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Infertile patients cannot afford to wait for treatment while their eggs get older.

Dr. Sherman Silber, Infertility Center of St. Louis, is offering free video consultations for patients who need to plan now for their treatment while stay-at-home orders are in place. He is talking to and evaluating patients in their home to comply with social distancing measures.

Dr. Silber is discovering that patients actually prefer this method of telemedicine consultation over the conventional office visit. Patients have conveyed that “it is so much more convenient and less stressful” to have a free telemedicine personal consultation than to take a day off from work to travel to the doctor’s office and sit with other nervous patients in the waiting room.

The COVID-19 pandemic is thus changing much of the way we will do things in the future, and for the better. “Our patients are surprisingly much happier with this approach. Of course, at some point we need to perform hands on treatment. But with this new manner of seeing patients, we can come to the right diagnosis and treatment plan for most patients more efficiently, quickly, and painlessly, with no loss of personal one-on-one communication.” This is a very welcome new era of telemedicine that has been forced on us by the current difficult times.

Mini IVF vs IVF

Mini-IVF was first developed by the Kato Ladies Clinic in Japan and then perfected and popularized by us at St. Luke’s Hospital in St. Louis. It takes advantage of your own natural FSH elevation with an ingeniously simple protocol that strives for smaller numbers of better quality eggs. Instead of massive doses of expensive hormones to try to blast out a few poor quality eggs, it more naturally teases out of even older ovaries their best quality eggs with a carefully devised protocol of minimal stimulation. There are no symptoms of huge hormonal swings or hyperstimulation. It is easier on the patient and much cheaper than conventional IVF.

Our approach to minimal stimulation (Mini-IVF) allows us to retrieve just as many (or few) eggs from the woman as more expensive, conventional stimulation protocols, but better quality eggs and at a lower cost with essentially no complications. We can freeze the embryos with impunity (our freezing does no damage to the embryo whatsoever) and then transfer them back to you in a later cycle when the uterine lining is more perfectly synchronized to the stage of embryo development than during a stimulated cycle. This all adds up to better success rates in even the most challenging cases, and at far less cost and aggravation for the patient.

Success Rates

Mini-IVF is tricky to perform well and many centers are not up to it. It is easier for the patient and more difficult for the doctor. There is no margin for error. There are several reasons for the success we have with these much lower cost mini-IVF techniques.

The success of this approach depends not only on a novel endocrine stimulation protocol, but also upon a flawless method of embryo freezing such as our vitrification system, and the highest level laboratory air purification system to give the eggs especially from older women the best possible environment in which to develop.

With our mini-IVF approach of storing up vitrified embryos month by month in older women, we have remarkable pregnancy rate even in women over 42-years of age of over 50%. But it takes a great deal of patience on the part of the patient to retrieve just a few eggs at a time every month until enough embryos are banked to warrant thawing and transfer. In addition, the endocrinology of mini-IVF is very innovative and requires close attention to each individual patient to avoid premature ovulation.

Is Mini-IVF Always Used ?

No, it is most useful for older women and women with low ovarian reserve. There are still many patients who are happy with conventional stimulation. However many of these women also prefer mini-IVF because of the lower cost and the lack of any risk of hyperstimulating syndrome.

Cost

Better results are the ultimate method for cost savings but also our charges remain very low to reasonable because we don’t try to empty your wallet with unnecessary testing and low yield procedures prior to your IVF.

Process

Mini-IVF is designed to recruit only a few (but high quality) eggs, thus avoiding the risks of hyperstimulation, reducing the number of injections and dramatically reducing the cost of medications. In many patients who had very poor quality embryos with conventional IVF stimulation protocols, mini-IVF dramatically improved their embryo quality and resulted in pregnancy in otherwise “hopeless cases”. This approach is not just a simple-minded reduction in hormonal stimulation. It is an ingeniously conceived and completely different stimulation protocol that saves the patient much of the complexity and cost associated with more conventional IVF protocols. Here is how it works:

On day 3 of the menstrual cycle, you start on a low dose of Clomid (50mgs), but you do not stop the Clomid in five days, as is usually the custom. You keep taking the Clomid until ultrasound monitoring shows the follicles to be ready for ovulation. A very low “booster” dose of gonadotropin (just 150iu of FSH) is added on days 8, 10, and 12. Clomid not only stimulates your own pituitary to release FSH naturally (by blocking estrogen’s suppressing effect), but when you continue the Clomid (a new approach), it blocks estrogen’s stimulation of LH release, and also usually prevents premature ovulation. Thus, with this simple change in protocol, the old-fashioned, inexpensive Clomid is able to stimulate the development of great-quality eggs for IVF.

Another advantage of this protocol is that you do not have to go on Lupron first to suppress the pituitary. Staying on Clomid blocks estrogen from stimulating your pituitary to release LH, and this added effect of Clomid will prevent premature ovulation. This means that you can be induced to ovulate with just a simple injection or nasal sniff of Lupron. This causes a more natural LH surge and avoids the defect caused by the prolonged effect of an HCG trigger. This leads to more “natural” maturation of the eggs.

The next step is to recognize that Clomid has a temporarily negative effect on the uterus (because it blocks estrogen’s support of the developing endometrial lining). That is one reason why results in the past have been so poor with the use of Clomid for ovarian stimulation. The embryos are less likely to implant in such an endometrium. But that problem is now easily solved by using the Japanese protocol for embryo freezing, “vitrification” which I discuss elsewhere. We can now freeze the embryos almost with impunity using this approach. Then these embryos are transferred a few months later in an endometrium that is more perfectly receptive.

For poor prognosis cases of older women with low remaining ovarian reserve, there is a huge advantage to mini-IVF over high-dose stimulation. Such patients normally yield very few eggs anyway, even with huge megadoses of gonadotropin. If they have any good-quality eggs remaining, mini-IVF is just as likely to yield as many eggs as giving huge megadoses of gonadotropin which in a sense would “poison” those eggs because of too high a level of FSH. Even in the worst case scenario, if there are no good eggs left at all, at least you can discover this with only $1,500 spent on drugs instead of $7,000 (the cost of the maximum dosage).

Clomid only prevents premature LH surges 90% of the time, so we cleverly prevent premature LH surges even in thse cases by paying close attention to each individual patient, monitoring their LH very attentively and by using both a low dose of GnRH antagonist and indocin when needed. So we never encounter the problem most physicians fear, of premature ovulation.

To get feedback from patients who have undergone treatment at our Center, click here to go to the Patient Comments page.

If you have any questions, you may call us at (314) 576-1400.

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