Mini-IVF is designed to recruit only a few, high quality eggs, therefore reducing the risks of hyper-stimulation, the cost of drugs, the number of injections, and avoiding completely the painful progesterone injections. This approach is not just a simple-minded reduction in hormonal stimulation. It is a completely different approach to IVF that saves the patient much of the complexity and cost associated with more conventional IVF protocols.
Here is how it works:
On Day 3 of the menstrual cycle, the patient starts a low dose of Clomiphene (50mg), which does not stop in five days as is usually the custom. On the contrary, Clomiphene is continued until ultrasound monitoring shows that the follicles are ready for ovulation. A very low dose of synthetic follicle stimulating hormone (FSH150 iu), is added on Days 8, 10, and 12. Clomiphene not only stimulates the pituitary to release FSH naturally, but also staying on the Clomid (a unique new approach) blocks estrogen’s stimulation of LH release, and prevents premature ovulation. Thus, with this simple change in protocol, the old-fashioned, cheap drug is able to stimulate the development of great quality eggs for IVF.
Another advantage of this protocol is that the patient does not have to go on leuprolide first to suppress the pituitary. Staying on Clomid blocks estrogen from stimulating the patient’s pituitary to release LH, and this prevents premature ovulation. This means that the patient can be induced to ovulate with just a simple injection or nasal sniff of leuprolide. This causes a more natural LH surge, and avoids the luteal phase defect caused by HCG that would otherwise require months of progesterone injections.
However, it is known that Clomiphene has a negative effect on the uterine lining (because it prevents estrogen from stimulating the endometrium). That is one reason why results in the past have been so poor with the use of Clomiphene for ovarian stimulation. The embryos are less likely to implant in such endometrium. But that problem is solved now by using a new protocol for embryo freezing, vitrification. Embryos can be frozen using this approach, with only a 1% risk of loss. Then these embryos are transferred the next month in a “natural cycle” with no need for taking any hormones at all.
Even if the woman does not normally ovulate predictably, she can be given one injection of leuprolide in the follicular phase to induce natural luteinization, and still have a natural cycle embryo transfer with no hormones.
Even for poor prognosis cases of older women with low remaining ovarian reserve, there is an advantage to mini-IVFTM over high dose stimulation. Such patients normally yield very few eggs anyway even with huge doses of synthetic follicle stimulating hormone. If they have any quality eggs remaining, mini-IVFTM is just as likely to yield as many eggs (very few, of course) as giving huge doses of synthetic follicle stimulating hormone.