Natural Cycle IVF
In-vitro fertilization (IVF) is a great option with high success rates for women who are having trouble conceiving. However, it is emotionally, physically and financially demanding with no guarantee for success. In light of these drawbacks to the popular and effective fertility treatment, another form of IVF is becoming popular called natural cycle IVF.
Natural cycle IVF is meant to model the natural conception process. The menstrual cycle is monitored and tracked very closely. Once the ovulation is pinpointed, the woman undergoes an outpatient procedure where the doctor will extract the egg from her ovary.
Natural cycle IVF is a scaled-down version of traditional IVF. For example in traditional IVF, fertility medication and injections are administered to generate multiple eggs for fertilization. The treatment philosophy is that the more eggs you have to work with, the better the chances of creating a healthy embryo. Natural cycle IVF instead focuses on the one egg you produce naturally without stimulating drugs.
Both natural and traditional IVF require the egg to be fertilized with the sperm in a lab. The main difference is that in natural cycle IVF, there is only one embryo, while traditional IVF usually has more. The embryo or embryos are then set aside to develop for a couple of days. If normal development is observed in the embryo or embryos, then it or they will be transferred back to the mother for implantation. In natural cycle IVF, this transfer will be of only one embryo, but in traditional IVF, there could be more.
Although no ovarian stimulation is used in natural cycle IVF, an injection of human chorionic gonadotropin (hCG) is used to prepare the egg for retrieval and time the procedure. Some doctors use a large does of Lupron, instead, to cause a release of the woman’s own LH.
While natural cycle IVF saves the couple considerable money and physical stress by skipping medication and reducing complications from ovarian hyperstimulation syndrome, it has been shown that overall, patients are still better off with conventional stimulated cycle IVF. Pregnancy rates are much higher and when extra embryos are available for freezing, this increases the efficiency of the process. Thus, women who benefit most from natural cycle IVF, are those who need IVF for problems like blocked tubes or male infertility, but cannot generate multiple eggs with stimulation. Such women include some women over 40, women with elevated FSH levels, and those with previously demonstrated poor responses to stimulation. In thee cases, “One egg may be better than none.”
There are also some patients who, on religious grounds are not comfortable with freezing embryos. These women may also benefit from natural cycle IVF.
There are a few drawbacks with natural IVF. Understandably, the pregnancy rates per cycle are much lower than with stimulated cycles. Some doctors will not offer the procedure because the egg retrieval can be uncertain and the quality of the egg once retrieved may produce unhealthy embryos. Because of this, woman may have to undergo more embryo transfer procedures until one implants and develops into a healthy pregnancy.
Another drawback to the procedure relates to the difficulty of accurately predicting ovulation without stimulation. Sometimes women will ovulate before the egg can be extracted. Modified natural cycle IVF helps with women who have this problem because doctors give medication to prevent premature ovulation. Paradoxically, this makes it less “natural.”
Certain women, such as those with irregular ovulation cycles, have no choice but to use the more intensive traditional IVF treatments with multiple stimulating injections and medications and higher costs. But for women who meet the doctor’s profile for good candidates, natural cycle IVF is an excellent option both less physically intense and expensive than traditional IVF. For these women, a more natural path to parenthood through IVF might be the way to have the family they always wanted.
Dr. Michael Feinman
Location: Encino, West Lake Village, and West Los Angeles