Tuesday, 22 April 2014

Natural Cycle IVF - Procedure, Treatment and Benefits

Natural IVF cycle or gentle IVF is a simpler way of doing in vitro fertilization. It is beneficial for patients with poor ovarian reserve because they do not respond well to superovulation with gonadotropin injections. The process is done using minimal or sometimes no ovarian stimulation.

It is a preferred because of the following perspectives,

  • Fewer side effects
  • Less expensive
  • Good success rate
  • It can be repeated

However, the patients treated under this type of IVF should understand the challenges involved in the treatment. The procedure is quite demanding in terms of egg retrieval timing and fertilization of egg.

The process adapted at Pahlajani Infertility Clinic for natural IVF involves,

  1. We start with vaginal ultrasound scan on day 7 to estimate the follicular size and thickness of the endometrium and ensure the viable and growing follicle.
  2. After the confirmation, the patient is given Gonadotropin-releasing hormone (GnRH) (also known as Luteinizing-hormone-releasing hormone (LHRH)) antagonist medication to avoid untimely LH surge.
  3. Later, the scan and E2 blood test is performed on Day 10.
  4. We wait for the follicle size to grow about 18 mm and E2 (estradiol) level to reach 200pg/ml, and then give the HCG trigger shot.  In general, a 'good' estradiol level is between 150- 500 pg/ml on day eight of an IVF cycle. Approximate doubling of the day eight value every 48 hours is a positive sign of continued follicle development. 
  5. After 36 hours of the HCG shot, we collect the egg. 
  6. Embryologist fertilizes the egg and the formed embryo is transferred to the patient’s uterus within 48 hours.

Another treatment that we recommend at Pahlajani IVF Clinic is mini-IVF. It has better pregnancy rate and involves mild super ovulation to ensure the growth of 2-3 follicles. The treatment is similar for mini IVF as used in natural IVF with some additional medical treatment. 

In mini-IVF, the first scan is performed on Day 2 to absence of ovarian cysts and down regulation. The slight difference is that the patients are put through Letrozole from day 2 to day 6 and Menogon from day 3 onwards. The scan is performed on day 7 and rest of the procedure is similar as natural cycle.

Dr Neeraj Pahlajani


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