Minimal Stimulation IVF

Eight cell embryo, day 3

A mini-IVF, or a minimal stimulation IVF is designed to give women only a few (but high quality) eggs, thus avoiding the risks of hyperstimulation, reducing the cost of drugs, reducing the number of injections, and completely avoiding painful progesterone injections.

In a standard IVF cycle, the patient receives FSH (Gonal-F®, Follistim®, Bravelle®, and Menopur) for the entire stimulation period. Using the Minimal Stimulation IVF Protocol, Clomid is usually administered on Days 3-7 of the cycle followed by FSH starting on Day 8 until the follicles reach maturity and are ready for retrieval.

Since FSH is not used during the first days of stimulation, medication costs are greatly reduced. For those who cannot afford standard IVF, the Minimal Stimulation IVF provides an acceptable, proven alternative therapy.

Disadvantages

The major disadvantage of the minimal stimulation protocol is that the pregnancy rate per started cycle can be lower than standard IVF stimulation regimens (Fertility Sterility 2002;78:1068-721 ). This lower rate is primarily due to the fact that fewer eggs (3-4) are produced than in standard IVF (8 -10 eggs). There is also a higher cycle cancellation rate due to “too few eggs” and there is a reduced chance of producing extra embryos for freezing and use in a future cycle.

Potential Candidates

Not every patient is a candidate for minimal stimulation; those excluded include:

  • Age > 42 years
  • Day 3 FSH Level > 15 miu/ml
  • Azospermia (sperm count = 0)
  • Uterine abnormalities or the presence of a hydrosalpinx
  • Patients with insurance coverage for IVF

Making the Decision

Dr. Sherman Silber, one of the process’s pioneers, explains the concept this way: “Think of this simple parable: If you are sitting under an apple tree, and wish to eat the most ripe and ready apples, you have a choice. You can chop down the entire tree and look at every apple on the fallen tree to see which ones are ready, or you can simply try to shake the lower branches and eat the one or two that were ready to fall. That is the idea of mini-IVF.”

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