February 16, 2012

Natural and Minimal IVF: Caveat Emptor

Environment friendly business promotions have a receptive audience. Cost consciousness together with ‘green’ polices embracing such terms as ‘small is beautiful’ and ‘less is better’ can be a good thing. However, when these neologisms are applied to In Vitro Fertilization (IVF) using terms like, “Natural Cycle IVF” or “Minimal Stimulation IVF” under the guise of being “Patient Friendly” are no doubt emotionally appealing, never the less they have a very low likelihood of achieving a healthy baby. These therapies are thus better termed, ‘Minimally Effective IVF.”

‘Natural Cycle IVF’ and ‘Minimal Stimulation IVF’ are not new techniques as they were tried decades ago and abandoned due to the very poor success rates, minimal change in the surgical risks compared to conventional IVF, and the costs involved to achieve a successful pregnancy.  For example, in approximately 20% of “Natural Cycle IVF” cases, no egg is obtained at the time of surgery for egg retrieval and of those that are retrieved, an additional 20% fail to fertilize resulting in no embryo. In cases where fertilization does occur, almost 50% fail to cleave into an embryo suitable for transfer. Even when embryo transfer occurs, the chance of a pregnancy is less than 10%.

Finally, in those rare cases in which a pregnancy does occur, the subsequent miscarriage rate is over 25% leaving the chance of a baby resulting form “Natural Cycle IVF” no higher than that achieved using non-IVF therapy. Sadly, the chance of a baby using “Natural IVF” is even lower in women who have been advised to have donor eggs due to poor oocyte stimulation in conventional IVF.

The emotional appeal to “Natural” and “Minimal IVF” is compelling especially to those in need of donor eggs due to diminished ovarian reserve.  However, these techniques will never be the standard of care, but will remain on the fringe. So for those who are contemplating such enticements, please be reminded of the ancient Latin adage, ‘Caveat Emptor,’ which is ‘Buyer Beware.’

 

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Joseph A. Hill, III, M.D.

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility