NATURAL CYCLE IVF

The first "test tube baby" – born in 1978 in England – was the result of obtaining the egg during a normal menstrual cycle. Natural Cycle IVF was thus the first method used to achieve pregnancy with IVF.

The reason this natural method was discontinued was because by using fertility medication we could obtain many eggs and thereby improve the chances of pregnancy. Obviously if 10 eggs could be stimulated, the likelihood of being able to retrieve at least several eggs was almost guaranteed and more eggs will be available for transfer. In the mid-80’s and well into the early 90’s, when the success rate of IVF was much lower than today – having more eggs and more embryos was a distinct advantage. As embryo culture techniques improved and the success rate for IVF was much higher, the shift in major centers was to continue to stimulate multiple eggs but to only transfer back 2 or 3 and to freeze remainder of the embryos.

Because of the improvement in the embryo culture technology, we are now at a point where even one egg gives a reasonable chance of success – about 15% per cycle.

Therefore, in women who do not wish to use fertility medications, cannot afford fertility medications, or who do not produce many eggs even when they use fertility medications – Natural Cycle IVF is a logical and often successful alternative.

Given that the success is 15% per attempt, it has been the experience of many centers that with several cycles of Natural IVF, one can achieve the same success rate of one cycle of stimulated IVF (45%).

I refer my readers to an article in Human Reproduction Update 2002 March-April 8 (2):129-39. The editors reviewed 20 selected studies that covered 1800 cycles of Natural Cycle IVF resulting in 15.8% pregnancy per embryo transfer.

The Natural Cycle IVF has the following advantages over Stimulated Cycle IVF:

• Natural Cycle IVF uses the body’s normal ovulation process
• There are no expensive hormonal medications
• Natural Cycle IVF can be repeated month after month if needed
• The cumulative pregnancy rate after 3 cycles will approach or equal the success    of Stimulated IVF

The disadvantages are that if only one follicle is developing:

• One may not be able to retrieve the egg
• The egg may fail to fertilize
• The fertilized egg may not develop into an embryo

How is Natural IVF done? – Timing is Everything

There are 2 ways to determine follicle maturity.

• Ultrasound determines follicular diameter.
• The Estradiol and/or the start of the LH (luteinizing hormone) surge.

Ultrasound studies are done daily several days before ovulation is expected and when the follicle size reaches 16-18mm and/or the LH begins to rise, the retrieval is planned shortly afterwards.

Interestingly, indomethacin (50mg 3 times daily with food) has been used by some clinicians once the follicle reaches maturity to help prevent collapse of the sac before the time of aspiration.

In summary, Natural Cycle IVF is a useful and logical technique for selective patients.

The cost for Natural Cycle IVF is around $3000.

This includes the following:

• Cycle monitoring
• Office visits
• All ultrasounds
• All lab work (Estradiol, LH, Progesterone and your first pregnancy test)
• The retrieval
• Anesthesia fee
• Cryopreservation fee

For any questions regarding Natural Cycle IVF, please contact Dr. Brandeis directly.

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