However, before actively pursuing natural IVF, it’s important to understand what it really entails, as its name can be a bit deceptive. We turned to the experts to learn more about the benefits and drawbacks of natural IVF, so you can decide if it’s right for you and your family.
Natural IVF vs. Traditional IVF
Natural in vitro fertilization, or natural IVF, is similar in some ways to conventional or traditional IVF. The basics are pretty much the same: your healthcare provider harvests a mature egg from your ovaries and fertilizes the egg with sperm in the lab. Then, the newly created embryo is transferred into your uterus. If all goes well, you wind up with a successful pregnancy. There are, however, some big differences between conventional and natural IVF. With conventional IVF, you’ll receive regular medical injections to stimulate your ovaries in efforts to produce multiple eggs. Experts call this superovulation, or controlled ovarian stimulation (COS). You also receive medications to prevent your body from releasing the eggs, so that they can be harvested and later retrieved. A commonly used medication for this purpose is a gonadotrophin-releasing hormone antagonist, or a GnRH antagonist, such as Ganirelix or Cetrotide. “This medication stops all messages from the brain to the ovaries, effectively preventing the signal for ovulation,” explains Michael Zinger, MD, an OB/GYN and reproductive endocrinologist with RMA Long Island IVF. By comparison, the name “natural IVF” might lead you to believe that it’s an entirely medication-free endeavor—but that’s not always the case. Some experts distinguish between fully med-free natural IVF and what some call “minimal stimulation” IVF or “mini-IVF.” With natural IVF, you skip the medications. With mini-IVF, your doctor will offer you small amounts of ovarian-stimulating medication before egg retrieval. Patients rarely ask for natural IVF, according to Peter Rizk, MD, an OB/GYN and a women’s fertility expert for Fairhaven Health in Bellingham, Washington, although some of them do question the cost of all the medications associated with standard IVF. Dr. Rizk usually tells them that the success rate of natural IVF is lower than stimulated IVF, but he’s willing to talk through the options with any patient who has questions. “A happy medium would be mild stimulation or gentle stimulation,” says Dr. Rizk.
How Natural IVF Works
With natural IVF, you forego the ovarian-stimulating medications designed to spur your ovaries into producing a whole cluster of follicles with eggs in them. When it’s time to retrieve the egg, the specialist or healthcare provider will insert an ultrasound probe into your vagina for visualization of the follicle and to make sure it’s mature enough to retrieve. Although it varies, some research suggests you’re hoping for a follicle that will measure somewhere between 17 and 20 mm. Other research suggests the optimal size of a follicle for egg retrieval is somewhere between 16 and 24.5 mm. Next, it’s time for the egg retrieval. Using the ultrasound for guidance, your healthcare provider will insert a thin needle into your vagina up toward the ovary and follicle. The fluid with the egg inside the follicle will be sucked out through the needle. The aspirated fluid with the egg will be removed and taken to the lab. In the lab, a technician will introduce the egg to the sperm, which will hopefully result in fertilization and an embryo. The embryo may spend a few days getting some TLC and monitoring in the lab before it’s ready for the embryo transfer procedure. Using a catheter, your doctor will carefully transfer the lab-created embryo into your uterus with the hope that it will implant.
Benefits of Natural IVF
There are several benefits associated with natural IVF, such as lower cost, fewer injections, and no risk of ovarian hyperstimulation syndrome, since you won’t be needing all those expensive, stimulating medications. Additionally, you won’t have to worry about the creation of multiple embryos, since only one egg is retrieved at a time during a typical natural IVF procedure. You also won’t have to worry about freezing and storing the leftover embryos, along with those associated costs. The cost savings of natural or even mini IVF could be appealing to you. For example, consider the fact that just one cycle of IVF in the U.S. costs approximately between $10,000 and $15,000. One 2013 study found that mini IVF was half the cost of traditional IVF. Additionally, a 2017 study found that a round of modified natural IVF was $7,000 less expensive per live birth than a round of traditional IVF.
Drawbacks to Natural IVF
The list of benefits may be very appealing, but it’s important to also consider the potential downsides. For example, your healthcare provider can only retrieve one egg from your ovaries at atime. That means you only have the chance to create one embryo. There’s also the risk of missing out on the egg altogether. “You have to be able to retrieve the egg just before it releases, and without medication, you’re not doing anything to prevent the release of the egg once it’s mature,” says Dr. Zinger. It’s a delicate balance for your doctor to retrieve the egg as late as possible so it’s mature enough to use in embryo creation, but you also run the risk of ovulating before the scheduled retrieval procedure. Plus, if you’re looking to get pregnant quickly, natural IVF might not be the best option for you. Research suggests that it takes longer for people undergoing natural IVF to conceive than those pursuing traditional IVF. In fact, it may take three natural IVF cycles to achieve the same pregnancy rate as one conventional IVF cycle. That can be stressful for potential parents. But the ability to only retrieve one egg at a time might not be such a major concern for people with a diminished ovarian reserve. No how matter how much medication their doctor gives them, it might be difficult to recruit more than one follicle anyway, says Allison Petrini, MD, an OB/GYN and reproductive endocrinologist with Texas Fertility Center in Austin. “Usually with those patients, the pregnancy rates with IVF are not good anyway,” she adds.
A Word From Verywell
Some doctors might be open to helping you pursue natural IVF (or perhaps mini IVF) if it is appropriate for you and your medical history. But some physicians may be more skeptical about the benefits when you consider the downsides, too. “I just see it as a suboptimal fertility treatment,” says Dr. Petrini. “The patient this is relevant for is very few and far between. It basically has been shown to be inferior to conventional IVF.” That said, if natural IVF is something that appeals to you, it’s certainly worth having a conversation with your reproductive endocrinologist, OB/GYN, or healthcare provider, in order to talk through all of the options to find the best fit for you. DOI:https://doi.org/10.1016/j.fertnstert.2012.07.972 https://doi.org/10.1016/j.beem.2018.10.005
