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Mini-IVF

The IVF procedure has 3 main components

  1. Medications that stimulate the ovaries to produce multiple eggs.
  2. Ultrasound monitoring and blood work (i.e. E2, LH, Progesterone) to assess growth of the ovarian follicles and egg production.
  3. IVF procedure (i.e. egg retrieval, embryo culture, and embryo transfer).

The cost of each component can be substantial. We feel that our IVF program is one of the most cost-effective based upon the actual IVF procedure. We hope that by offering a mini-IVF procedure more patients will be able to take advantage of this technology. In general, mini-IVF refers to minimal ovarian stimulation with less medication and less cost for monitoring. Patient selection is important, as this may not be the best protocol for all patients. It is probably best for patients that are ≤ 35 years of age with good ovarian function (i.e. low day #3 FSH, high AMH) who tend to make > 5 eggs with conventional stimulation.

Over 30 years ago IVF was done with natural cycles. It was very difficult to actually get mature eggs. Most of the cycles were cancelled before egg retrieval or resulted in failed egg collection. The addition of ovarian stimulation medications such as clomid or gonadotropins (i.e. FSH) led to the production of more eggs and improved outcomes. Furthermore, the addition of gonadotropin releasing hormone agonists (i.e. leuprolide) or antagonists (i.e. ganirelix) resulted in even more egg production by suppressing the body’s natural tendency to ovulate as estrogen levels rise. With greater ovarian stimulation came greater risks, however, such as ovarian hyper-stimulation syndrome and the increased need for embryo cryopreservation due to the excessive numbers of eggs and embryos that were generated. There has always been a feeling among practitioners that it would be preferable to have fewer eggs as long as they were of good quality. It is important to realize that many infertile patients need a relatively large number of eggs just to have a few good embryos. Mini-IVF would not be for them. In general, the pregnancy rates with mini-IVF tend to be lower based upon fewer eggs retrieved and decreased implantation secondary to clomid, which is often used in the stimulation regimen. Protocols based upon clomid typically have about a 20% pregnancy rate, which is less than the pregnancy rate with the conventional long lupron protocol, considered to be the standard stimulation regimen. Clomid has an anti-estrogenic effect on the endometrium, which probably leads to luteal phase defects and decreased implantation and pregnancy rates. This clomid effect is very difficult to overcome in part because clomid has a long half-life and stays in the bloodstream for almost one month. Some mini-IVF programs have used embryo cryopreservation to transfer embryos into a more suitable endometrial environment, when clomid has been used during the initial ovarian stimulation. The pregnancy rates with the fresh cycles were about 20% but were higher with the cyropreserved embryo cycles showing the negative effects clomid has on the endometrium in the fresh cycle.

We think that gonadotropins clearly improve pregnancy rates over clomid-based regimens and prefer to use these in mini-IVF. The cost is more than the clomid-based protocols but less than conventional stimulation. We feel that we should do ICSI (included in the price of the procedure- $850) to assure fertilization.

Typical Protocol

Stimulation:

Cycle Day FSH dose  
3 75 Baseline ultrasound
4 75  
5 75  
6 75  
7 75 Estradiol level, cancel if too low.
8 75  
9 75  
10 75 LH level, assess premature ovulation.
11 75  
12 75 Follicle ultrasound, HCG to mature eggs
14   Egg retrieval

Estimated Costs

Meds:

  1. GF 300 pen ($260) plus 450 pen ($390).
  2. HCG ($65).
  3. Progesterone in oil ($50), Estrace ($4).

Monitoring:

  1. Scan day 3 ($300), scan on day 12 ($180).
  2. E2 day 7 ($100).
  3. LH day 10 ($90).

Procedure w/ ICSI:

  1. $4850 ($4000 for IVF, $850 for ICSI).
  2. Anesthesia ($550).

Total estimated including medications, monitoring, and ICSI;

  1. $6839.

Embryo lab procedures not included:

  1. Assisted hatching ($400).
  2. Embryo cryopreservation ($450).
  3. Blastocyst culture and day #5 transfer ($400).

 

 

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