What is ‘natural IVF’?
Midland Fertility has offered natural cycle IVF (also known as ‘gentle’, ‘mini’ or ‘mild’ IVF) since the clinic was established in 1987.
Natural cycle IVF has been around since the beginning of IVF as the first IVF baby, Louise Brown, was born using this technique. Since her birth, research has led to the development of new techniques – and specifically new drugs – that have significantly improved the success rate of IVF. However these more successful, drug-controlled cycles may not suit some women and so, as an alternative to standard IVF or ICSI Midland Fertility can offer:
- natural cycle IVF
- modified natural cycle IVF
- mild stimulation IVF (Midland Fertility’s first baby, Brett Rigby was conceived with this treatment protocol and was born in October 1998)
Who may benefit from natural, modified or mild stimulation IVF?
Some evidence suggests that an egg that is naturally selected by the body for ovulation may be of a higher quality that those produced under the influence of drug stimulation. Other research suggests that high levels of stimulation can affect the receptivity of the uterus, reducing the chance of embryo implantation. Sometimes the clinical team will advise that natural IVF is the best protocol to enable the woman to conceive, including:
- women with a raised FSH and low AMH levels – sometimes there is no advantage in using high amounts of stimulation drugs as they are unlikely to produce more than one or two eggs, despite this huge and costly intervention
- women with high AMH levels and polycystic ovarian syndrome (PCOS) may be at risk of Ovarian Hyperstimulation Syndrome (OHSS) due to the stimulating drugs used to increase the number of eggs in standard IVF treatments
Or other factors may cause a woman to request natural IVF as a matter of choice, including:
- women who do not like the idea of having fertility drugs
- women who have had problems in previous cycles with side effects
As natural or minimal stimulation IVF uses far fewer drugs, each treatment cycle may be more affordable. However, as there is minimal intervention with this approach, treatments may need to be repeated in consecutive cycles if necessary.
For whom is natural IVF not suitable?
The three natural IVF protocols are suitable for most patients who need IVF, but other protocols may give a woman a higher chance of getting pregnant; the clinical team will give a recommendation based on the results of the treatment assessment. It is not suitable for:
- women with normal ovarian reserve who want to maximise the chance of achieving one or more pregnancies from a single cycle by having the prospect of frozen embryos for subsequent transfer
- couples with male factor infertility who choose not to use ICSI
What does natural cycle treatment involve?
All women/couples have a first appointment with a senior member of the clinical team. The female hormone levels are checked and an ultrasound scan performed as part of any investigations, and a sperm test will be undertaken for any male partner. Following this, an individualised treatment plan is made.
The woman will attend a scan and consultation approximately one week before her period is due. A member of the clinical team will discuss the treatment with her in detail and explain the consent forms that will be required. She will then phone Midland Fertility at the start of her next period and book a scan for between days five to seven (depending on her cycle length). She will need a further two or three scans depending on her cycle. These are usually carried out every other day. Egg collection is usually carried out around day 12 to 14 of her cycle (at the time she would naturally be ovulating).
To maximise the chance of retrieving a mature egg, an injection or nasal spray is used 34 to 35 hours before the egg collection. Occasionally anti-inflammatory tablets such as indomethacin are used to reduce the chances of ovulation before egg collection – which is performed under conscious sedation with pain relief.
What is modified natural cycle IVF?
Like natural cycle IVF, the aim of modified natural cycle IVF is to use minimal drug intervention. It retains the advantages of natural cycle IVF, but with the additional benefit of a higher success rate by reducing the risks of spontaneous ovulation before egg collection.
Medication is given once the follicle gets to the optimum size to prevent the surge of luteinising hormone (LH) that triggers ovulation. A second medicine keeps the follicle growing until it is large enough to contain a mature egg. The woman will usually take these medications for between one and three days.
To maximise the chance of retrieving a mature egg, an injection or nasal spray is used 34 to 35 hours before the egg collection to produce a natural LH surge at the optimum time. Egg collection is performed under conscious sedation with pain relief.
What is mild stimulation IVF?
Mild stimulation is often carried out at Midland Fertility as it is particularly helpful where the woman has low ovarian reserve. It works with the natural menstrual cycle using lower doses of medication than in conventional IVF. This results in a more natural stimulation process and can reduce the side effects associated with high doses of fertility medicines as well as reducing the cost of treatment, whilst maintaining excellent success rates. By reducing the stress on the body, mild stimulation may, in some women, improve the overall quality of the eggs and embryos as well as improve the implantation potential of the uterine lining. Mild stimulation IVF may be recommended for:
- women who have high FSH and low AMH and are predicted to produce a lower than average numbers of eggs
- patients with PCOS or raised AMH who are predicted to over respond to fertility medication and have an increased risk of developing OHSS
Benefits to these patients include:
- a shorter treatment time as it is carried out within a ‘natural menstrual cycle’
- by using fewer drugs than conventional IVF, the costs of treatment are reduced
- a greater probability of having surplus embryos to freeze in comparison to natural IVF
How long does natural IVF treatment take?
Natural IVF is carried out within a natural menstrual cycle, so egg collection is undertaken around the normal time for ovulation (day 12 to 15), embryo transfer is two to three days later, and the pregnancy test can be taken approximately 12 days after that.
What is included in the cost?
- treatment planning
- ultrasound monitoring scans
- egg collection
- sperm preparation
- standard insemination of eggs
- embryo transfer
- electronic witnessing
- embryo freezing and storage for first year (if suitable)
- pregnancy test
- six week scan and/or follow-up to review the treatment cycle
What is not included in the cost?
- first appointment or follow-up consultation (as appropriate)
- investigations and/or repeat screening (as appropriate)
- cost of fertility drugs
- fee for freezing sperm (if required)
- fee for donor sperm (if required)
- the HFEA levy for the creation in vitro, or transfer of, embryos
- any subsequent frozen embryo transfer
- any other fertility investigations, treatments or preservation services for either partner
Cost of natural cycle treatment (mild IVF 3 cycle package) at Midland Fertility: £6,250.00
Cost of natural cycle treatment (mild IVF 6 cycle package) at Midland Fertility: £9,750.00
Also, go to the Midland Fertility Patient Treatment Information page and download:
- natural IVF infosheet
- Embryo Transfer Policy and eSET infosheet
- Fertility Treatment with Donor Sperm infosheet
- Freezing and Storing Sperm infosheet