Why Choose Natural Cycle IVF?
Why Dominion Fertility Remains Enthusiastic About Natural Cycle IVF (NCIVF)
With over 10 years of performing Natural Cycle IVF, we remain most enthusiastic with our program, which is the largest program in the United States and one of the largest in the World. To date, we have performed over 2,500 NCIVF procedures.
And we have had remarkable success with Natural Cycle IVF. From 2007-11, the pregnancy rates for ALL of our patients less than 43 years old, regardless of their “ovarian reserve” or FSH or AMH levels were 32% per embryo transfer and for patients less than 30 years old 49% per embryo transfer. Most of our NCIVF pregnancies (84%) occurred in their first or second embryo transfers. Most patients who were successful had only one or two embryo transfers (see stats).
“We saw that many of our patients were getting pregnant with just one embryo so we decided that the time was right to offer Natural Cycle IVF.”Dr. DiMattina, 2007
We perform Natural Cycle IVF on any patient who has regular menstrual cycles regardless of their day 3 FSH or AMH levels. We don’t find lower pregnancy rates in patients with “diminished ovarian reserve” with abnormal FSH or AMH levels compared with patients with normal levels. In fact, they may be better compared with stimulated IVF and this is in concert with modern publications regarding Natural IVF success rates for patients with poor ovarian reserve (Schimberni et al, 2008, Fertility/Sterility., Matsuura, 2008, J Assist Reprod Genetics) We have witnessed many patients who have failed stimulated IVF or who were not even candidates for stimulated IVF, obtain a successful pregnancy using Natural Cycle IVF. Some were told that their only options for pregnancy were ova donor IVF or adoption. Some experts now recommend that patients consider Natural IVF prior to undergoing ova donor IVF or adoption (Kadoch et al., 2011, Fertility/Sterility)
In September, 2011, a 48 year old patient of ours delivered a healthy baby following her first NCIVF embryo transfer. Her day 3 FSH level was 20 mIU/ml (normal <10), AMH 0.6 (normal >1.8) and she had previously failed 4 stimulated IVF treatments at another clinic 4 years earlier. Many other patients of ours with advanced reproductive age and diminished ovarian reserve have achieved a successful pregnancy using Natural Cycle IVF. (read about their stories on Fertile Grounds, post October 10, 2011, November 30, 2011 etc)
Why does NCIVF work when stimulated IVF has failed?
Although NCIVF and stimulated IVF may share the same common denominator (both involving IVF), we have learned and witnessed first hand that they are very different forms of IVF. One is not necessarily better than the other but we believe that the processes are remarkably different in terms of egg and embryo quality, thus allowing some patients to obtain pregnancy using Natural Cycle IVF that were not previously attainable using stimulated IVF.
Some believe that the success with Natural IVF is related to the natural selection of the egg. Since no ovarian stimulation drugs are used, the body naturally selects out the best egg for that particular cycle. With stimulated IVF, many eggs that were never intended to grow are produced and they may not have the same quality of eggs naturally selected.
Our embryologists regularly observe the natural cycle egg and embryo to be of very high quality. Furthermore, reports in the literature show that the endometrium with NCIVF may be more receptive than the endometrium in stimulated IVF (Zhu et al, 2011, Fertility/Sterility) This combination of a better quality egg, embryo and endometrium may be the reasons for the higher embryo implantation rates that we have witnessed for Natural IVF in patients over 35 years old.
“With Natural Cycle IVF, we are essentially going Back to the Future: one egg, one embryo and one baby. At Dominion fertility we believe that the success of IVF should be defined as achieving a singleton pregnancy with the least amount of stress, discomfort and cost. NCIVF is a kinder and gentler technique that has less emotional and physical impact.”Dr. DiMattina, 2012
We invite you to examine our experience with NCIVF by reviewing our statistics. The numbers really tell the story and confirm the validity of Natural Cycle IVF as a viable treatment option for infertile patients. In figure 1, we compared our Natural IVF implantation rates with the 2009 SART stimulated IVF rates. There were no statistical differences in the implantation rates for women less than 35 years old. In other words, if one embryo was transferred using NCIVF or stimulated IVF, the chances for pregnancy were the same. However, in patients over 35 years old, NCIVF had a superior implantation rate compared with stimulated IVF. Furthermore, for women with “poor ovarian reserve”, the implantation rates for NCIVF exceeded those for stimulated IVF in patients both less than and over 35 years old (figure 2)!
Given the excellent clinical success that we have experienced with NCIVF, Dominion Fertility enthusiastically performs and excels in treating patients with NCIVF. And without question, our patients have greatly appreciated the opportunity to achieve an IVF pregnancy with the simplicity of Natural Cycle IVF but without the risks and costs associated with stimulated IVF.
- DiMattina, et al, IVF Lite, 2014, 1; 1:81-7 “Natural Cycle IVF IMplantation Rates Compared to Stimulated IVF & Role of Serum AmH.
- Schimberni M, et al, Fertil Steril 92:1297, 2009, “Natural Cycle IVF in poor responder patients: a survey of 500 consecutive cycles.
- Kadoch I, et al, Fertil Steril 96:1066, 2011 Modified NCIVF should be considered as the first approach in young poor responders.
- Matsuura T, et al, J Assist Reprod Genet 25:163, 2008, “Natural IVF cycles may be desirable for women with repeated failures by stimulated IVF cycles.
- Shapiro B,et al 96: 344, 2011, Evidence of impaired endometrial receptivity after ovarian stimulation for IVF: a prospective randomized trial comparing fresh and frozen-thawed embryo transfer in normal responders.
- Zhu D et al, Fertil Steril 95:1691, 2011, Vitrified – warmed blastocyst transfer cycles yield higher pregnancy and implantation rates compared with fresh blastocyst transfer cycles-time for a new embryo transfer strategy