Mild IVF – is it worth doing or not?

Is mild IVF, or minimal stimulation IVF, worth considering? For some patients, this lower cost alternative to a standard IVF cycle means lower success rates, so why bother? But a growing number of clinics are seeing good results from mini IVF cycles. Let’s look at the facts.

In brief, mild stimulation IVF is a treatment cycle that often uses a lower daily dose of injectable FSH medication, combined with clomiphene (Clomid) pills. The FSH medication is the same as for high-dose cycles (Menopur, Gonal-F, Puregon). In traditional IVF cycles, a patient may inject between 125 and 450 daily units. In a mild IVF cycle, the FSH dose drops to between 75 and 150 units daily, depending on your personalised protocol. Typically a minimal-stimulation cycle adds in 150 to 200 mg of Clomid pills each day. Clomid stimulates follicle growth in a slightly different way to FSH injections.

So what’s the aim of a mild stimulation IVF cycle? Generally, to grow fewer but better-quality follicles. If you’re in your forties and/or have an AMH level below 10 pmol/l, a mild IVF cycle may produce more viable eggs. Blasting your ovaries with 475 daily units of Menupur may do more harm than good. Think of blowing bubbles. Blowing gently can lead to bigger and better bubbles. With mild IVF, the approach is the same: keep it light and gentle.

This approach, using lower levels of ovarian stimulation, is catching on. It’s less aggressive than a standard IVF cycle. It’s kinder on the body. It’s cheaper, because FSH medication is very expensive. Although producing fewer eggs generally leads to poorer outcomes, mild IVF may work better for those patients who respond badly to high-dose cycles.

Looking at the success rates at our clinic for mild stimulation IVF cycles, there are encouraging signs. Mini IVF cycles produced, on average, around 3 eggs at egg retrieval. Standard IVF cycles averaged around 9 eggs. Fertilisation rates were just as good for both approaches (around 75%). But despite producing a third of the number of eggs as standard IVF cycles, mild IVF cycles had a pregnancy rate of 36.1%, compared to 51.7% for standard cycles. So lower, but not by that much.

For the right patient, a mild stimulation cycle may be worth considering. Clinics may make more money with traditional IVF cycles. But clinics with integrity, skilled at judging what is truly best for patients, are carrying out more mild IVF cycles than 10 years ago. After all, the interest of the patient is paramount.