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Natural Cycle IVF

Natural cycle IVF (in vitro fertilization) is a safe & natural approach with increasing success rates. Book a consultation at one of our fertility clinics.

Patients with poor ovarian reserve ( diminished ovarian reserve or DOR) can be challenging patients to treat. They do have a few eggs left ; and some of them even get pregnant on their own. However, when we superovulate them for IVF, their ovarian response it quite poor; and they often end up growing just 2-3 follicles, inspite of aggressive superovulation.

Natural cycle IVF ( or gentle IVF or minimal stimulation IVF) can be a good option for patients who are poor ovarian responders - especially patients who ovulate on their own. However, it can be difficult to monitor their cycles; and it's important to find an experienced expert if you want to explore this option.

It's possible to do natural cycle IVF au naturelle - with no stimulation whatsoever. Some clinics wil use gentle superovulation, with low dose HMG or letrozole.

The procedure seems so simple , so why can it be so challenging ? This is because while there are no medical risks involved with natural cycle IVF. The major risks are

1. The follicle / egg may not grow, leading to a cancelled cycle
2. The follicle may rupture early, before egg collection, due to a premature LH surge
3. The doctor may not be able to collect the egg at the time of egg retrieval .
4. The embryologist may not be able to fertilise the single egg or may damage it during ICSI.

This is why, in order to maximize your chances of success, you need a skilled IVF clinic. This is the protocol we follow, to ensure high success rates.

We do a vaginal ultrasound scan on Day 7 or 8, to track follicular growth. Once the follicle is more than 12 mm, we start GnRH antagonists ( usually from Day 7) to prevent a premature LH surge. We scan every 2-3 days; and when the follicle is 18 mm with an E2 level of more than 250 pg/ml, we trigger with HCG and do an egg collection 36 hours later. At the time of egg collection, we flush the follicle, to ensure we can collect the egg. Our embryologist is very skilled; and treats the egg and embryo with a lot of love and care.

Patients who come from out of Mumbai , need to stay for only about 7 days.

This is the protocol we use.

Phone and email me on Day 1. Do your first scan on Day 7 . You need to find a digital ultrasound scanner the scan . They will burn the images as a jpeg file on a CD or flash drive. I want the raw images as jpeg files please - not scanned in copies of the paper printout - too much loss of resolution with this ! The vaginal ultrasound scan checks for the following.

a. Follicular size
b. endometrial thickness and texture

This scan will confirm you are growing a follicle. If you are, we continue the cycle. You start taking Inj Cetrorelix ( GnRH antagonist) daily to prevent a premature LH surge ; and do your next scan on Day 10, along with an E2 blood test

You come to Bombay on Day 11. Once your follicle is mature ( size of about 18 mm with an E2 level of about 200 pg/ml) , we will give you the HCG trigger shot and do the egg collection after 36 hours. Embryo transfer will be after 48 hours.You can fly back 2 days after the ET

Our charges for a natural IVF/ICSI treatment cycle are US $ 2000 only. This includes all medical treatments and procedures. Medications will cost about US $ 200 more

Another option which is very similar to natural cycle IVF is mini IVF or gentle stimulation IVF. This has a higher pregnancy rate because we use a mild dose of superovulation medications and injections to help you grow 2-3 follicles. This is what we prefer.

This is the treatment plan for mini-IVF.

Phone and email me on Day 1. Do your first scan on Day 2 . You need to find a digital ultrasound scanner the scan . They will burn the images as a jpeg file on a CD or flash drive. I want the raw images as jpeg files please - not scanned in copies of the paper printout - too much loss of resolution with this ! The vaginal ultrasound scan will check that you are downregulated and that there are no ovarian cysts.

From Day 2 - Day 6, you take 5 mg of Letrozole ( Femara) daily. This helps is superovulating you. From Day 2 onwards, you also start taking 2 amp of Gonal-F ( 75 IU each) sc daily

You do your next scan on Day 7. The vaginal ultrasound scan on Day 8 should check for the following.

a. ovarian volume
b. antral follicle count
c. uterus morphology
d. endometrial thickness and texture

This scan will confirm you are growing one or more follicles. If you are, we continue the cycle. You continue the Menogon and also start taking Inj Cetrorelix ( GnRH antagonist) daily to prevent a premature LH surge ; and do your next scan on Day 10, along with an E2 blood test

You come to Bombay on Day 11. Once your follicles are mature ( size of about 18 mm with an E2 level of about 200 pg/ml per follicle) , we will give you the HCG trigger shot and do the egg collection after 36 hours. Embryo transfer will be after 48 hours.You can fly back 2 days after the ET

Our charges for a mini IVF/ICSI treatment cycle are US $ 3000 only. This includes all medical treatments and procedures. Medications will cost about US $ 400 more

There are lots of benefits to doing natural cycle and mini IVF ! It is designed to be very repeatable; and there are no side effects. It is less expensive; and the success rate is as good as with conventional IVF for poor ovarian responders, when done in a good clinic.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.