Friday, August 17, 2012

When less is more – or is it ? The pros and cons of mini IVF

Patients with poor ovarian reserve can be extremely challenging. Because we know that not every egg becomes an embryo and not every embryo becomes a baby , doctors will do their best to get IVF patients to grow lots of eggs to maximize their chances of getting pregnant.

However, it can be very hard to super ovulate patients with diminished ovarian reserve. It seems that no matter what we try, these ovaries just do not respond well to our medications. This can be very frustrating both for doctor and patient , which is why doctors have come up with lots of strategies to deal with these patients.

The standard approach is to be more aggressive with super ovulation and use a higher dose of gonadotropin injections to help coax the ovaries to grow more eggs. Doctors have also tried to tweak the super ovulation protocol by using a mix-and-match of various drugs, which is supposed to help the ovaries to perform better during the IVF cycle. These include androgens such as DHEA; injections of growth hormone which can be extremely expensive; and supplements such as Royal jelly and wheat germ. Many clinics will also combine the super ovulation with acupuncture and yoga.

However, the results with a lot of these protocols have been mixed and while some patients do well, the vast majority still end up growing only a few eggs no matter what we do.

This is why some clinics will use the mini IVF or a gentle IVF protocols for these patients. The logis is simple - since we cannot get them to grow lots of eggs , then why not just make the best possible use of the few eggs which do grow , without making them spend a fortune on expensive drugs which don't seem to do much good.

This is a perfectly reasonable alternative treatment option, provided patients have realistic expectations of what this approach can achieve . Unfortunately, the proponents of mini IVF tend to over promise too much in order to convince patients and doctors that this is a better approach. They highlight the successes without explaining the limitations and the downsides.

The fact remains that with the mini IVF approach , the cancellation rates of IVF cycles is extremely high and patients need to be prepared for this. The mini IVF approach is a sensible approach, provided the patient is well informed and who has realistic expectations. As the patient your best option is to find the clinic, which is flexible enough to use all the possible options and alternatives so that you can maximize your chances of having a baby and achieve peace of mind that you gave it your best. However, this may involve doing repeated cycles , in order to find out what works best for you.

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  1. Mrs. Pandey4:23 PM

    I agree with you, dr. Malpani! I am such a patient and the kind of frustration which both us and doctors undergo is just unbearable sometimes. Tell me, how many cycles should I undergo , having amh: 2.11. I had 2 cancelled ICsi cycle using short protocol ( 4 follicles lutenized on 14th day)and antagonist protocol using the dose of 450 units (5 follicles but didn't reach 10mm size despite 450 units given for 5 days. Doc said that's the max dose, 600 unit too will yield same results)and 1 non
    resulting pregnancy using long protocol (6 eggs, 5
    fertilised 4 cell stage b). Am also frustrated, avoiding donor egg program as I am not comfortable with it . Now turned 36 in July. Plz guide

  2. Dear Mrs Pandey,

    Some decisions are too important to be left upto anyone else. You need to make them yourself !

    Take the path of least regret. What will give you peace of mind you did your best ?

    Best of luck !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    My Facebook page is at

    You can follow me on twitter at!/drmalpani

    Watch our infertility cartoon film at

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at !

    Read my blog about improving the doctor-patient
    relationship at


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