NATURAL CYCLE IVF at the Brandeis Fertility Center in New York
The Brandeis Fertility Center, Leaders in Natural Cycle IVF and minimal Dose Stimulation IVF
The Brandeis Center specializes in natural cycle IVF, modified natural cycle IVF, and minimal stimulation techniques – all of which are attempts to rely upon the patients natural cycle to harvest a limited number of eggs that are most likely to be healthy.
Natural Cycle IVF is in contrast to conventional IVF where more drugs are used, more eggs are achieved - but some of these eggs may not be able to be fertilized.
The Brandeis Fertility Center specializes in natural cycle IVF.
1. pure natural cycle IVF
2. ovulation triggered natural cycle IVF
3. modified natural cycle IVF
We also offer
1. Minimal Dose Stimulation IVF
2. Conventional IVF
Premise of Natural Cycle
The number of eggs a person has during the first days of the menstrual cycle and number of follicles that respond to stimulation are very important fertility parameters. Patients should never be told that even if they only make 1 egg their chances are just as good as patients who make many eggs in response to stimulation.
However, if we capture the best possible egg that patient is able to produce with either a natural cycle or low dose stimulation – the chances for success for that patient maybe better then subjecting the same patient to an strong aggressive cycle stimulation with high doses of medication which at best will yield very fews egg.
Natural cycle IVF is useful for the following patients:
1. Patients who prefer to have a natural holistic approach avoiding any injections, steroids
2. Patients who are afraid of injections
3. Patients who are over 35
4. Patients who do not respond well to stimulation
5. Patients who have a history of breast cancer or ovarian cancer
6. Patients who have religious or ethical concerns embryo reduction.
7. Patients who have failed to conceive despite multiple cycles of IVF
8. Patients who cannot afford the high cost of fertility medications
9. Patients who are unable to come for daily monitoring - for the daily monitoring needed for conventional IVF
Advantages of Natural Cycle IVF over Conventional IVF: The disadvantages of pure cycle IVF and modified cycle IVF Only 1 egg gets produced therefore couples aren't able to freeze extra embryos for later use. Every study in medical literature has shown that the success rate per cycle is less with pure natural cycle IVF or modified cycle IVF compared to conventional IVF.
1. Lower cost because of minimal medication
2. Less discomfort to the patient
3. No anesthesia required in some patients
4. No risk of multiple birth, so less risk of pre-term delivery
5. No risk of hyper-stimulation
6. No ethical problems about embryo freezing or fetal reduction
However the cumulative pregnancy rate after several cycle of natural cycle IVF is similar to the success rate of conventional IVF in selected patients.
For patients who wish to freeze embryos. They can achieve pregnancy through natural cycle IVF and then use additional cycles to obtain additional embryos for a later use. These embryos can be stored at an embryo bank and then transferred years later. Additionally, minimal dose stimulation can be considered and one or two embryos transferred and the rest can be frozen.
Pure Natural Cycle IVF
Many patients choose pure natural cycle IVF because it is natural method and is the method of IVF that is close to natural conception – avoiding the use of any chemicals or steroids.
Pure Cycle IVF is the most natural method of invitro fertilization possible. No fertility hormones or drugs are given.
Near the time of ovulation a thin needle is passed through the vaginal wall into the ovaries with the hope of recovering the 1egg produced during the natural cycle. In some cases no anesthesia is required the egg is fertilized with the sperm and the embryo then transferred into the uterine cavity 3 to 5 days later.
Patients undergoing pure natural cycle IVF are monitored carefully using urine LH kits, blood testing, and sonogram.
When blood testing and sonograms indicate the follicle is mature it is removed as in standard IVF. In some cases no anesthesia is required.
See sample calendar. See important articles.
Ovulation triggered natural cycle IVF
The difficulty with pure cycle IVF is that in some cases despite best attempts at monitoring, the patient ovulates too soon.
To avoid this, HCG is given when the follicle appears to be mature.
As in pure natural cycle IVF, patients are carefully monitored using urine LH kits, blood testing, sonogram.
HCG - a natural hormone preparation is used to help insure egg maturation - is given when the egg-bearing follicle reaches a size of 18mm. egg retrieval is usually done 32-36 hours after HCG.
How is Natural IVF done? – Timing is Everything There are 2 ways to determine follicle maturity. • Ultrasound determines follicular diameter. Ultrasound studies are done daily several days before ovulation is expected. 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 $2900 for 1 cycle. 3 cycles for $7000. What drugs are used? What is a typical Cycle of Natural Cycle IVF Examples Pre-retrieval sonograms How are patients followed after aspiration? Why see us for Natural Cycle IVF?
• The Estradiol and/or the start of the LH (luteinizing hormone) surge.
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
No medications are used to obtain the egg.
Progesterone, suppositories are used after egg retrieval in selected patients.
For any questions regarding Natural Cycle IVF, please contact Dr. Brandeis directly.
Beginning the Cycle
1) The patient calls us with the first day of her period
2) An office visit is scheduled during the first 3-4 days of her cycle to perform a baseline bloodtest (Estradiol, LH, Progesterone) and a vaginal sonogram.
The purpose of the sonogram is to see
1) If there are cyst present
2) To see how many follicles are available for that cycle (the antral count).
If the FSH is favorable and there is no cyst then a decision is made to proceed with the cycle.
Deciding when to do retrieval – remove the egg
A sonogram is repeated 3 days before ovulation is expected to occur.
1) If the usual cycle is 28 days apart – that patient will be seen day 11 – because ovulation is expected to occur by day 14.
2) If the usual cycle is 24 days apart - that patient will be seen in day 8 - because ovulation is expected by day 10.
3) If the usual cycle is 35 days apart – that patient will be seen on day 18 - because ovulation is expected by day 21.
Sonograms are done everyday or at least every other day and in the several days before ovulation is expected to occur.
Retrieval is planned on the basis of the following factors.
1) The rise of Estradiol over 250
2) The size of the follicle increases to 20 millimeters
3) The Estradiol or LH rises quickly
Removal of the Egg with Natural Cycle IVF
The method of anesthesia depends upon patient safety and comfort.
Very mild sedation or local anesthesia are the best options.
Most patients can leave 1-2 hours after the aspiration of the egg.
The protocol is the function of the patient
1) If the lining is thick and there is no history of miscarriage – sometimes no medications are given
2) If the lining is thin and there is a history of miscarriage – Progesterone, Estrogen tablets and low-strength aspiration should be considered.
3) If there are repeated failed IVF attempts – medications should be done to improve implantation.
Natural IVF requires a hands-on approach with a good understanding of the Patient’s history
and past treatment attempts.
Dr Brandeis sees all patients at each monitoring visit and performs all aspiration and transfers
There is a opportunity to discuss matters of concern and as well as to look more carefully at the cycle itself.
