fees (ultrasounds and bloodwork), egg retrieval, anesthesia for egg retrieval, embryology including ICSI (when performed at the discretion of the embryologist), and embryo transfer. Please note that in order to initiate Natural Cycle IVF you must have an office consultation with our physician ($200/hr) at which time you will spend about 1-2 hours with the doctor and staff reviewing all risks and benefits of the different IVF treatment options in order to choose the best protocol for you, the testing that needs to be completed prior to IVF (blood work, semen analysis, sonohysterogram or hysterosalpingogram), consent forms, and procedures. It is also usually a good idea to complete a trial menstrual cycle with monitoring prior to the actual IVF cycle to determine the pattern of your own menstrual cycles and how you respond to the medication to trigger ovulation (some women do not respond to one or the other of the ovulation trigger medications and we do not want to arrive for egg retrieval if your follicles are not ready to ovulate).

Minimal Stimulation IVF: $6,000 per cycle. This excludes medication, which can cost $500-$1,500 dollars. This includes the IVF cycle monitoring fees (ultrasounds and bloodwork), egg retrieval, anesthesia for egg retrieval, embryology including ICSI (when performed at the discretion of the embryologist), and embryo transfer. Please note that in order to initiate Minimal Stimulation IVF you must have an office consultation with our physician ($200/hr) at which time you will spend about 1-2 hours with the doctor and staff reviewing all risks and benefits of the different IVF treatment options in order to choose the best protocol for you, the testing that needs to be completed prior to IVF (blood work, semen analysis, sonohysterogram or hysterosalpingogram), consent forms, and procedures. It is also usually a good idea to complete a trial menstrual cycle with monitoring prior to the actual IVF cycle to determine the pattern of your own menstrual cycles and how you respond to the medication to trigger ovulation (some women do not respond predictably to the ovarian stimulation medication and/or to one or the other of the ovulation trigger medications and we do not want to arrive for egg retrieval if your follicles are not at their best).