Natural Cycle IVF/M – A New Alternative approach to Conventional IVF Treatment

There is an increasing interest in Natural cycle IVF among patients because it relies on natural selection, does not involve ovarian stimulating drugs, results in fewer side effects, and is therefore safer and more comfortable.

During each menstrual cycle, usually only a single follicle (egg sac) grows to the ovulation stage to release an egg for potential fertilisation. However there are several small follicles called antral follicles in the ovary which contain immature eggs.

In natural cycle IVF, a single, naturally selected egg is collected for fertilization and a single embryo is transferred. In natural cycle IVF with IVM, we would aim to collect one mature egg together with several immature eggs. Immature eggs are matured in the laboratory using special and advanced culture conditions (IVM) to create several embryos. This could be an exciting and new alternative for infertility treatment. Normally, 70-80% of these immature eggs collected from the ovaries will mature 24-48 hours after culture in the laboratory. In comparison with current IVF treatment, the major advantages of natural cycle IVF combined with IVM include avoidance of stimulation drugs and associated side effects including ovarian hyperstimulation syndrome.It is carried out in a woman’s own menstrual cycle with no suppression with drugs which cause menopausal symptoms. There is no artificial cycle and women feel that they are in control. It costs less and simplifies treatment.

Recently, it has been demonstrated that immature egg collection followed by IVM is a successful alternative to conventional IVF for women with polycystic ovaries (PCO) or polycystic ovarian syndrome (PCOS) – related infertility (Chian et al, 1999). In general, the clinical pregnancy rates are 30-35% in infertile women with PCO or PCOS, based on approximately 1,000 cycles of IVM-treatment. So far, there are more than 250 healthy infants born worldwide following the collection of immature eggs which were matured with IVM. (Data from Canada, Denmark, France, Korea, Japan, Taiwan and China).

Studies have also demonstrated that immature eggs collected from small follicles can be successfully matured and fertilized in vitro, resulting in pregnancies and healthy live births even from women with normal ovaries and in older women. Therefore, one very attractive possibility for enhancing the successful outcome of natural cycle IVF treatment is its combination with immature egg collection and subsequent maturation with IVM. If both the mature egg from the dominant follicle and the immature eggs from the small follicles were collected, the chance of achieving a pregnancy would be greatly increased with IVM and result in several viable embryos some of which could be frozen and transferred in a subsequent cycle. IVM, once considered a challenge, is now a reality. However, it will continue to be important to individualise natural cycle IVF treatment with or without IVM treatment for different patients in order to optimise the success rates.

Frequently asked Questions & Answers

What is Natural cycle IVF?

In Natural cycle IVF, we collect a naturally selected, single mature egg from the ovary for fertilization and a single embryo is transferred.

What is IVM?

IVM means “In Vitro Maturation of eggs”. In this method, we are able to collect immature eggs from smaller follicles in the ovary and mature them in the laboratory with the use of specially designed and sophisticated culture conditions. Several embryos could be created without exposing women to high doses of stimulating injections and their side-effects.

What are the advantages of IVM?

Women are usually not given stimulating injections.Therefore,they are not exposed to harmful side-effects and risks of ovarian hyper stimulation syndrome (OHSS).The cost of treatment cycle is lower than conventional stimulated cycle.

What is Natural cycle IVF/M?

This is a new and exciting development in infertility treatment. Recent scientific publications have shown that this could be an alternative approach to conventional IVF.

Women with normal ovaries, reduced egg reserve and older women can also try this treatment if they have small (antral) follicles in their ovaries. Essentially, we can potentially create more embryos from a Natural Cycle usually without stimulating drugs. This can be a “win-win” situation for the woman. There are no side-effects or risks of drugs, it costs less and can potentially have the same advantages of stimulated cycles (i.e.: more eggs and embryos from one natural cycle).

How is Natural cycle IVF/M different from Natural cycle IVF?

It is a type of natural cycle IVF with additional benefit of potentially producing more than one embryo for transfer or freezing. In Natural cycle IVF withIVM, smaller follicles are also emptied to find immature eggs which could be matured in the laboratory to more create embryos. This increases the success rate per cycle.

How is it different from Conventional stimulated IVF?

It is fundamentally different to conventional stimulated cycle. Natural cycle IVF /M treatment is carried out in a woman’s own natural cycle usually with no stimulation hormones. It is aimed at producing more than one embryo from a natural cycle. It has all the advantages of a natural cycle as regards to cost, safety and natural selection with additional benefit of producing more than one embryo without high or no ovarian stimulation.

How is it different from Mild IVF?

There are usually no stimulating drugs involved.

It has the advantages of potentially having more than one embryo in a natural cycle .It costs less than a mild IVF cycle.

What are the disadvantages?

The success of Natural cycle IVF/M depends on the availability of smaller follicles in the ovary. There is a possibility that immature eggs are not collected or matured in the laboratory. Not every woman is suitable for this treatment.

Is IVM safe?

The scientific papers and the data from birth of hundreds of IVM babies across the world have shown it is safe for the mother and child.

Is it licensed by the HFEA?

Yes, it is licensed treatment in the UK.

It is successfully practiced in Canada, Japan, Korea and China.

How do I know if I am eligible to have Natural cycle IVF/M?

If you are ovulating and have smaller follicles (usually 7 or more) in your ovaries, you will be able to have this treatment. You will need an advanced ultrasound scan to assess your suitability for this treatment.

Can I have IVM if I am not ovulating?

Yes, as long as you have smaller follicles in your ovaries as described above.

If you have PCO, you can also have IVM treatment cycle.

What is its success rate?

The success rates of Natural cycle IVF/M are encouraging. The pregnancy rates will of course, depend on your age, egg reserve, hormone profile and other factors affecting implantation. Recent scientific paper on Natural cycle IVF/M has shown the following results (Lim et al, Fertility & Sterility Vol 91, 4, 2009).

A total of 417 cycles were started, and 410 cycles (98.3%) were completed. Of 410 cycles, 151 (36.8%) were treated by natural cycle IVF/M, 63 (15.4%) underwent IVM alone, and 196 (47.8%) underwent COH. With increasing age fewer cycles can be treated by natural cycle IVF/M or IVM. Clinical pregnancy rates were 40.4% (61 of 151) for natural cycle IVF/M, 41.3% (26 of 63) for IVM alone, and 37.8% (74 of 196) for COH. There were no differences in implantation rate in the three groups (17.8% [82 of 462], 16.7% [35 of 210], and 20.1% [103 of 513]).

Natural cycle IVF/M together with IVM-alone treatment can offer more than 50% of infertile

women with an acceptable pregnancy and implantations rates.

Initial results of Natural IVF/M in our clinic are encouraging .

For further information, please e mail info@createhealth.org .You can also attend Free Patient open day conducted on Saturdays once a month. Please see www.createhealth.org for details.