Minimal stimulation IVF and when to use it
Minimal Stimulation IVF, (a.k.a. “Mini” or “gentle” IVF) is a protocol for women with Diminshed Ovarian Reserve who have fewer follicles (eggs). All of the medications we use in IVF stimulate follicle growth, they do NOT create new follicles/eggs. Thus giving higher doses of FSH does not result in an increased number of eggs retrieved. In fact, we often observe that we can get as many or more eggs in DOR patients by using pills alone for the first five days, followed by very low doses of injectable hormones. Patients can achieve the same outcome at a fraction of the treatment costs and with far fewer injections or blood tests. We average 2 mature eggs for patients with an AMH <0.2 and 3-4 mature eggs when the AMH is closer to 0.5.
Patients who are ideal for Mini Stim IVF, typically have an antral follicle count of 4 or less and an AMH of < 0.5pg/dl. When your numbers are higher than this, you can usually get more eggs and have a better chance of success with a more conventional approach.
Egg quality: Is mini stim better than conventional? While most studies show no difference in egg quality, we have anecdotally noted excellent outcomes among eggs from minimal stim cycles (we will share this data in future posts).
To understand the minimal stim strategy, it’s helpful to think of your ovaries as a garden. If you only have three seeds, adding extra fertilizer or water doesn’t lead to more flowers. However, too much fertilizer or water can damage the soil. Our job is to make sure that your seedlings (follicles) have the right amount of nutrients and yield the best flowers possible.
If your antral follicle count is less than 4 and your AMH is less than 0.5, we’d encourage you to speak with your doctor about this approach. The best protocol for one person is not the same best protocol for another person.
Lastly, it’s important to remember that diminished ovarian reserve does NOT mean that you’re infertile or that you must give up.