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Mini IVF

What is Mini IVF?

Lower costs more safely, using no hormones or minimal doses with the Mini IVF!

 In vitro fertilization treatments can be considered by some patients as very aggressive, in large part partly because of the need to use high doses of hormones to produce eggs. These hormones produce adverse effects that can be more intense in some patients and in others even harmful (risks of thrombosis or neoplasms). There are also some patients who can’t use this type of medication, such as patients who have had breast cancer, for example. Thus, we can use minimally IVF techniques invasive. These techniques can be summarized in three types: natural cycle, minimal stimulation and in vitro maturation (IVM).

Natural Cycle?

This technique is possible to be used in all patients who ovulate normally. Young women who wish avoiding stimulation of the ovaries with hormones can try the natural cycle beforehand. We also have results very good in older women and those who previously had little response to conventional induction. Is the treatment indicated for women who – for reasons of choice and conception – don’t want to use medications for controlled ovarian stimulation. We include in these conditions women who can’t receive hormones due to the risk of developing hormone-dependent neoplasms (cancer) (such as breast, for example). It is a safer and healthier technique than conventional treatment that employs hormones in high doses.

The total cost of treatment is significantly lower than a conventional treatment, considering that medicines represent between 40 and 50% of the cost of in vitro fertilization. There is no suppression of the ovaries or the appearance of symptoms similar to those of menopause (relatively common in some types of stimulating hormones) and the treatment cycle is completed following the natural growth of the woman’s egg.

What is the natural cycle for IVF?

Briefly and simplistically, it is an IVF treatment performed without the use of medications. In treatments conventional IVF or ICSI, patients receive high doses of hormones so that the ovaries produce more eggs. In the natural cycle for IVF, the ovary produces only one follicle, which develops naturally and spontaneously, producing only one egg (although it is possible that more than one egg naturally develops or none at all). This is not an innovative treatment or anything revolutionary. It is just a different conception and a way of not attack the organism with the risks of hormones, such as thrombosis, neoplasms, ovarian hyperstimulation syndrome, among others. Louise Brown, the first child born by IVF in the world, was conceived in a natural cycle in 1978.

There are safe and effective methods that allow the preservation of fertility, before the woman loses quality and quantity of eggs and ensuring low risk of malformations and genetic syndromes.

Want to say that hormones aren’t used in this technique of IVF?

There are no side effects such as mood changes, fluid retention, swelling, ovarian hyperstimulation syndrome and other conditions related to ovarian stimulation. Due to the effects of medications on the body, patients performing conventional treatments, they should wait on average two months to repeat the treatment; in contrast, patients undergoing a natural cycle can undergo treatment in successive months, without the need for breaks. How only one embryo is transferred in natural cycles, multiple gestation is practically impossible (unless the embryo splits in two; the risk for this is 1: 1,000 treatments). In addition, medications for stimulation are very expensive and the natural cycle is much cheaper than a conventional treatment (between 40 and 50% any less).

What are the disadvantages of the natural cycle?

As taxas de sucesso são baixas se comparadas ao tratamento convencional. Há também um risco elevado de ovulação espontânea antes da coleta do óvulo (se não realizarmos o bloqueio hormonal) e de não termos óvulos produzidos no ciclo.

Who can do natural cycle for IVF?

Women under 45 and who ovulate normally can be candidates for this type of treatment.

Who can’t take a natural cycle for IVF

Women who don’t ovulate regularly. In this case, we must employ the least stimulus or maturation in vitro.

Minimum Stimulation?

It is an adaptation of the conventional IVF treatment. The difference is that we use very low doses of hormones, usually 75 units every other day, in contrast to 225, 300 or more units a day in treatments conventional.The goal is to obtain few eggs, between 2 and 7. We don’t do the pituitary block beforehand, we start the treatment synchronously with the normal menstrual cycle. Spontaneous ovulation is performed so that we can collect the eggs. This type of treatment is safe, cheaper and minimizes – or even eliminates – side effects conventional stimulation. It is also a rare occurrence of the Ovarian Hyperstimulation Syndrome in this treatment modality.

IN VITRO MATURATION (IVM)

In vitro maturation is a technique widely used in veterinary medicine, as in cattle, for example. The idea in this treatment modality is to remove the eggs from the ovaries before they undergo the selection and apoptosis process (when the ovary causes only one egg to continue growing in that cycle). Thus, we remove the immature eggs, before the dominant follicle begins to appear. Immature eggs are then taken to the laboratory (in vitro) and placed in a special culture of hormones to “ripen”. When the eggs are finally ripe, the husband’s semen is collected and then fertilized. There after the steps are identical to those of conventional IVF.

What are the advantages of IVM?

In vitro maturation eliminates the need to administer hormones in the woman, saving her from all the consequences and risks of this stimulation.

What are the disadvantages of IVM?

IVM still shows inferior results to conventional IVF. It is considered an experimental procedure and is still under development.

Who can perform IVM?

As a rule, women with polycystic ovaries are the best candidates for this treatment because they have numerous immature eggs at the same time in the ovary. Other conditions in which women have a good egg reserve (more than 10 antral follicles counted in the ultrasound) also make it possible to perform IVM. Women undergoing cancer treatment are also good candidates for this treatment.

Who can’t perform IVM?

Treatment isn’t  indicated for older women or those who don’t have a large amount of eggs (ovarian reserve).

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Written by Dr. Fernando Prado

Dr. Fernando has been a doctor specializing in assisted reproduction for over 20 years, with a PhD from Imperial College London and the Federal University of São Paulo, and clinical director of Neo Vita.

CRM/SP 103.984 - RQE 391631
Curriculum Lattes: http://lattes.cnpq.br/3562749827441899

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