Natural cycle in vitro fertilization

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Natural Cycle In Vitro Fertilization (IVF) is an assisted reproductive technique designed to closely mimic a woman's natural menstrual cycle. In traditional IVF, a woman's ovaries are stimulated with fertility medications to produce multiple eggs, which are then retrieved and fertilized outside the body. A natural cycle IVF, on the other hand, works with the woman's natural hormonal fluctuations and ovulation cycle.

Contents

Natural Cycle IVF is in vitro fertilisation (IVF) using either of the following procedures:

History

The first baby conceived through this method of IVF was Louise Brown, the world's first 'test-tube baby.' However, as the field of infertility medicine progressed the protocol drifted away from this method and began incorporating the use of fertility drugs to promote greater production of eggs during one cycle. The idea behind this was to increase the number of eggs a woman can produce per cycle, thus increasing their chance of producing an embryo that will result in a live birth. However, as this protocol to use more and more infertility drugs became the conventional IVF that we know today, many physicians began seeing the risks associated with conventional IVF. Dr. Osamu Kato, the founder of the Kato Ladies Clinic, spearheaded the movement to begin a more natural and mild protocols for IVF. [4]

No hyperstimulation drugs

With no hyperstimulation drugs, the treatment cycle relies on the spontaneous development of one follicle only and therefore the aspiration of only one egg from the follicle (it is possible however that the cycle can have more than one egg or no eggs). GnRH antagonists may still be given for ovulation suppression. In addition the patient will need to take hCG (as with other less invasive treatments such as ovulation monitoring and intrauterine insemination) to time egg collection as well as progesterone pessaries to supplement the body’s progesterone levels. Progesterone aids implantation and supports pregnancy in its early stages.

It can be suitable for women who want to avoid ovarian stimulation or fertility drugs as a matter of choice, and for those for whom there may be no other choice, such as women at risk of hormone-related cancers. There is no suppression of the ovaries and associated menopausal symptoms and the treatment cycle is completed within a woman’s own menstrual cycle.

Advantages

There are no side-effects such as ovarian hyperstimulation syndrome (OHSS), bloating, mood changes or other concerns relating to ovarian stimulation. Due to the effect of ovarian stimulation drugs on the body, patients undergoing stimulation cannot pursue consecutive cycles of treatment and need to take 2–3 months break between treatment cycles. In contrast, natural cycle patients can repeat their treatment in consecutive cycles. As only one embryo is transferred in a natural cycle, there is virtually no risk of a multiple pregnancy. Furthermore, ovarian stimulation drugs are expensive and this means that the cost of each cycle is significantly less.

Drawbacks

The success rate per cycle is low compared to stimulated IVF. HFEA has estimated the live birth rate to be approximately 1.3% per IVF cycle using no hyperstimulation drugs for women aged between 40–42. [5] There is also a small risk of spontaneous ovulation before egg collection. As a consequence, there is a need for a much larger number of cycles before achieving a live birth on average, in turn resulting in an average cost per live birth that is larger than with conventional IVF.

Natural cycle IVF is not suitable for those who do not ovulate spontaneously.

Mild IVF

Mild IVF, [6] sometimes called Soft IVF or IVF Lite, is aimed at producing 2-7 eggs. It does not involve shutting down the hormones for 2 weeks. It is conducted in the woman’s natural menstrual cycle. Smaller dosages of stimulating drugs are given for a shorter period to help ripen the 2-7 eggs. Spontaneous ovulation is blocked with injections so that eggs could be collected. Some authors claim that it is safer, less expensive [7] and avoids side-effects associated with suppression of hormones in a conventional IVF cycle. Others question the claim of economic superiority of mild IVF. One study, after comparing mild IVF and conventional IVF in good-prognosis patients, concluded that there was no cost difference between the two protocols on the basis of a "take home baby." [8] Mild IVF reduces the risk of Ovarian Hyperstimulation Syndrome (OHSS).

Definitions

TerminologyAimMethodology
Natural cycle IVFSingle oocyteNo medication
Modified Natural cycle IVFSingle oocytehCG only Antagonist & FSH add-back
Mild stimulation IVF2-7 oocytesLow dose FSH, oral compounds & antagonist/agonist
Conventional IVF≥8 oocytesDownregulation weak agonist

Related Research Articles

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In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro. The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova from their ovaries and letting a man's sperm fertilise them in a culture medium in a laboratory. After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is transferred by catheter into the uterus, with the intention of establishing a successful pregnancy.

<span class="mw-page-title-main">Menstrual cycle</span> Natural changes in the human female reproductive system

The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that makes pregnancy possible. The ovarian cycle controls the production and release of eggs and the cyclic release of estrogen and progesterone. The uterine cycle governs the preparation and maintenance of the lining of the uterus (womb) to receive an embryo. These cycles are concurrent and coordinated, normally last between 21 and 35 days, with a median length of 28 days, and continue for about 30–45 years.

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Ovarian hyperstimulation syndrome (OHSS) is a medical condition that can occur in some women who take fertility medication to stimulate egg growth, and in other women in very rare cases. Most cases are mild, but rarely the condition is severe and can lead to serious illness or death.

Fertility medications, also known as fertility drugs, are medications which enhance reproductive fertility. For women, fertility medication is used to stimulate follicle development of the ovary. There are very few fertility medication options available for men.

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Ovarian follicle dominance is the process where one or more follicles are selected per cycle to ovulate.

Female fertility agents are medications that improve female’s ability to conceive pregnancy. These agents are prescribed for infertile female who fails to conceive pregnancy after 1-year of regular and unprotected sexual intercourse. The following will cover the advancements of female fertility agents, major causes of female infertility. Next, it emphasizes on common female fertility agents in terms of their mechanism of action, side effects, fetal consideration and clinical application and ended up by the introduction of supplements and herbal medicines for female infertility.

References

  1. ↑ IVF - Natural cycle IVF Archived 2012-05-12 at the Wayback Machine
  2. 1 2 Allersma, T.; Farquhar, C.; Cantineau, A. E. (2013). Allersma, Thomas (ed.). "Natural cycle in vitro fertilisation (IVF) for subfertile couples" (PDF). The Cochrane Database of Systematic Reviews. 8 (8): CD010550. doi:10.1002/14651858.CD010550.pub2. hdl: 11370/22af26c0-9968-4fbe-9ed5-e840adb14738 . PMC   7390465 . PMID   23990351.
  3. ↑ Evans, J.; Hannan, N. J.; Edgell, T. A.; Vollenhoven, B. J.; Lutjen, P. J.; Osianlis, T.; Salamonsen, L. A.; Rombauts, L. J. F. (2014). "Fresh versus frozen embryo transfer: backing clinical decisions with scientific and clinical evidence". Human Reproduction Update. 20 (6): 808–821. doi: 10.1093/humupd/dmu027 . ISSN   1355-4786. PMID   24916455.
  4. ↑ "ISMAAR » Osamu Kato".
  5. ↑ Natural cycle IVF Archived 2012-05-12 at the Wayback Machine at the Human Fertilisation and Embryology Authority homepage.
  6. ↑ Verberg MF, Macklon NS, Nargund G, et al. (2009). "Mild ovarian stimulation for IVF". Hum. Reprod. Update. 15 (1): 13–29. doi: 10.1093/humupd/dmn056 . PMID   19091755.
  7. ↑ Nargund, Geeta (2009). "Natural/Mild Assisted Reproductive Technologies: Reducing Cost and Increasing Safety". Women's Health. 5 (4): 359–360. doi: 10.2217/whe.09.32 . PMID   19586428.
  8. ↑ Gleicher, Norbert; Weghofer, Andrea; Barad, David H. (April 2012). "A case-control pilot study of low-intensity IVF in good-prognosis patients". Reproductive Biomedicine Online. 24 (4): 396–402. doi: 10.1016/j.rbmo.2011.12.011 . ISSN   1472-6491. PMID   22377152.
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