Home : Mini-stim IVF™

Mini-stim IVF™ at Infertility Solutions, P. C.

 

Mini-stim IVF™ is an advanced reproductive technology that uses a gentler/milder ovulation induction to produce mature eggs than does routine IVF.  The objective of the ovulation induction with Mini-stim IVF is to produce two good embryos.  Most physicians believe that an ovulation induction that uses less medications and produces fewer embryos, produces better quality embryos than an ovulation induction that uses significantly higher doses of medications.  Such an approach can result in significant savings in terms of medications and monitoring.  It may also be an easier process for a patient to undertake with fewer doctor visits and blood tests.  

For Mini-stim IVF, we use a mild ovulation induction similar to what we have used over the years for IUI.  The approach is significantly more powerful than IUI, but less effective than traditional IVF.  The trade-off of possibly having to do more cycles to achieve pregnancy is compensated for by a lower cost and an easier experience.  Our program is based on the research of two groups: Fauser from the Netherlands and Teramoto from Japan.  Fauser has published several well designed studies on good prognosis patients which can be used to scientifically justify the use of Mini-stim IVF.  Teramoto has published details of over 40,000 cycles of Mini-stim IVF which enables us to estimate its effectiveness for all age groups.

How is Mini-stim IVF done?

We usually have our patients take oral contraceptives for two to four weeks.  They then have a baseline ultrasound and start an oral medication called letrozole for five days.  Letrozole shares some mechanisms of action with clomiphene citrate but has fewer side effects on the reproductive system.  The ovaries are again evaluated with ultrasound and if indicated the patient will be started on ganirelix to prevent an LH surge which could damage the success of the procedure.  Patients are also started on a small amount of gonadotropins.  They are usually on these injectable medications for 2 to 5 days before receiving HCG to mature the eggs.  Egg recovery is done under conscious sedation anesthesia, because we don’t want our patients to experience pain and we want to be able to flush follicles if we need to enhance egg recovery.  ISCI is performed on all mature eggs to optimize the fertilization rate.  Eggs are replaced two or three days after fertilization.

Our objectives are to create two good embryos and to make the procedure as simple as possible for the patient.  Monitoring is primarily by ultrasound (usually three) with minimal blood tests (usually one).  The entire process takes place over about two weeks and is easy to fit into the life of someone with a busy schedule.

How much does Mini-stim IVF cost?

The total cost is about half that of a traditional IVF cycle.  Costs include medications, office monitoring visits, anesthesia costs, and IVF specific procedure and laboratory costs.  Some patients without IVF coverage will have some of these costs covered by their insurance.  The cost of the IVF specific procedures and laboratory costs is about $5000.

Which patients should do Mini-stim IVM?

Potentially anyone could do mini-stim IVF and the choice to use this technique depends a  lot on patient preferences.  We think the informed patient can make better choices and this is an objective of this web site.  The patients who do best are the younger good prognosis patients.  ICSI compensates almost completely for male factor and IVF compensates for tubal factor which makes mini-stim IVF a good choice if these problems are present or suspected.  The increased cancellation rate seen with mini-stim IVF compared to traditional IVF may be overly trying for some patients and these patients will do better with IVF.  Generally, a patient planning mini-IVF should expect to need to do more cycles prior to getting pregnant than if she did traditional IVF.  IVF provides more information to the treating physician than does mini-stim IVF and anyone with a complex history may find that to be a disadvantage of mini-stim IVF compared to traditional IVF.  IVM performed on good prognosis patients will generally result in more embryos than with mini-stim IVF since you will have embryos created from both mature and immature eggs.  IVM provides more embryos to choose from, more left over embryos to freeze, and requires fewer medications.

We think that patients with a recognized ovarian problem are likely to better with traditional IVF.  Women between the ages of 35 and 40 who are almost always in a period of decreasing ovarian reserve are likely to do better with traditional IVF.    However, we are not aware of any published study that has looked directly at this issue.

The group for whom we most strongly recommend mini-stim IVF is the group of women above age 40.  For these women, with traditional IVF, we push as hard as we can to maximize the number of eggs we have to work with.  We maximize the medication dose, but usually only get fewer than five eggs.   Teramoto’s work shows the pregnancy rate with minimal stimulation is in the same range as with traditional IVF for this age group.  (Both therapies have high cancellation rates for this age group.)

How successful is Mini-stim IVF?

Because of the very large number of cycles reported by Teramoto, his published results provide the best estimate of success with this technique.  The potential for pregnancy is age related.  Up to age 36, the ongoing pregnancy rate per IVF transfer varies from 15 to 22%.  From age 36 through 41, the ongoing pregnancy rate per IVF transfer varies from 5 to 11%.  These rates are about half the average US success rates for IVF. However this is likely an unfair comparison.  For example, for women under 35 with male factor, mini-stim IVF has a three to four times higher pregnancy rate than IUI.  The process of mini-stim IVF is not much more complicated for the patient than IUI  (and has much lower risks of multiple births and of ovarian hyperstimulation).

How many cycles of Mini-stim IVF should I do?

This depends in part on your prognosis and your decision making process about traditional  IVF or IVM.  The Fauser group reports results in terms of three cycles (20% pregnancy rate in good prognosis patient).  Teramoto averages more than 10 tries in his oldest subgroup of patients.  As with everything in infertility, this is a decision that should be individualized for a particular patient.

How does our program differ from the Teramoto/Japanese protocol for mini-IVF?

Based on our reading of their protocols, our programs differs in the way we use oral medications, the way we prevent the LH surge, the way we trigger egg maturation, our routine use of anesthesia, our routine use of follicle flushing, and our routine use of ICSI.  We use slightly more medications than some of their protocols, but utilize less monitoring and fewer blood tests.  

Our approach to the ovulation induction is a variation on one we have used for the last twenty years for superovulation and IUI.  We found it was less expensive for the patient and more efficacious  compared to a more traditional superovulation approach.  We expect that this protocol will cost the patient about as much as the Teramoto approach while being somewhat more convenient and about as effective.  It should also have a lower cancellation rate and take less time to complete.

How does it differ from the Fauser/Dutch protocol for mini-IVF?

Our protocol uses oral medication which should decrease the potential for cycle cancellation.  Our routine use of conscious sedation anesthesia, follicle flushing and ICSI are also different.  The costs are about the same and the monitoring is similar.

How does Mini-stim IVF compare to IVM?

Mini-stim IVF is an established procedure as far as the laboratory and patient management are concerned.  Mini-IVF should be in the skill set of any practice which provides IVF.  IVM requires some additional skills and additional laboratory processes.  IVM uses less medications than mini-stim IVF and takes less patient time.  In good prognosis patients, it provides embryos from both immature and mature eggs, which in theory should translate into a higher pregnancy rate.  There are several publications where the pregnancy rate for IVM is the same as traditional IVF in that program.  This combined with a lower cancellation rate makes IVM a more successful procedure in the qualified patient.

How does Mini-stim IVF compare to natural cycle IVF?

Pure nature cycle IVF probably should be replaced by either mini-IVF or a natural cycle version of IVM.  Pure natural cycle IVF is a more complicated procedure in terms of patient management and convenience than either mini-IVF or IVM, has a higher cancellation rate and a lower success rate.

How does clomid with IUI and gonadotropins with IUI compare to Mini-stim IVF?

Mini-stim IVF completely compensates for male factor.  IUI only partly compensates for it.  (Under age 35, it is 3 to 4 times as effective.) Similarly, mini-stim IVF similarly completely compensates for tubal factor, but other therapies only compensate in terms of producing extra eggs (and thus extra chances to have an egg picked up).   Doing mini-stim IVF may save the cost of a diagnostic laparoscopy.  The cost differences depend on insurance coverage.  For gonadotropins with IUI therapy, with the increased cost of medications, it is likely to be similar in price to the total cost of mini-stim IVF.

Almost all cases of high order multiple births occur using gondotropin-IUI therapy.  With mini-stim IVF, the risk of multiple births is at most twins.  The risk of ovarian hyperstimulation is lower with mini-stim IVF than gonadotropin IUI therapy (but not as low as with IVM).

Mini-stim IVF and IVM are new tools that can be used to help you get pregnant as quickly and cost effectively as possible.  Our effectiveness as a program is enhanced by having many different tools rather than just IVF.