When a patient requests a fertility procedure called minimal stimulation in vitro fertilization (IVF), also known as "mini IVF," explicitly because they've heard it offers a "better" quality egg, I know I have some explaining to do.
There are reasons mini IVF -- which involves a shorter course and lower dose of medication to stimulate egg production, along with the retrieval of fewer eggs -- may be reasonable to pursue as a fertility treatment. Higher quality eggs is not one of them.
Though the hope is always for better quality eggs, there are no clear data to support the commonly repeated, and too-often believed, claim that mini IVF will yield them. This type of promise highlights the informational uphill battle the fertility field faces, where marketing (over)promises can give patients false hope. Optimism should not replace facts when patients face serious, sensitive medical challenges.
As physicians working in an environment where egg freezing and IVF are becoming increasingly common, we must set the record straight for our patients who are beginning this journey.
The reality is that mini IVF is actually less effective than conventional IVF for most people, and is only useful in a few circumstances. It's typically not a first-line treatment in my practice because the typical goal of IVF is to retrieve a high number of eggs to boost the chances of creating more embryos for implantation, and the expectation in mini IVF is that it stimulates the production of fewer eggs.
Sometimes, however, the standard doses of medication that stimulate egg production in conventional IVF aren't the most effective path.
Reasons to Pursue Mini IVF
One of the most common reasons to pursue mini IVF is because a patient has low ovarian reserve, or diminished ovarian reserve. This medical condition refers to a lower-than-expected quantity of eggs that affects the ability to conceive. It can simply be the state of fertility for a particular patient, or a result of anything from autoimmune diseases and viral infections to treatments like chemotherapy. Some patients with very low ovarian reserve don't respond to conventional doses but will respond with gentler stimulation like mini-stimulation IVF.
Some patients struggle to tolerate the higher levels of medications used in conventional IVF. In about 1-5% of IVF cycles, ovarian hyperstimulation syndrome may occur, in which ovaries swell, become painful, develop cysts, and leak fluid, leading to abdominal bloating and pain. Sometimes it makes sense to switch to lower doses and shorter courses of medication if treatments such as leuprolide acetate-only trigger shots are ineffective.
Cost can be another reason patients pursue mini IVF. It can be less expensive than conventional therapy because it uses less medication, which is typically what's driving the variable cost. But costs for mini IVF can mount and become as expensive as traditional IVF (anywhere from $15,000 to $25,000 per round, sometimes more with a donor egg) if patients have to undergo multiple cycles.
Finally, ethical considerations abound in the fertility field for both patients and doctors. Some families express religious and/or ethical concerns about conventional IVF because they don't want to create an excess of embryos that eventually may have to be stored, adopted, or destroyed. They see mini IVF as an opportunity to create only as many embryos as they plan to use.
No 'Better' Embryos
Still, there are no guarantees about the quality of the eggs. We only know that mini IVF is more likely to produce fewer eggs, and conventional treatments may yield more. That message can be difficult for patients to hear when they've been told there are "better" embryos, that they can "optimize" embryos, or prioritize some embryo characteristics over others. It may seem a small linguistic step from "better" to "optimal," but it's a steep ethical slope.
Experienced fertility specialists understand how vulnerable fertility patients and their families can be as they navigate procedures, costs, and sometimes, disappointments. That vulnerability isn't the time for hard-sell promises, but instead, a moment to be up-front with hard truths about what to expect throughout their fertility journey.
IVF can be both medically and numerically complex, making it our duty to be data-driven, to clearly communicate what reliable studies show, and to be honest about the unknowns. Amid specious claims that the fertility process can be optimized, we specialists must separate the marketing from the evidence, and share that with patients responsibly so they can grow their families with healthy knowledge, and in good health.
Randi H. Goldman, MD, MBA, is the program director of the Reproductive Endocrinology and Infertility Fellowship for the Northwell Health Department of Obstetrics & Gynecology.
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