Dr. Zhang’s Video Blog
Today my topic is what kind of IVF protocol is best. I always get this question from fertility patients and my answer is always, “ there is no one protocol that will be the best protocol for any one patient or for different menstrual cycles. So whatever protocol can be tailored and suited for you is the best protocol. In New Hope Fertility Center we have four major IVF protocols and the difference between these IVF protocols is in the fertility medications that the patient may get.
For example, we will start with the natural cycle IVF which uses no medication because you are trying to catch only one natural egg. The most suitable patient for Natural Cycle IVF is a woman who wants only one child and has a very good prognosis and just needs help through IVF. A woman who is 32 years old and who already has 3 children may have had a tubal ligation. But now she wants one more child. So she has a perfect reproductive system and could make a baby but the fallopian tube is blocked. The best protocol for this patient is Natural IVF. She wont need to freeze more embryos. A second situation where Natural IVF may be a good fit is male factor infertility. A female may be extremely fertile but her male partner has severe male factor infertility. We don't need to retrieve lots of eggs. We just collect his sperm and proceed with the Natural Cycle IVF.
Who will be a candidate for Conventional IVF to make 25 eggs and try to get pregnant. This may be a patient who has cancer and is preparing to go through chemotherapy and wants to preserve her fertility. In this case we want to get as many eggs as possible. Also Conventional In Vitro Fertilization is best for a patient who may be young. In many cases these women have a good ovarian reserve and good egg quality. What is good egg quality? We define good egg quality as any egg that has a good chance of creating a live birth baby.
So another protocol is called minimal stimulation in vitro fertilization or Mini IVF. We also developed Ultra mini IVF. In this fertility procedure, the ovaries will be stimulated only with oral pills such as Letrozole or Clomid pills. What kind of patient is suitable for Mini IVF or Ultra Mini IVF? For this procedure patients with low ovarian reserves, people who produce only one or two or three good eggs can rely solely on pills to do the job. Minimal Stimulation IVF patients will usually take 9 (nine) days of oral fertility medication, again, Letrozole, Clomid, or it could be a combination of the two, together with a couple days of very low dose injections of fertility medications like Bravelle, Follistim, Gonal F, or Menopur. Usually in minimal stimulation IVF, the patient will get 75 to 150 units per day for three to five days. In totally this is only about 25% of the medication a patient would receive during Conventional IVF. Typically you will get 6-8 eggs. Usually these patients have reasonable ovarian reserve or 20%-30% lower than normal counts. For example the patient’s Antral Follicle Count may be around 6 or AMH (anti mullerian hormone) level is between 0.4-1.4.
The modern trends of IVF protocols are about finding the appropriate protocol that is best for you. Now I often have older patients around the age of 39 who have already gone through several ivf cycles and are taking lots of medication but failing their cycles and not getting pregnant. When they ask why, it is simple. The quality of the eggs and the number of eggs you produce is closely linked with age. Taking more gonadotropins has recently been proved to actually reduce the egg quality.