Sunday, October 04, 2015

Natural cycle versus standard IVF

Many IVF patients are worried about the side effects of all the hormones which the doctor is pumping into their body . They are worried that these hormones could increase their risk of having health problems in the future - for example, an early menopause , or breast or ovarian cancer. They're looking for a kinder and more gentle alternative, such as natural cycle or minimal stimulation IVF.

While natural cycle IVF is a great option, we need to remember that just like any other treatment, it has advantages as well as disadvantages. Thus, for most young patients with a good ovarian response, the first choice should still be standard IVF . Not only does this have a high success rate, it helps us to get lots of eggs and therefore lots of embryos. As a result of this, we can freeze the extra embryos and then use them in future cycles . This means that even if the first fresh cycle fails, the cumulative pregnancy rate with a single egg collection is actually very high.

By contrast, in a natural IVF cycle, because we only have one egg, we will only get one embryo, as a result of which the chances of conceiving is significantly lower. While it's true that a natural cycle can be less expensive ( because we don't have to spend money on the expensive injections used for superovulation) on a per cycle basis, a standard IVF cycle can actually be far more cost effective, when you calculate the number of embryos generated per rupee spent. This means it's well worth spending the money on hormone injections for patients with good ovarian reserve.

It's also important that patients understand that the hormones which we use are natural hormones, which all get excreted promptly. They don't hang around the body , and don't have long-term risks . Neither will these deplete your ovarian reserve , because these hormones only save the eggs which would otherwise have died in any case .

Lots of patients who have failed a standard IVF cycle protocol are pretty much at their wit's end , and are looking for alternative options. Because the standard IVF treatment cycle has failed, they want to know what they can do differently to achieve success the next time around. One of the worries is that the IVF injections may affect their endometrial receptivity because of the supraphysiological high levels of hormones achieved at the time of a fresh transfer. However, when we transfer these embryos after freezing them in a natural cycle, this problem automatically goes away.

Natural cycle IVF or mini stimulation IVF is a very useful option for a selected group of patients , and shouldn't be used routinely across the board for everyone. Thus, for older patients or for patients who've had a poor ovarian response even to high doses of injections, it makes a lot more sense to use a natural cycle. This may not be very intuitive, but if the patient is growing only one or two follicles even with a high dose of injections, then why not just use the one follicle which she grows in a natural cycle ? This this will give her an equally good chance at getting pregnant, without her having to waste her money on  the injections.

As a patient,  you need to select a versatile, flexible IVF clinic, which has experience and expertise in using different protocols. This way your doctor can tailor your treatment , and select the one which is right for you, rather than use a standard " one size fits all " for everyone who comes to them. It's not that one protocol is always better or worse . The truth is that for an individual patient , one particular protocol will definitely have advantages as compared to another , and both the patient and doctor need to sit together and decide jointly what works best.

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