You know, when I think of IVF conventionally or traditionally, the way IVF is done is that physicians will use primarily injections of hormones to try and stimulate the ovaries to produce lots of eggs or lots of follicles. It’s probably best to go through whether what a natural cycle is first and then to kind of move into what IVF is and what conventional stimulation is.
So, in a natural cycle your body puts out just a little bit of hormone every day and that hormone is enough to grow one egg, and typically women will ovulate or grow one follicle during that cycle. So, for a typical 28-day cycle you’re growing month follicle, the patient is ovulating around day 14 and ideally they have intercourse during that time and they’re able to get pregnant. But during every month more than one egg is recruited or wakes up, so there’s a whole group of eggs every month that wake. As women age, that group of egg gets a little bit smaller in quantity and potentially even smaller in quality. The whole point of IVF is to try to exploit so that we don’t just wake up one egg but we actually wake up and stimulate that entire group. So, we make the process of ovulation a little bit more efficient, and that is why the conventional IVF approach was initially developed for. So the idea here is that we are giving excess or super physiological amounts of hormones traditionally something like FSH or follicle stimulating hormone which is an injection, potentially along with some other injections like Menopur, which is a combination of FSH and LH, which is luteinizing hormone. Then those high doses of hormones really allow for not just the one egg to grow but maybe five eggs or ten eggs or the entire group of eggs, if possible. That’s the conventional.
There are risks to that, as well. Probably, the biggest risk is what’s called ovarian hyperstimulation syndrome, that’s the most common thing that people get. You often hear stories that someone does an IVF cycle and they’re nauseous throughout the cycle, vomiting and their belly gets bloated, they build up a fluid or their ovaries can twist. That can lead to problems with blood supply and they developed numerous cysts. That’s something that we really would love to avoid and I think that’s really what started the whole trend to do minimal stimulation. So the way you should think about minimal stimulation is we are trying to do a more gentle, controlled and holistic approach to IVF. We feel that bigger is not always better. It may not necessarily fit every person to take ten times the normal hormones and take three injections a day, and go through this procedure that puts you at significant risk for hyperstimulation. With many other centers around the world, especially in Japan, we have pioneered this idea of mini stim which lets us try and personalize the medicine, understand how many follicles the patient actually has and what’s the required amount of medication.
In general, a mini protocol is typically a combination of some injectables and then some oral medication to supplement, and allows us to really get excellent quality stimulation without the use of these really high conventional doses. Of course, the biggest benefit is that we avoid a lot of these severe side effects that we see with conventional IVF. We’re focusing on quality as opposed to quantity by supplementing the injections or we’re reducing the injections and supplementing it with some oral medication, which is certainly easier to take. We can even avoid certain injections like trigger shots, we have various nasal sprays, and also we avoid the high risk of hyperstimulation.