April 27, 2009
FertilityTies.com decided to put together information on Micro-IVF. Many of our members have been inquiring about it and we wanted to provide you with information from all perspectives on this new procedure being offered by some Clinic throughout the country. Please note that FertilityTies.com does NOT promote any specific fertility treatment. Our goal is to provide you information from all perspectives so that you can be informed and make the right decision for you along with your own physicians.
Micro IVF in general can be described as taking either solely oral fertility meds with or without minimal use or injectable gonadotropins when going through InVitro fertilization. The process is the same as doing conventional IVF which entails egg retrieval, fertilization, embryo culture and embryo transfer. This process can diminish the risk of multiple births. Some center offer this procedure at a lower cost than conventional IVF plus there are additional savings from having to purchase less fertility meds.
Here we have 4 quotes from different REs (Reproductive Endocrinologist) who gives us their views on this procedure:
Dr. Rudy Quintero, M.D., F.A.C.O.G. Founder and Medical Director of C.A.R.E. Fertility in Los Angeles, CA.
He earned his medical degree at the UCLA School of Medicine, and completed a fellowship in Reproductive Endocrinology and Infertility at Stanford University Medical Center.
Minimal Stimulation IVF. IVF over the past twenty years has evolved and been optimized from a point where pregnancy rates were at best quoted to be 10% to about 50% today. We have become better with our stimulation protocols and techniques over this time period and are continuing this trend. Nevertheless, this success has its unintended consequences being the possibility of an overproduction of embryos along with multiple embryos being transferred.
Minimal Stimulation IVF is currently being touted as a solution for this, and we all hope that it soon will. However, we currently lack good data from proper clinical trials to support its use without adequate patient consent when gonadotropins/IUI cycle may be appropriate for sub-fertility. In one of the better trials to date from Pelinck et al (Netherlands), they noted an 8% pregnancy rate, with a 20.8% pregnancy rate after three attempts with Minimal Stimulation IVF. It is well accepted that couples with Unexplained Infertility, the pregnancy rate for gonadotropins/IUI is 17%. Some authors have published success rates of up to 40% using Minimal Stimulation IVF, but these percentages may be influenced by bias and other study errors due to their retrospective design.
I welcome the use of Minimal Stimulation so long as the patient is fully aware of the option to use conventional dosing for IVF to achieve accepted pregnancy rates. Centers are touting the diminished cost when providing this service, but the patient should be aware that if this particular treatment it’s not right for them they could end up spending money on a treatment that won’t increase their chances of pregnancy. There will also be a significantly increased possibility of having frozen embryos for future use when undergoing conventional stimulation. With the use of gonadotropins agonists for an ovulatory trigger, the risk of OHSS development has been shown to be significantly diminished without compromising pregnancy rates.
More data needs to become available to truly assess the success of this procedure for different types of patients and all Fertility Specialists should follow this closely to assess whether or not it could be a solution for some of their patients while clearly providing all their available options with associated costs.
One should consider that it is generally accepted that IVF does slightly increase the risk of birth defects since our synthetic culture media and incubators may never be as good as the environment provided by a maternal womb. These are some considerations that should be taken before performing IVF routinely and without indication when other options are readily available.
Dr. David Kreiner, M.D., F.A.C.O.G, Medical Director of East Coast Fertility in NYC.
Dr. David Kreiner completed his Reproductive Endocrinology and Infertility fellowship in 1987 at the Jones Institute for Reproductive Medicine.
MiniIVF is a low cost minimal stimulation form of IVF that is the ideal alternative to lesser aggressive fertility therapies such as intrauterine insemination. Today, IVF, even with a single embryo transfer has become more successful than IVF was 10 years ago with the more risky three embryo transfer. MiniIVF is a great way to assist our patients with achieving their goal of having a single baby while minimizing their risk of complications such as multiple pregnancy, hyperstimulation syndrome or producing financial hardship.
MiniIVF is most appealing to patients who are uncomfortable with taking large doses of gonadotropins with the associated risk of hyperstimulation syndrome. Since there are not as many eggs produced, patients interested in only one baby and not having excess frozen embryos will also find this option appealling. Of course, the lower cost will be an added benefit all uninsured will appreciate. As its appeal and popularity to potential patients grows, other doctors and fertility centers will be motivated to offer it. Their hesitancy would be mostly a concern that pregnancy rates may not be quite as high as that seen with fully stimulated IVF cycles. However, its lower cost and risk should outweigh this diminished pregnancy rate which for young high responders and older poor responders will be minimal.
The reason these groups would see a minimal decrease in success is that the younger high responders have a higher implantation rate per embryo and do not need as many embryos to produce the healthy embryo that will result in a baby. The older poor responders do not make extra embryos with aggressive stimulation and have nothing to gain by adding gonadotropins.
Dr. Eva Littman, M.D., F.A.C.O.G. Founder & Medical Director of Red Rock Fertility in Las Vegas.
She earned her medical degree from Duke University and completed a fellowship in Reproductive Endocrinology and Infertility at Stanford University Medical Center.
The Micro Ivf procedure has received a lot of press recently. This procedure consist of using gonadotropins to stimulate multiple eggs on the ovary during the follicular phase and then performing an egg retrieval, incubating the embryos for 3-5 days then placing them back inside the uterus.
My biggest fear is that this procedure will be misused by couples and patients who really need regular IVF but because of the economy they opt for the lower price and subsequently lower chance at success. The basic ideology behind micro IVF is to stimulate less eggs than regular IVF, which requires less medication costs and less monitoring. However, at each stage of the IVF process there is some drop off. If you are only starting with 4 eggs and only 3 of those eggs are mature, even if you get 60% fertilization you have 2 eggs left and both eggs may not continue to develop and there may be nothing to transfer. Hence, for $5000 you have no chance. Whereas with regular IVF, which usually cost about $3500 more, this very same patient may have generated 16 eggs, 12 of which were mature and 9 or 10 of those fertilize and she not only gets a transfer, she may have some left to freeze and try again if unsuccessful.
Unfortunately, most patients might not be aware of these two scenarios and when you are just looking at price and the way it is described, micro IVF may sound just as good as regular IVF when in reality it is far from it. It worries me that in order to try to conserve money, that patients may fall for this gimmick and use up the money that they could have spent on a real chance at success and have no take home baby.
Dr. Vicken Sepilian, M.D. F.A.C.O.G., Medical Director of CHA Fertility in Los Angeles.
Dr. Sepilian completed his residency in obstetrics and gynecology at Drexel University College of Medicine in Philadelphia, then he attended the University of Texas Medical Branch for his fellowship in Reproductive Endocrinology and Infertility
Micro-IVF or Mini-IVF as it is referred to is not much different than IVF. It requires administration of injectable gonadotropins, periodic ultrasounds and blood tests to monitor response, ultrasound guided egg retrieval and ultrasound guided embryo transfer. It is done in young patients with favorable prognosis, therefore there is no indication for ICSI or assisted hatching. Furthermore, lower doses of medications used will all result in lower costs and bigger savings for the patients. This is something we have been doing for many years in my practice. The difference is lately it is being reffered to as "Micro-IVF."
Patients who will benefit the most are the young patients, less than 35 years of age, with tubal factor infertility and normal semen analysis. The most appropriate patient for "Micro-IVF" is the less than 35 year old multiparous woman who had a tubal ligation and now desires to have another child and her partner has a normal semen analysis. Infertility patients have available to them a number of treatment options, including IUI and IVF. Each couple is unique and they must decide on the treatment that best suits them after taking into consideration their specific infertility factors, their age, the potential success rates for each treatment and cost.
I believe many fertility practices already do perform "Micro-IVF," they just don't call it that. I would advise that consumers should educate themselves as much as possible prior to making the informed decision to proceed with treatment. Indeed, the educated consumer may proceed with caution in the absence of data demonstrating its efficacy.
FertilityTies.com also want to hear from you, if you’ve gone through Micro-IVF we want to hear your experiences, positive and negative. The goal is to provide all our members with as much information from both medical perspectives but also from those who have experience on this procedure. If you’re thinking about doing this procedure also let us know your thoughts!