The Fertility Doc | IVF & Infertility Specialist Dr. David Kreiner

MiniIVF

Posted on 29. Apr, 2009 by David Kreiner, MD in IVF, Infertility Information, Micro IVF

MiniIVF, also known as MicroIVF and minimal stimulation is an IVF procedure utilizing oral medications with or without minimal use of injectable gonadotropins when going through In Vitro fertilization. The process then proceeds in similar fashion to conventional IVF with egg retrieval, fertilization, embryo culture and embryo transfer. This new protocol is said to not only cut down on costs, but to diminish risks of multiple births. The following were opinions expressed by experts nationally recently in a debate on MiniIVF.

I. Dr. Rudy Quintero, M.D., F.A.C.O.G. (on the CON side of the debate) Founder and Medical Director of C.A.R.E. Fertility in Los Angeles, CA.

“IVF over the past twenty years has evolved and been optimized from a point where pregnancy rates were at best quoted to be 10% back then to about 50% today. We have become better with stimulation protocols and techniques over this time period. Nevertheless, this success has unintended consequences including the possibility of embryo overproduction and multiple births.

Minimal Stimulation IVF is currently being touted as a solution for this, and we all hope that it soon will be. However, we lack sufficient data from clinical trials to support its use. In one of the better trials to date from Pelinck et al (Netherlands), an 8% pregnancy rate was noted, with a 20.8% pregnancy rate after three attempts with Minimal Stimulation IVF. Some authors have published success rates of up to 40% using Minimal Stimulation IVF, but percentages may be influenced by bias and other study errors due to their retrospective design.

More data needs to become available to truly assess the success of this protocol for different types of patients.”

II. Dr. David Kreiner, MD, F.A.C.O.G. (PRO Micro IVF), Medical Director of East Coast Fertility in NYC.

“Micro IVF is a great way to assist patients with achieving their goal of having a single baby while minimizing their risk of complications such as multiple pregnancy, hyper-stimulation syndrome or producing financial hardship. Its lower cost and risk should outweigh diminished pregnancy rate which for young high responders and older poor responders will be minimal. The reason these groups would see a minimal decrease in success is that the younger high responders have a higher implantation rate per embryo and do not need as many embryos to produce the healthy one that will result in a baby. The older poor responders do not make extra embryos with aggressive stimulation and have nothing to gain by adding gonadotropins in a conventional IVF cycle.”

III. Dr. Eva Littman, M.D., F.A.C.O.G. (CON)

Founder & Medical Director of Red Rock Fertility in Las Vegas.

“My biggest fear is that this procedure will be misused by couples and patients who require conventional IVF, but because of the economy they opt for the lower price and subsequently, the lower chance of success. It worries me that in order to try to save money, patients may fall for a ‘gimmick’ and use up funds that could have gone towards a real chance at success.”

As a new procedure, time will tell what its ultimate role will be as one of the fertility treatments offered by fertility specialists. My opinion is that for patients without insurance coverage for intrauterine insemination, for a few extra dollars it offers a better success rate with lower risk of multiple pregnancy and hyperstimulation syndrome.

Tags: Gonadotropins, Intrauterine Insemination, iui, IVF, microivf, miniivf, minimal stimulation