Mild IVF Medications

Mild IVF minimizes the amount of hormonal medications used for ovarian stimulation, so that there is less alteration of the natural (physiological) process that occurs within the woman’s reproductive organs, in hopes of obtaining higher quality mature eggs and a more receptive uterine lining for embryo implantation.

Some of the benefits of mild IVF when compared to conventional IVF may include, but are not limited to:

  1. less drug oriented, where low doses of FSH or HMG injectable hormonal medications may be used to produce only 2-7 mature eggs per cycle in minimal stimulation IVF and no FSH or HMG medication is an option in natural cycle IVF;
  2. decrease the psychological stress patient feel, possibly due to less physical stress from medications, reduced exposure to the risk of complications (including ovarian hyperstimulation syndrome and multiple pregnancy), fewer injections and greater use of oral medication, less out of pocket cost, reduced number of office visits for monitoring, and increased patient convenience;
  3. improved patient friendliness, where mild approaches to IVF focus more on patient interests rather than fitting patients into the interests of the IVF center, patients previously offered only donor egg IVF can now consider the use of their own eggs for IVF, patients desiring a more natural experience can use less medication and undergo less monitoring, patients at high risk of over responding to the stimulation medications that are used now have reduced or no complications
  4. reduced patient drop-out, in a study (Why do couples drop-out from IVF treatment? A prospective cohort study Verberg, MF et al Hum Reprod 2008) it was noted that the physical and psychological burden of treatment was the most common cause of patient drop-out (associated with 28% of those that dropped out of IVF treatment prior to pregnancy) and mild IVF was associated with a greater than 50% reduction in patient anxiety score and drop out from IVF treatment when compared to conventional IVF;
  5. better egg quality, although controversial there is research suggesting that the egg quality is improved for those eggs retrieved during mild IVF compared to egg quality for those eggs retrieved during conventional IVF when aggressive ovarian stimulation protocols use very large amounts of medication including GnRH agonists or antagonists and FSH and/or HMG to completely disrupt and override the natural physiological process that normally occurs within the reproductive organs;
  6. improved endometrial (uterine lining) receptivity to an embryo that is trying to implant, since the amount of circulating (serum) estrogen (estradiol) and progesterone can be elevated in mild IVF but no where near the markedly supra-physiological levels that are associated with conventional IVF (which can accelerate endometrial development to de-synchronize the normal relationship between the embryo and the uterine lining and result in lower implantation rates)

The protocols for mild IVF are constantly being developed and improved so the terminology for the types of mild IVF vary within the available literature.  One set of definitions from a consensus paper published by the International Society for Mild Approaches in Assisted Reproduction (ISMAAR) includes:

  1. natural cycle IVF, aim is retrieval of a single mature egg, protocol uses no medication;
  2. modified natural cycle IVF, aim is retrieval of a single mature egg, protocol uses hCG only to trigger ovulation or alternatively uses a GnRH antagonist with add back FSH or HMG to prevent premature LH surge and then triggers ovulation with hCG;
  3. mild stimulation IVF, aim is retrieval of 2-7 mature eggs, protocol uses low dose FSH or HMG, oral compounds and/or GnRH antagonists and hCG or GnRH agonist to trigger ovulation