For couples that know they need in vitro fertilization (IVF) to get pregnant, natural cycle IVF and minimal-stimulation IVF (mini-IVF) options may sound enticing. Some fertility clinics aggressively market these near drug-free procedures as alternatives to standard IVF by boasting lower costs and high pregnancy success rates. But such claims are simply not the case.
Frisco Institute for Reproductive Medicine (FIRM) does not recommend that couples use natural IVF or mini-IVF because they are not nearly as effective as standard IVF. Consequently, they may end up costing a patient more to successfully have a child.
Natural cycle IVF and mini-IVF
For some couples, the term natural might elicit the notion that alternatives to standard IVF are less invasive. Natural cycle IVF is much like standard IVF, as it combines eggs and sperm to create an embryo outside the body. This requires many of the same medically-challenging (and costly) aspects of standard IVF: Frequent appointments with your doctor, egg retrieval surgery and embryo development in a lab.
Natural cycle IVF and mini-IVF also include combining the sperm and egg outside of the body in a medical setting.
Early IVF was all natural, until fertility specialists sought to improve success rates by increasing the number of eggs available for fertilization. Primarily used today in Japan, natural IVF is similar to standard IVF, but does not rely on medications to stimulate the ovary to produce multiple eggs. This procedure is nearly drug-free but it still requires the use of the human chorionic gonadotropin (hCG) hormone used to mature and release the egg for retrieval.
This type of IVF requires a woman to have a regular period, and she will usually produce just one mature egg, just as she normally would on her own during each cycle. Natural IVF success depends largely upon the quality of the one egg retrieved and the ability to retrieve it. In around 20 percent of patients, the lone egg is not retrieved and another cycle must be initiated. The pregnancy rate is unusually low with less than 15 percent chance of getting pregnant per cycle.
Minimal-stimulation IVF is the more popular version of reduced-drug IVF. Unlike natural cycle IVF, mini-IVF uses a small amount of medication to stimulate a woman’s ovaries in order to grow a few more eggs.
This can be done with oral medications such as clomiphene citrate (Clomid) or low-dose injectable drugs. The oral medications typically induce egg growth and development by blocking the estrogen receptors in the brain. More than normal follicle stimulating hormone (FSH) and luteinizing hormone (LH) are now naturally produced by the patient, which allows for multiple eggs (3-5) to develop.
Simply put, this method tricks the brain into thinking that the ovaries are under performing and need a little extra help. Blocking communication signals from the brain to the uterus however, does not promote the best endometrial lining for implantation and may ultimately limit a healthy embryo’s ability to implant in the uterus.
The laboratory procedures and timelines for natural and mini-IVF are quite similar to standard IVF.
The true cost of mini-IVF
Some couples exploring fertility treatments will find natural and mini-IVF to be an attractive option because of the purported cost savings. Clinics advertise minimal-stimulation IVF cycles as “low cost” because of the savings from using less injectable drugs.
Injectable superstimulation drugs are typically used over an 8-15 day period. These fertility medicines required for standard IVF cost on average around $4,000 per treatment cycle. Patients using mini-IVF can expect to spend significantly less–about $1,000.
Use of drugs for a standard IVF cycle may require a few more visits to a clinic for testing in the days preceding the egg retrieval, adding to the overall cost.
However, these cost savings are offset by an overall reduced pregnancy rate. The published success rates for minimal-stimulation IVF are significantly lower than the national average for standard IVF. At the 2016 American Society of Reproductive Medicine’s Scientific Congress and Expo, new findings on IVF were presented to show that with an increase in the number of eggs retrieved per cycle, so increased the likelihood of a live birth per embryo transfer.
Because of mini-IVF’s significantly lower success rate, albeit at a lower cost, we recommend standard IVF. Even though standard IVF may be more expensive than mini-IVF, the ultimate cost per baby is significantly lower, and the average time to achieve that pregnancy is shorter when using standard IVF.
Why the need for multiple eggs?
Unfortunately, not all eggs are created equal. On average, it takes fertile couples up to five cycles to get pregnant. That is because in these couples, only 1 out of 5 eggs are of baby-making potential.
When performing IVF, we expect to see the same ratio of only 1 of 5 eggs to be viable. For that reason, we attempt to extract at least 10 eggs to end up with the potential of two viable embryos.
In reproductively older women (over 34 years of age), more than 10 eggs may be needed to produce two viable embryos. With more eggs, we expect more viable embryos and therefore, a higher chance of having a baby.
When undergoing mini- or natural IVF, even one viable embryo is not produced for all patients, with the majority of patients (less than 60 percent) not having any viable embryos.
Why mini-IVF may be more expensive?
Many programs touting low cost IVF also often cut costs (beyond the use of injectable drugs) by skipping a full workup of the patient and might miss other medical conditions that would jeopardize the patient’s chance of getting pregnant.
Indeed, there are fewer upfront costs when opting for the mini-IVF cycle. But when taking into consideration the lower chances of creating a viable embryo per cycle, the potential of not having the most fertile endometrial lining for implantation, and the choice to perform less testing to identify underlying reasons for infertility, the mathematics of cost change. It is clear that the cost per baby may be much higher and the time to achieve that pregnancy may be significantly longer going this route, than the modestly more expensive standard IVF option.
Ultimately it is up to the couple to decide what the most advantageous route of infertility treatment is for them. We do not believe that natural cycle IVF and mini-IVF are the best options available to our patients if they want to get pregnant as soon as possible.
Undergoing standard IVF frequently produces additional healthy embryos to be used for a second attempt or for a second baby at a fraction of the cost of another standard IVF cycle or even a mini-IVF cycle. Mini-IVF almost never provides a second chance or a sibling from the same treatment attempt.