Fertility Road Issue 06

FEATURE | |mini-IVF
CASE
STUDIES
In reality mini- IVF is tricky
and many centres are unable to
perform it successfully as there is
absolutely no margin for error.
the air quality in the operating theatre. Organic, volatile toxins are
present in microscopic quantities in the air – while these do not
affect our wellbeing on a day-to-day basis, they do have an adverse
effect on embryos, causing damage through over exposure. “We
cannot stress how important this is to mini-IVF,” adds Silber.
The very unusual approach to minimal stimulation also plays a
very large part in the success of this procedure, with smaller
numbers of better quality eggs retrievable through gentler
hormone administration – i.e. shaking the tree rather than
chopping it down. While less eggs will be retrieved, they have a
better prognosis for success.
The storing procedure for the embryos plays the final part in
the success of mini-IVF, with vitrification paramount. Vitrification
is a new freezing technique that uses super high concentrations
of anti-freeze (DMSO and ethylene glycol) to allow a drop in
temperature so rapid the water never actually becomes ice. If ice
gets into the cells during the freezing procedure, it will damage
the cell during the defrosting process. With vitrification, embryos
can be frozen and defrosted several times without any risk.
The procedure
So how do patients interested in mini-IVF go about this procedure
and how does it differ from traditional IVF in its administration?
With this more gentle approach, day three of the menstrual cycle
is when mini-IVF patients are given low doses of Clomid (50mg).
They continue to take this drug until an ultrasound shows there are
sufficient follicles ready for ovulation. Staying on Clomid for longer
than the usual five days associated with traditional IVF stimulates
natural pituitary and releases FSH by blocking the suppressing the
effect of estrogen. A very low boost of Gonadotropin is then added
on days eight, 10 and 12 of the cycle.
Other than the cost advantages – Clomid is cheaper than those
stronger hormones that need to be injected – another advantage
“We recently took care of such
a case in a young woman I had
known since she was a little girl,”
says Dr Silber about one of his
first mini-IVF patients. “She had
undergone multiple surgeries at various clinics for other health
problems, but the result of her cure was just one remaining ovary
with hardly any eggs left. In fact she did not just want one baby
but a big family. The misery this brave young woman had to go
through was heartbreaking, being told by everyone that she
would never be able to have her own children. We put her through
a total of six cycles of mini-IVF, retrieving only a few eggs each
time until she eventually had 10 healthy embryos in storage. This
resulted in a healthy pregnancy and enough frozen embryos to
eventually have the big family she had always dreamed of.
Another example is a 43 year-old woman who married at 38 to
a 34 year-old man. She had already conceived naturally before but
wanted a second child and was told donor eggs were her only
option. Not wishing to have her son’s sibling with a different DNA
to his own, she visited St Luke’s Hospital in St Louis and went
through two rounds of back-to-back mini-IVF cycles, storing up to
three embryos, only one of which looked viable. Six months later,
the embryo was thawed and transferred back into her uterus for
implantation. The patient gave birth to a healthy baby at 44
without the need for donor eggs.
A more determined case was in that of a 45 year-old woman
who underwent four cycles of mini-IVF stimulation resulting in a
healthy 14 frozen embryos. However, as was to be expected due
to the age of the embryos, and despite transferring four during
the first attempt, the patient failed to get pregnant. However, six
months later we thawed and transferred four more embryos,
finally delivering a healthy baby using her own eggs at the age
of 46. This lady has six frozen embryos remaining meaning
it’s possible for her to have a second child in a few year’s time
before she reaches the maximum age for treatment of 50. How
wonderful would it be for her to be able to give birth to a sibling
for her first miracle birth?
is that patients do not need to take Lupron at the beginning of the
cycle, rather at the time of ovulation through small injection or
nasal sniff. This causes a more natural LH surge and avoids the
defects that can be caused by a HCG injection – the ovulation
booster used in more traditional IVF.
Patients then embark on several of these treatment cycles backto-back,
waiting until there are sufficient embryos formed before
attempting to have them implanted back.
Unfortunately at the present time, mini-IVF is only available in
the United States, but hopefully Dr Silber’s work will eventually
become more readily available in Europe for older woman with
fewer egg reserves.
24 fertility road | may - june