What is natural IVF and how can it help?
IVF is a household name in trying to conceive, but Geeta Nargund, pioneer of natural and mild IVF, talks to us about these gentler, safer and more affordable methods that are now available know as mild or natural IVF
1. Can you explain exactly what natural IVF is?
Natural IVF involves the collection of "naturally selected eggs" from a woman's ovary in her natural cycle without the administration of any drugs. The first test tube baby Louise Brown was born via natural IVF.
Modified natural IVF is also conducted in a woman's natural cycle with the aim to collect "naturally selected eggs" but a small dose of medication is used in order to reduce risk of spontaneous ovulation and increase the success of natural IVF. This method is now the widely used form of natural IVF.
2. Can you explain exactly what mild IVF is?
Mild IVF is conducted during a woman's natural cycle using low dose medication given for around 5-9 days only. The aim is the quality and not quantity of eggs. This method reduces side effects, discomfort and health risks associated with the overstimulation of ovaries. It can eliminate the risk of ovarian hyperstimulation syndrome (OHSS).
3. How do these methods differ from traditional (conventional) IVF?
Conventional IVF involves a long medicated cycle with daily injections lasting for around 4 weeks. The initial 2 weeks are aimed at suppressing woman's ovaries causing a temporary menopausal status followed by higher doses of daily stimulation injections. This method can have higher health risks associated with OHSS.
4. What are the benefits of natural/mild IVF?
Natural and mild IVF work in conjunction with a woman's natural cycle, and avoids the health risks, side-effects, discomfort and emotional and psychological effects associated with stimulation hormones.
Natural cycle treatments can be done in subsequent cycles without any break. Because they don't use unnecessary expensive drugs, both methods are also cheaper.
5. What is the success rate? In comparison to traditional (conventional) IVF?
The success rates of mild IVF are similar to conventional IVF and can be higher in some situations for younger women. In comparison to conventional IVF, the success rates of natural/modified natural cycle IVF could be better in women with low egg reserve and in older women. The reason being, women with very low egg reserve whose ovaries do not respond to stimulating drugs and who have been told that using donor eggs is their only option can have babies with their own eggs with natural IVF if they are still ovulating.
When we define the "success of IVF", it is important to take into account the reduction in side-effects and complications for mother and child as a result of treatment. Research has shown that conventional IVF cycles where more than 15 eggs are collected are more likely to lead to "low birth weight" and "premature" babies. Such cycles also increase risk of life threatening severe OHSS for women.
We need to adopt a paradigm shift in defining the success of IVF. Mild and natural IVF reduces cost and health risks whilst also offering good chances of success. It is a "win win" situation for women in modern IVF practice.
6. Why would natural/mild IVF suit older women more?
Older women tend to have lower egg reserve. This means that the quantity and quality of eggs are reduced in their ovaries. Such ovaries can have compromised blood circulation too. Stimulation drugs cannot produce more eggs in such situations. There is also a risk of further compromising egg quality if high dose stimulation is used in the presence of low ovarian blood supply. We cannot make eggs that do not exist in ovaries by using high dose drugs. Natural forms of IVF relies on "natural selection" of eggs where better blood circulation is seen around such follicles that are naturally selected. That's why, older women can have babies from natural IVF even when drugs do not work. The lining of womb is also healthier for implantation in natural cycle IVF.
7. How does it benefit women with a low ovarian reserve?
Women who have low egg reserves, regardless of their age, can have successful treatment with natural IVF. It is naturally selected eggs that make babies and not drugs - many women's ovaries may not respond to drugs.
8. How available/expensive is natural/mild IVF?
Because natural and mild either uses no or very low drug dosages, the overall cost is cheaper compared to conventional IVF.
Create Fertility is the first and still the only dedicated centre for natural and mild IVF and we would like to see natural and mild IVF becoming more available to women all over the UK. Pioneers at Create Fertility are always working on making natural and mild IVF more successful and less expensive.
Interestingly, natural and mild IVF is widely available in Japan, South Korea and the Scandinavian countries.
9. What's your advice to women contemplating the IVF route?
It is vital that women ask questions about their IVF options, and consider the expertise of the clinicians, potential health complications of individual treatments, total cost per cycle and success rates for their particular situation. For every extra test and procedure recommended by a clinic which increases cost, there should be evidence-base and scientific justification. Women should not risk their and their child's future health by taking "off label" drugs and using invasive and unnecessary procedures during IVF treatment. Women should demand clear and transparent information about costs, health risks, expertise and success rates before starting treatment.
If you do opt for natural or mild IVF, it is important to ensure that the clinic provides you with 7 day a week availability – this is critical when working with a woman's natural, as opposed to artificially manipulated, cycle.
Research different clinics and look into their track record - the Human Fertilisation and Embryology Authority can be a great source of independent information.
It is important to remember that success rates cannot be directly compared between clinics as clinics treat women with different prognosis and offer different methods. Women should ask about health risks when drugs and treatments are prescribed.
The IVF industry needs to be open and we owe it to women and couples who put their trust in us.