What is IVF in the natural cycle (IVF-EC)? This method is also called the "natural protocol." Its prominent feature is the lack of need for hormonal stimulation.
The scheme for obtaining one egg, naturally ripened, is used for patients who have categorical contraindications for stimulation. It is used if, in previous IVF attempts, mature oocytes were obtained insufficiently or they had poor quality.
In the Medical Plaza Medical Center, the natural protocol is used in the following cases:
- if woman refuses to undergo the stimulation;
- if patient has a "PCOS";
- if there is a high risk of developing OHSS (ovarian hyperstimulation syndrome);
- with oncology before chemotherapy;
- in the presence of contraindications for hormonal stimulation.
Thanks to this method, it is possible to avoid side effects that occur because of the introduction of additional doses of hormones. Also, the natural protocol increases the likelihood of obtaining a single high-quality egg cell, chosen by the body itself. The following describes in detail how IVF passes in the natural cycle, what advantages and disadvantages this reproductive technique has.
IVF IN A NATURAL CYCLE - MANDATORY STAGES
For each patient, it is important to have an idea of how IVF is done in the natural cycle. With this approach, the main processes of follicle growth and oocyte maturation should occur in the female body. Ultrasound monitoring is required to clarify the features of follicle growth. Sometimes it becomes necessary to measure certain hormonal parameters, for which venous blood should be taken. To obtain a mature oocyte, a chorionic gonadotropin medication is injected intramuscularly before it is taken (36 hours before the procedure).
During IVF in the natural cycle without stimulation, transvaginal puncture of the ovary is performed to take the egg. This surgical procedure can take place either under a short intravenous anesthesia or without anesthesia (such moment must be discussed with patient in advance).
The day, the ovulation should occur, the doctor takes an oocyte from woman, which is the subject to fertilization in vitro. For this purpose, the biomaterial of the partner (in some cases, the donor) is used. Over the course of 5 days, resulting embryo reaches the blastocyst stage, then it is introduced into the cavity of female uterus. Conditions of this process are similar to the traditional IVF program.
PROGRAM STRUCTURE
Immediately before the procedure,a consultation, a gynecological examination, an ultrasound examination carried out at the beginning of the menstrual cycle are provided. After that, specialists of our clinic carry out:
- folliculometry (ultrasound monitoring that tracks follicle growth);
- transvaginal puncture of the follicle (performed without anesthesia or under general short anesthesia).
After these manipulations, the patient enters a comfortable ward, where she stays for two hours. At the next stage, the doctor places the embryo inside the uterus, monitors its condition before pregnancy.
WHO IS THE ECO PROGRAM IN THE NATURAL CYCLE RECOMMENDED
There are various indications for IVF in the natural cycle. The method is applied to the following categories of patients:
- Women of various ages with confirmed ovulation (ECO-EC should be used up to 37 years old, the program also brings positive results in a more mature period).
- Couples with diagnosed tubal or male infertility.
- Women who have a FSH level below 15-18 mIU / ml and estradiol content exceeds 75 pmol / L on days 2-4 of the menstrual cycle.
- Patients with oncological diagnoses prone to thromboembolic complications (conditions that are direct contraindications to hormonal stimulation of superovulation).
- Couples who want to avoid the acquisition of expensive ovarian stimulants (such funds are necessarily used in standard IVF).
- Partners refusing to perform cryopreservation of embryos. If the resulting embryo has good characteristics and can be transferred to the uterine cavity, it is not necessary to freeze the remaining specimens. This applies to patients undergoing the usual in vitro fertilization program. Moreover, specialists receive not one, but more oocytes, the remaining of which can be used for cryo IVF in the natural cycle.
The IVF-EC program is also recommended for patients who consider it unethical to choose the best embryo among those received and use it for transfer to the uterine cavity (this moment is one of the basic principles of traditional in vitro fertilization).
It's important to know! Performing IVF in a natural cycle, reproductologists of the Medical Plaza clinic often use the ICSI technique, which contributes to a successful conception. In this case, the choice of an egg and a healthy sperm is performed manually, and the male reproductive cell is inserted through the membrane of the oocyte using a thin needle. In the EC, they receive no more than 1-2 eggs, and ICSI becomes "insurance" against possible failure.
The IVF-EC program is often seen as an alternative for patients who in the past have had unsuccessful attempts to conduct conventional IVF (at the background of lack of response to ovarian stimulation, receiving low-quality oocytes).
With a significant decrease in the ovarian reserve (it is specified after the level of the anti-Mullerian hormone, estradiol parameters, the number of antral follicles determined by the transvaginal ultrasound method are ascertained), the couple can use donor eggs. Under such circumstances, an IVF program is carried out in a natural cycle using biomaterial taken from a donor.
WHAT ADVANTAGES DOES THE IVF-EC PROGRAM HAVE
IVF in the natural cycle, the pros and cons of the method are covered in detail by the doctors of our center before the procedure. Reproductive technology has a considerable number of advantages.
IVF in the natural cycle with minimal stimulation is considered as a safe and effective method of fertilization, not requiring the use of a large number of pharmacological supplies. In addition to a reduced medication load, the method is characterized by the absence of high economic costs associated with the need for expensive drugs (such drugs must be used in the process of stimulation of superovulation, provided for by standard IVF).
A significant advantage of the IVF program in the natural cycle is the possibility of its implementation over several consecutive cycles. In addition, the procedure helps to prevent multifetal pregnancies and avoid the development of OHSS.
Studies have confirmed that embryos obtained during the implementation of standard IVF and the use of drugs that stimulate ovarian function have lower quality compared to embryos obtained through the IVF-EC program. This is due to the negative effect of pharmacological medications on the quality of eggs, as well as the properties of the endometrium, which are required for successful conception and gestation.
The cost of IVF in the natural cycle is available for different categories of patients. The method is approved by many qualified doctors. IVF-EC is widely used in reproductive blades of large cities of Ukraine - Kiev, Kharkov, Dnipro, etc.
EFFICIENCY OF REPRODUCTIVE TECHNIQUE
Effectiveness of the procedure is largely determined by the age of the patient. IVF is the least effective in the natural cycle after 40 years.
Current medical statistics reports the following:
- after IVF-EC, the probability of pregnancy at the age of 40 years or more is on average 3-6%;
- for patients younger than 39 years, this figure reaches 11-53%.
Reproductologists at Medical Plaza Medical Center say that among those who have completed IVF in the natural cycle, women under 36-38 years old predominate. In this category of patients, the frequency of full pregnancy was at least 36%.
DOES THE PROGRAM HAVE DISADVANTAGES?
According to long-term observations, 10-15% of women during the ultrasound monitoring, before the stage of transvaginal puncture, premature ovulation is observed. Also, the fence of an insufficiently mature oocyte, or its complete absence, cannot be ruled out. Despite this likelihood, for most patients the transvaginal puncture procedure is successful, with gaining a healthy egg.
After fertilization, the doctor does not always receive high-quality embryos. Some of them are not able to continue their development in vitro, and are considered unsuitable for introduction into the uterine cavity.
Based on the foregoing, we can talk about the average effectiveness of the program. In numbers, this figure reaches 20%, which is also confirmed by reviews of IVF in the natural cycle.
CONTRAINDICATIONS
The list of contraindications for use of the IVF program in the natural cycle coincides with the requirements applicable to standard in vitro fertilization. Reproductologist after a thorough examination of the patient’s body can talk about the presence or absence of restrictions for this procedure. In some cases, woman needs to consult with other specialists (mammalogist, endocrinologist, neurologist, oncologist).
Preparation for IVF in the natural cycle is similar to the standard method. Patients undergo tests that completely coincide with the list of procedures required in the implementation of the standard program of in vitro fertilization. Only an experienced specialist should choose the effective tactics of leading a couple who wants to become parents and clarify the feasibility of performing IVF in the natural cycle.
The reproductologists at the Medical Plaza will help to determine exactly if the IVF-EC protocol is appropriate for the patient. Clients of our clinic receive the maximum chances of doing IVF in the natural cycle the first time.
Reaching out to doctors of Medical Plaza clinic, you can maintain complete confidence in the high chances of pregnancy and the birth of long-awaited, healthy baby. The price of IVF in the natural cycle is said during an individual conversation with a reproductologist and determined after taking into account the individual characteristics of the patient.