Saturday, May 17, 2008


For an ivf cycle, a woman’s body is practically bombarded by powerful drugs; first to shut down her ovaries (down regulation), and then other drugs to stimulate them to produce more eggs(FSH), and yet another drug to trigger ovulation (HCG). Women react to these drugs in different ways and one (costs aside), may understandably be wary of subjecting the body to them. The effects of long term use of these drugs (necessary when one has to repeat treatment cycles) can be worrisome and is still being studied.

NATURAL CYCLE IVF is definitely worth considering. In effect, you get the best of both worlds. For this procedure, it is the single egg produced in a woman’s normal cycle that is inseminated. Also known as no or low stimulation IVF, it is an invitro fertilisation procedure which uses no artificial fertility drugs, or very low dose ones.

Why Would I Want To Have IVF Without Fertility Drugs?
For some couples, the choice is financial. It is done at a fraction of the cost of standard IVF, so it may be their only chance at treatment. Some people prefer to try this method before moving on to traditional IVF.

For others, the choice may be medical. They may be contraindicated to fertility drugs (for instance, with a previous history of ovarian cancer or depression) or they may have reacted badly to a course of fertility drugs before. Women who have suffered with ovarian hyper stimulation syndrome may be offered this type of treatment as the syndrome is very serious and can be life-threatening so it may not be safe for them to continue with standard IVF.

Some couples just don't like drugs and prefer a more natural approach to infertility.

A point to note is that because of the improvement in the embryo culture technology, we are now at a point where even one egg gives a reasonable chance of success – about 15% per cycle. Therefore, in women who do not wish to use fertility medications, cannot afford fertility medications, or who do not produce many eggs even when they use fertility medications – Natural Cycle IVF is a logical and often successful alternative. Given that the success is 15% per attempt, it has been the experience of many centers that with several cycles of Natural IVF, one can achieve the same success rate of one cycle of stimulated IVF (45%).

Indeed, a study published in Europe’s leading reproductive medicine journal, Human Reproduction*, has found that for the majority of women the chances of pregnancy are just as good if doctors rely on the woman’s natural menstrual cycle.
The researchers’ view is that, in 60% to 70% of cases, a series of treatment cycles without using ovarian stimulation would be safer, less stressful and mean fewer multiple births. It also costs only a fifth of the price of current practice and would bring IVF within the reach of more childless couples worldwide and enable countries that state-fund IVF to help more women.

Dr Geeta Nargund and colleagues reached their conclusion following a study of 181 treatments in 52 women at the Assisted Conception Unit at King’s College Hospital, London. All the women had treatment based around their natural menstrual cycles.
They were found to have the same chance of having a baby after an average of three to four cycles of treatment as women undergoing conventional drug-stimulated treatment – about a third (32% as against 34%).
The first test-tube baby – born in 1978 in England – was the result of normal menstrual cycle IVF treatment, but the practice was pretty well abandoned with the onset of extensive use of hormonal drugs to stimulate the ovaries into producing more eggs per cycle. This new study is the first to establish that basing treatment on a woman’s natural cycle can achieve comparable results with those of drug-stimulated cycles.

Dr Nargund, who now directs the fertility centre at St. George’s Hospital, London, said: "We’ve demonstrated that it is an effective and potentially cost-effective option for certain groups. With a trend now to reducing the number of embryos transferred, our study must open the debate as to whether a series of natural cycle treatments should become a mainstream conception technique for female infertility."

Natural cycle IVF has several advantages over stimulated cycle IVF:
*Natural cycle IVF utilizes the body's normal ovulation process
*There are no expensive hormones to buy and fewer injections with natural cycle IVF.
*Natural cycle IVF may be repeated month after month, if necessary.
The cumulative pregnancy rate from three months of natural cycle IVF is over 50%
*At Olympia Women's Health, the cost of three cycles of natural cycle IVF is less than the cost of one stimulated cycle.

usually, there is only one follicle... one chance for an egg.
*one may not be able to retrieve the egg
*the egg may fail to fertilize
*the fertilized egg may not develop into an embryo

How is Natural IVF done? Timing is Everything
There are 2 ways to determine follicle maturity.
*Ultrasound determines follicular diameter.
*The Estradiol and/or the start of the LH (luteinizing hormone) surge.
Ultrasound studies are done daily several days before ovulation is expected and when the follicle size reaches 16-18mm and/or the LH begins to rise, the retrieval is planned shortly afterwards. Interestingly, indomethacin (50mg 3 times daily with food) has been used by some clinicians once the follicle reaches maturity to help prevent collapse of the sac before the time of aspiration. In summary, Natural Cycle IVF is a useful and logical technique for selective patients.

The cost for Natural Cycle IVF is around $1800.

This includes the following:
cycle monitoring
office visits
all ultrasounds
all lab work (Estradiol, LH, Progesterone and your first pregnancy test)
the retrieval
anesthesia fee
cryopreservation fee

The women most suited are those with reasonably regular menstrual cycles who ovulate normally but who have problems with their fallopian tubes, or those couples where the reason for the infertility is inexplicable. It would not be suitable for women who don’t ovulate or who have very erratic menstrual cycles and probably also not for couples undergoing ICSI (the injection of a single sperm into the egg), although research into its feasibility for ICSI is to be carried out.

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