Mini-Stim IVF

Minimal Stimulation In Vitro fertilization (MS-IVF) is an alternative to traditional IVF. For most couples who are candidates for IVF, the traditional approach should be used because of the proven record of success (approximately 40+% clinical pregnancy rate).

“Traditional IVF” requires the administration of several injectible medications to hyperstimulate the growth of multiple eggs. These medications are expensive and are associated with certain potential health risks. Careful monitoring must be performed to insure safety and efficacy. Recovery of oocytes (eggs) is performed at the Center for Reproductive Medicine with monitored anesthesia care.

These requirements lead to increase cost and time commitment for the patient, but the result is an increased number of oocytes and embryos available for transfer. Also, cryopreservation of surplus embryos for transfer in a non-stimulated cycle may be available. All of these factors lead to the overall expected take-home baby rate of approximately 30%.

Minimal Stimulation IVF is just as it’s name implies ­ less than traditional IVF stimulation. As opposed to the normal Ovulatory cycle, in which one follicle (developing oocyte) is produced and is available for release and fertilization, the MS-IVF cycle typically results in the production of two to four follicles. Following medications and serial monitoring, these oocytes are retrieved in the office under conscious IV sedation.

• 1. Tubal Disease: bilateral tubal occlusion should be proven.
• 2. Endometriosis: traditional treatments have been unsuccessful.
• 3. Cervical Factors/Antibody Problems: usual corrective measures have failed.
• 4. Unexplained Infertility: conventional treatments have been unsuccessful.
• 5. Severe Male Factor Infertility is NOT an indication for MS-IVF.

• 1. Couples must be married.
• 2. Wives may not exceed 37 years of age.
• 3. Wives must not weigh more than 200 pounds.
• 4. A hysterosalpingogram (HSG) or hysteroscopy to document normal uterine cavity should be performed within one year of the MS-IVF treatment cycle.

Minimal Stimulation IVF involves the following process:

Initial Screening

During a preliminary consultation with a physician, the various aspects of minimal stimulation IVF-ET will be explained in detail, including the risks and complications associated with the procedures. Thereafter, a nurse will explain the logistics of the cycle and blood will be drawn from both husband and wife to test for HIV, syphilis, hepatitis B and C and Rubella, and cultures will be taken from both for Chlamydia. A semen sample will also be requested at this time; therefore, please abstain from sexual relations for 2-3 days prior to your consultation.

Monitoring

On day 1, 2, or 3 of your IVF period, an ultrasound appointment will be scheduled to check for any ovarian cysts. Blood will also be obtained for measurement of FSH and Estradiol (E2) levels. Injectible ovulation induction medications (e.g. Bravelle®, Follistim®, Gonal-F®, Pergonal®, or Repronex®) will be used. A repeat ultrasound will be performed on a predetermined day to check for follicular development; blood will also be drawn for an E2 level. A GnRH antagonist (e.g. Antagon® or Cetrotide®) may be added to help prevent premature ovulation. Depending on the results of these tests, you may be scheduled for another ultrasound in 1-2 days or you may be instructed to take an ovulation triggering medication called human Chorionic Gonadotropin or hCG (Ovidrel®). This injectible medication causes the release of the egg from the follicle approximately 36-38 hours after administration.

Oocyte Retrieval

Egg retrieval is scheduled for 35-36 hours after administration of the hCG. This procedure is performed in the office under conscious IV sedation. Under transvaginal ultrasound guidance, a needle is placed into the ovary. One or more eggs may be retrieved. Also on this day, the husband will be required to give a semen specimen.

Embryo Transfer

After egg retrieval, the egg(s) will be incubated approximately 6-8 hours and then inseminated with the sperm. Should fertilization take place, the embryo transfer would be performed approximately three days after egg retrieval. Embryo transfer is a very simple procedure requiring no anesthesia. A small, pliable catheter is passed through the cervix and the embryo is transferred into the uterus. Progesterone support will be routinely administered beginning the day of the egg retrieval and continuing until the results of the pregnancy test are available.

Pregnancy test

Approximately fourteen days after the embryo transfer, a blood pregnancy test will be performed. If it is positive, a repeat blood pregnancy test will be drawn 48 hours later.

In contrast to traditional IVF, MS-IVF is logistically easier and cycles may be repeated monthly. This approach is also more cost-effective, but there may be increased frustrations because of less predictable cycles and the reduced chances for a pregnancy to occur. In addition, the indications for MS-IVF differ somewhat from traditional IVF; for example, there are some age and male factor infertility constraints. Please contact the IVF Team for more information about the MS-IVF program.