You've heard the expression 'less is more,' right?
Maybe you've even experienced the value of a little bit less - from less talking (and more listening) to less spending (and more saving), to less stuff (and more memories), 'less is more" is not just a cutesy trope - it's true.
And in the case of Minimal Stimulation In Vitro Fertilization treatment, known as mini-stim IVF, that's definitely the case.
How Mini-IVF can help women with Diminished Ovarian Reserve
Mini-stim IVF, which uses less medication than traditional IVF, is ideal for several types of fertility patients. One group benefits tremendously from this type of treatment - women with low ovarian reserve or Diminished Ovarian Reserve (DOR).
In other words, women who have fewer eggs than average benefit from lower doses of medicine and a less aggressive treatment protocol. Sound counterintuitive? Actually, it's quite the opposite.
But before we get into why, let's take a step back and quickly go over what mini-stim IVF is and how it's different from traditional IVF.
How is Mini-IVF different than traditional IVF?
Simply put, mini-stim IVF is a form of IVF that uses much less medication than traditional IVF, and as a result, produces fewer eggs in a woman's ovaries. But there's more to it than that.
A traditional IVF cycle aims to create as many embryos as possible for future implantation and pregnancy. Because not all embryos will mature, and not all that mature will be genetically healthy, not all of those will successfully implant inside a woman's uterus. Having many embryos 'in the bank' to act as backups is ideal in traditional IVF.
The IVF Process - The Race to Ovulation
- To create an embryo, you need an egg and sperm.
- Since sperm is usually plentiful (one round of ejaculate contains tens of millions of sperm), the focus turns to a woman's eggs to complete the second half of the equation.
- At any given time, the only eggs accessible to doctors are the eggs growing and maturing inside each ovary that month in preparation for ovulation.
- Depending on the woman's age, the number of eggs competing to develop in a healthy reproductive system each month is between one and two dozen, give or take. You can think of it as a race - there are "runners" racing to grow into the biggest egg so it can finish the race first and ovulate. But as the finish line, or ovulation, nears, one runner emerges as the leader, outgrowing the rest.
- That egg is the one that ovulates each month in hopes of being fertilized, implanting inside a woman's uterus and leading to an ongoing pregnancy and live birth.
Doctors in traditional IVF give medication containing hormones that tell all the runners to grow and mature simultaneously. Hence, there is no one dominant egg, and all the eggs in that cycle can be retrieved to make embryos. The result is collecting a dozen or more eggs in one cycle, when naturally, only a few of those eggs would have been near the finish line, with only one egg finishing the race and ovulating.
To grow all the eggs inside a woman's ovaries at one time, women undergoing traditional IVF have to take high doses of injectable medication daily for 10-14 days. Women's bodies work very hard to mature these eggs before retrieval. The theory among many researchers and proponents of mini-stim is that the traditional IVF protocol is highly taxing on the body, and all those eggs may not be of the highest quality.
"With mini-stim IVF," Pearl IVF founder and Medical Director Dr. Anne C. Davis said, "we're working with the body to give us what it wants instead of shouting at it to give us everything it's got."
The mini-stim protocol is much more aligned with the way ovulation naturally occurs. Women take a mix of oral and injectable medication at lower doses and less frequency than traditional IVF.
With less medication, the body works more in line with its natural rhythm and matures only a few eggs a time - likely the same eggs that would have been close to ovulating naturally. While this method does lead to fewer eggs retrieved, the retrieved eggs tend to be of higher quality, and the body has not exhausted itself by growing many extra eggs.
Diminished Ovarian Reserve & Infertility in Women
So now let's move into how this relates to women with DOR, or low ovarian reserve.
- Women with this condition have fewer (and often poorer quality) eggs than they should for their age, meaning that they are approaching menopause at a much quicker pace than expected.
- Most women reach menopause, or the end of menstruation, around 50 years old, although fertility declines dramatically for most women by 40. For example, a 28-year-old woman with DOR could have the same quality and number of eggs as a 40-year-old woman.
- While the reason behind DOR is not widely understood, doctors and scientists know that a woman's ovaries are aging rapidly.
- However, the good news is that DOR is a common diagnosis, and many women with DOR do go on to have a successful pregnancy (or multiple successful pregnancies) through IVF.
Is Mini-IVF better for Diminished Ovarian Reserve a better option than traditional IVF?
Interestingly enough, many women with DOR do not do well with traditional IVF. They respond poorly or not at all to the heavy drug protocol, or most of the eggs retrieved from this protocol are low quality. Low-quality eggs mean they are not fully mature at the time of retrieval, fail to fertilize with sperm or lead to an abnormal embryo that will either not implant, or lead to miscarriage.
For this reason, women with DOR benefit from mini-stim IVF. Since mini-stim IVF uses less medication to stimulate a woman's egg, only the eggs the body would have naturally chosen to be the frontrunners in the batch respond to the drug and grow big enough to be retrieved. As a result, Dr. Anne Davis usually only retrieves 3-6 eggs, sometimes less, from women with DOR.
What's fascinating is that these eggs are often high-quality eggs. One of them will usually proceed through every stage with success - maturity, fertilization, embryo growth, embryo competence (normal vs. abnormal), implantation, ongoing pregnancy, and live birth. Suppose none of those 3-6 eggs progress through these stages.
In that case, women with DOR can do one or two more mini-stim cycles because mini-stim is less expensive than traditional IVF due to its more natural approach, requiring less medication and less monitoring. It's also is much less physically and emotionally taxing; doing several rounds of treatment is not only tolerable but relatively easy.
The beauty of mini-stim is hands down, the way it works with your body, just slightly enhancing the body's natural operating wisdom. And for women with DOR, that type of less is, in a life-changing way, a whole lot more.
