What is Mini IVF?

“Natural”, “gentle” fertility treatments seem appealing when it comes to in vitro fertilization. However, the evidence is not swayed by marketing. After performing a review of the literature, there are several points to be aware of when considering mini IVF.

• Variable terminology in the field of mini-IVF can cause confusion of clinicians and patients.
• Many different protocols are utilized in the literature making comparisons and firm conclusions difficult. Standard protocols and large research studies are needed.
• “Minimal” or “mild” stimulations intended to minimize cost and avoid medications result in lower live birth rates.
• Mini IVF protocols often use similar dosing to conventional IVF thereby mitigating any cost benefit.
• Natural and modified natural cycle IVF have lower costs but also have lower live birth rates.
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Advantages		Disadvantages
Lower medication cost per cycle		Higher rate of cycle cancellation
Reduced risk for hyperstimulation		Possible need for multiple cycles which increases cost
Reduced risk for multiple gestation		Lower pregnancy & live birth rates
		Reduced opportunity for cryopreservation

Protocol	Medication	Objective
Natural cycle IVF	None	1 oocyte
Modified natural cycle IVF	hCG with or without GnRH antagonist with FSH/hMG add back	1 oocyte
Minimal or mild IVF	Low dose FSH/hMG +/- oral agents & GnRH antagonist	2-7 oocytes
Conventional IVF	Conventional dose FSH/hMG + GnRH agonist or antagonist	≥ 8 oocytes

The American Society of Reproductive Medicine will be coming out with a formal position statement on the above. Stay tuned.

Christina Boots, MD contributed to this article. Dr Boots did her OBGYN residency at the University of Chicago School of Medicine and is currently a fellow in Reproductive Endocrinology and Infertility at Washington University St Louis School of Medicine.