That’s the patients with lower ovarian reserve. Generally, in patients with, let’s say, an antral follicle count between 4 and 6, the response to the mini IVF usually seems to be the same as, like, the full-dose IVF. Even within Europe, there are differences in what kind of medication may be used. In some countries, for example, using the anti-estrogens is prohibited — for example, such as in France — so you see different stimulation protocols with really high doses of gonadotropins because they actually may not use any other medication.
There’s a group of ladies who but it’s a declining proportion I think who still have a feeling that they would like to keep to a simpler treatment protocol, they like, maybe they’ve read bad things about IVF or they’ve got intrinsic issues with excessive ovarian stimulation and they like the idea of either natural or low dose stimulation: one or two follicles insemination either with partner or donor but I think, again, in the private sector it’s difficult to, I think I try to but that’s maybe because I’ve still got half an NHS hat on as well, I would always present that option to ladies stroke couples because I think, if there’s no rush and that’s always a big part of it so, if you’ve got a lady of 30 essentially with not much else going on who needs donor sperm, why not spend some months doing simple treatment, very simple treatment and I think, that’s the picture I try to sort of, I would give them the options and the pros and cons of the two options and again, if they say well actually that’s all very well but I just want to know what’s the most likely thing to get me pregnant to go back to what I said earlier, you can always if you want to sell the IVF but I think, you need to give people the opportunity to consider whether they want simpler treatment and again, even for ovulatory, for PCO, I think a lot of a lot of clinics, the vast majority of their PCO ladies probably go straight to IVF. Over the years, I’ve seen multitudes of ladies get pregnant with IUI with PCOS so, I think that bit of the market is shrinking for perhaps non-clinical reasons sometimes and I think that’s disappointing because it does have success.
Well, actually women that have a very very low ovarian reserve and because we know that if we gave them a lot of medication rather than giving the minimum dose, we’re still gonna get the same response from the ovaries so, the best candidate would be a woman that doesn’t want to go through an egg donation program, have a very very low ovarian reserve and this is where we can actually do natural cycles or mini IVF.
Usually when we have satisfactory ovarian reserve according to the age group, mainly what we are trying to do is to try with low doses of medication to achieve the number of the follicles in order to increase the chances to find the normal embryos and good quality embryos. Basically, all the women, with satisfactory ovarian reserve they can have mild stimulation in order to be able to create more than one embryo and increase the success rate in one only IVF cycle.
Patients in higher age and the poor responders where let’s say during the classic stimulation we only get less than six eggs and in that case the Minimal stimulation might actually be preferable. Once again the number of eggs obtained is a little lower but still it might give us a good chance for success at a lower cost overall.
If you are someone who has a very high ovarian reserve, you have a much larger number of follicles that are available and you have a very good reserve, all you need is mild stimulation to get a good response. Or on the other extreme, you may be someone who has a very poor ovarian reserve and you do not have that many follicles. So in that case, what we know is that even if we give you full stimulation or we do conventional IVF for you, we will end up getting only as many eggs as are available. It could be 2, 3 follicles or 4 follicles that you have so we are expecting a maximum of that many eggs. So giving you more medication is not going to give us any more results, we are going to get what we’re going to get. The result may be poor and in those cases, they benefit from that little stimulation and little push to the ovaries, to get more than one and the best available amount an ovary can offer us. Or it could be a medical reason, you may be someone who has a family history of thrombosis or stroke amnesia if anything. This means you are at a high risk of forming blood clots which when stimulated, and with a high estrogen state, can increase the clotabilty of the blood. In this case we would like to keep it closely monitored, keep the dosages very low and mild and try not to increase the level of hormones too high in your body so that we can keep you safe. There could be other medical conditions where we have to be careful such as a candidate who cannot go under sedation because of certain medical reasons, so we have to use local anesthesia so we keep it as mild as possible to give the best benefit.
