At the Advanced Fertility Center of Texas (AFCT) we have a Mild Stimulation protocol for patients with low ovarian reserve. In the minimal stimulation protocol we can use less medication and accumulate more embryos over one to two cycles, which will in turn increase the chance of conception.
In patients with low ovarian reserve, Antimullarian hormone (AMH) < 0.5 ng/mL, or less than four antral follicle count (eggs in the ovary), the traditional IVF protocol would result in only one or two eggs and one to none quality embryos for transfer. We now understand that in these cases it is better to utilize a protocol that exposes the ovary to a smaller dose of gonadotropins instead of bombarding the ovary with an exaggerated amount of hormonal stimulation. It appears that our previous protocols may also be harmful to the egg by altering the chromosomal alignment by high gonadotropin exposure. In the minimal stimulation protocol we can use less medication and accumulate more embryos over one to two cycles, which will in turn increase the chance of conception.
What medications are used in the mild stimulation?
We usually use Clomiphene Citrate daily and then start gonadotropin injections (2-3 ampoules daily) on day 6 of stimulation. Vaginal ultrasounds are used to monitor the follicular growth, and the medication regimen continues until the follicles reach mature sizes. The medication that we use is a fraction of the typical IVF cycle, which results in a substantial cost reduction.
How long is the minimal-stimulation process?
With the minimal-stimulation IVF, we attempt to collect about five embryos. This means that from five embryos we should be able to select at least two good quality embryos, which will lead to a successful pregnancy. This may require one to two cycles of stimulation.
Using Clomiphene Citrate will have a negative impact on the endometrium so we prefer to freeze the embryos.
The embryos are frozen by a process called vitrification, which is performed by removing the water from the embryos and then freezing them rapidly. This results in about 98-99% survival rate for the embryos once they are ready for transfer.
How does the embryo transfer occur?
Once we have accumulated about four or five embryos, we can prepare the patient for the embryo transfer. This will include evaluation of the uterine cavity by a process called a hysteroscopy and an endometrial biopsy. This procedure has shown to improve embryo implantation by creating a new layer of endometrial cells.
The uterus lining is prepared and thickened by estrogen therapy, which lasts for about 14 days. The estrogen phase is followed by 4-6 days of progesterone. The embryos are then thawed and transferred.
How is the minimal-stimulation IVF differ from the natural cycle IVF?
In a natural cycle IVF we don’t typically use any medications to induce the growth of the follicle (egg). This makes the process much more problematic because it is difficult to pinpoint the exact time of follicle maturation and can result in cancellation of the egg retrieval. By using gonadotropins, we have more control over the growth of the follicle. Also, we can stimulate the growth of more than one follicle, which allows us to select the best ones.
If you are interested in our fertility treatments please call our office at (713)467-4488.