By Dr. DiMattina
Which IVF is Best for You? No “One Size Fits All”.
Patients often wonder which type of IVF is best for me? How do I decide? What do I do? It can be a bit overwhelming. I will show you the different types of IVF treatments available and how I help patients decide which type of IVF is best suited for them.
I should first mention that Dominion Fertility assesses each patient individually as each couple has their own unique situation. Treatment plans are then specifically designed for that particular couple. We do not use fixed formulas or “one size fits all” approach for our patients; rather we offer a variety of customized treatments so that the best one is provided for that couple i.e. unique patient, unique treatment. We believe this philosophy optimizes couples’ chances for a baby.
3 types of IVF: Stimulated IVF, Natural Cycle IVF (NCIVF) and Donor IVF
There are 3 types of IVF: Stimulated IVF, Natural Cycle IVF (NCIVF) and Donor IVF that includes either ova donor or embryo donor IVF. Here is a brief description of each. Then, I’ll show you how I recommend which type of IVF is best for our patients.
1. Stimulated IVF – This IVF is best suited for those patients with normal or strong egg quantity, also referred to as “ovarian reserve”. With this IVF, ovarian fertility drugs are used to obtain many eggs and embryos. We recommend performing preimplantation genetic screening (PGS) on the embryos to determine which embryo(s) are genetically normal. All the embryos at Dominion Fertility are routinely frozen and stored and later transferred once we have determined which embryos are genetically normal. By performing PGS and a frozen-thaw embryo transfer, pregnancy rates are very strong, usually exceeding 60% per embryo transfer. After one or two embryo transfers, most of our patients are pregnant and off to their Obstetrician. The remaining stored embryos can later be transferred so that the couple may have another pregnancy without going through the entire IVF process again. The advantages of stimulated IVF are very high pregnancy rates in those patients with PGS normal embryos and the ability to have more pregnancies at a later date using the frozen stored embryos. The disadvantages are the cost, side effects of the stimulation drugs and multiple office visits. Dominion Fertility is a premier center in the United States for performing PGS. It allows us to sort out the best embryos for embryo transfer, which increases the implantation rate and decreases the risk for a spontaneous abortion or a genetically abnormal pregnancy. The cost for PGS has significantly decreased because of advances in the technology. At Dominion Fertility, our genetic laboratory, Good Start Genetics, charges our patients $1,350 for testing up to 8 embryos.
2. Natural Cycle IVF – NCIVF is very simple and can be performed monthly. This IVF is best suited for those patients with poor ovarian reserve (few eggs), patients of advanced reproductive age, those who have failed stimulated IVF or those who wish to try IVF with their own egg prior to undergoing ova donor IVF. Patients who need IVF but do not wish to use ovarian stimulation drugs or who cannot afford stimulated IVF are also candidates for NCIVF. This IVF requires the patient to have fairly regular menstrual cycles. The egg in that cycle is monitored, retrieved, fertilized and then transferred fresh back into her uterus in that cycle. Pregnancy rates per embryo transfer are age dependent and similar to stimulated IVF. One disadvantage with NCIVF is the high cycle cancellation rate of about 50% per started cycle. With stimulated IVF many eggs and embryos are usually produced and this better assures an embryo transfer. Using NCIVF, we have produced many successful pregnancies in patients who had failed stimulated IVF and were told that their only options were either ova donor IVF or adoption.
3. Donor Ova and donor Embryo IVF – Our ova donor program only uses donors who are in their 20’s in order to obtain the strongest eggs for our patients. The donors are thoroughly screened with genetic, psychological, drug, metabolic, hormonal and imaging testing of their reproductive anatomy prior to acceptance into our program. Patients are allowed to review their donors’ test results prior to stimulating their donor. This allows the infertile couple to get a good understanding of the person they have chosen as their donor while maintaining anonymity.
Our ova donors typically produce many eggs and embryos, so the pregnancy rates for ova donor IVF are quite high. Indeed, most of our recipient patients are pregnant after only one or two embryo transfers. I truly enjoy performing ova donor IVF as most patients walk away with a baby especially when ova donor IVF is combined with PGS.
Donor embryo IVF or also called embryo adoption. Here, extra embryos produced using stimulated IVF in an infertile couple are anonymously donated by that couple for adoption by another infertile couple. There is a national embryo donation bank called Snowflakes that sorts out and makes available these embryos. The quality of the embryos will vary depending on the age of the patient who produced the eggs and the quality of the IVF program at the infertility center that produced the embryos. Overall, we have had good success with such embryos.
Which IVF option is best? Each patient is unique, and so it their treatment solution. Some examples of when to use each IVF treatment.
So, which IVF is best for you? Here is what I tell my patients. Let’s assume that the patient’s only option is IVF. Most of my patients have a pretty good understanding of the IVF process, so I first ask them how they feel about IVF. Their attitude and comfort level is important to me in order to reduce any unnecessary stress that is simply inherent in those who suffer from infertility. Then I look at her ovarian reserve. If it is normal or strong, I would recommend stimulated IVF and capitalize on the many eggs and embryos that are typically produced. By using PGS, we can then sort out which embryos are genetically normal thereby maximizing their chance for a genetically normal pregnancy and decreasing their chances for a spontaneous abortion. PGS also results in fewer unnecessary embryo transfers for the patient.
If the patients’ ovarian reserve is low or she has failed stimulated IVF or she does not wish to use ovarian stimulation drugs or she is an older age patient, then I recommend NCIVF. The only requirements for NCIVF are that the patient has regular menses and a normal uterus. Our experience shows that patients with poor ovarian reserve have the same pregnancy rates as patients with normal or strong ovarian reserve (DiMattina et al, 2014, IVF Lite). We have a 41 year- old patient with an FSH of 42 who delivered a healthy baby after her first treatment using NCIVF.
Patients generally like NCIVF because it is so simple to perform and for many it offers hope when none was offered. Dominion Fertility is the largest NCIVF center in the United States and NCIVF is performed extensively in many other countries. In fact, in 1978, the world’s first IVF baby resulted from NCIVF. The cost for this procedure is much less than stimulated IVF making it more accessible for many. Access to infertility care is a big problem in the United States. In September 2016, the NIH is hosting a conference to address this problem and NCIVF is a great option that helps address this issue. When patients have failed all options or their eggs are no longer capable of producing a successful pregnancy, then ova donor IVF or embryo donation may be the answer. These options are highly successful and provide much hope for many.
In summary, the practice of reproductive medicine has rapidly progressed over the past few years, providing more treatment options, so that we are now able to successfully assist most infertile couples achieve their dream.