IVF in the natural cycle
IVF in the natural cycle (IVF in the NC) refers to one of the assisted reproductive technology options; during the procedure an ovocyte, independently matured in the female ovaries is used for fertilization. The difference of the method is that there is no need for the medications to stimulate ovulation. This key feature allows to improve the safety of the procedure and gives a chance to get pregnant to women with contraindications to hormonal stimulation of the ovaries.
Indications for the IVF in the natural cycle
The procedure is suitable for women from 18 to 35 years, with menstrual cycle from 28 to 35 days, without dysmenorrhea, and regular ovulation. In this case, the woman has the right to choose an IVF protocol – with or without hormonal stimulation of the ovaries. However, it is not always just one woman’s desire to choose the method of the procedure. There are a number of medical indications for in vitro fertilization in the natural cycle, among them the following:
- High risk of ovarian hyperstimulation syndrome.
- The presence of cancer.
- Increased blood clotting, thromboembolism.
- Infertility caused by the fallopian tubes obstruction.
- Severe diseases of internal organs.
- Recent surgical cardiovascular interventions.
IVF in NC without ovarian stimulation is also used in cases of male infertility. Thus, the main task of the method is to help a woman to get pregnant, but at the same time to eliminate additional effects on her body and thereby minimize the likelihood of complications.
Features and efficiency of the procedure
Among the positive and negative characteristic features of the IVF program in the natural cycle are the following:
- The minimum probability of multiple pregnancy.
- Low risk of complications that are associated with hormonal drugs.
- The best endometrium quality resulting the high chances of successful attachment of the embryo in the uterus.
- The cost of IVF in the natural cycle is lower comparing the protocol with hormonal stimulation.
- IVF in the NC can be repeated frequently, long breaks are not required.
- Success depends on the regular ovulation. If it comes early, the protocol should be canceled.
- Ovocytes that are extracted during ovarian puncture may be immature.
- The method involves obtaining only one ovocyte and one embryo, which is not always viable. Therefore, it is not always possible to get pregnant from the first attempt.
IVF in the natural cycle statistic data indicate that the probability of getting pregnant from the first attempt is from 7% to 15%; however, due to low cost and high safety, the procedure remains relevant and is performed quite often.
In some cases, specific hormonal drugs can still be used during IVF without stimulation in the natural cycle, but they do not contribute to pronounced stimulation of the ovaries. All these features are necessarily taken into account by the reproductive specialist during the patient`s consultation. The final choice of the IVF type will be performed only after weighing all the pros and cons.
IVF in the natural cycle: protocol scheme
Reproductive doctors of the IVF Center Vitalis use three protocols in their practice:
- IVF without hormonal stimulation. A woman’s condition is monitored throughout the entire menstrual cycle. Starting from the 7th day is performed daily ultrasound scan; it will help to monitor the follicle condition. As soon it reaches the size of 15-16 mm, the level of blood luteinizing hormone is additionally determined. The reproductologist performs puncture when he is reliably convinced that ovulation has occurred.
- Modified protocol. This protocol is used in cases of low ovocytes quality that needs to be improved. As in the previous protocol, the follicle growth is monitored using ultrasound and as soon as follicle size reaches 17-18 mm, the endogenous hormone hCG is administered, that creates optimal conditions for the follicle maturation. Ovarian puncture is performed 28-34 hours later. After the hCG administration, the woman condition is closely monitored, since the danger of preterm ovulation.
- Modified IVF protocol in the natural cycle. It is used in cases with a high risk of spontaneous ovulation. The doctor monitors the size of the follicle using ultrasound, and as soon as it reaches 15 mm, the woman is administered an antagonist of ganadotropin-releasing hormone, that blocks the synthesis of luteinizing hormone and thereby inhibits the ovulation. In order for the normal follicle development, the follicle-stimulating hormone is administered for several days. As soon as the size of the follicle reaches18 mm, the fertility specialist injects the hormone hCG and 30-34 hours later performs the ovarian puncture.
After receiving the ovocyte, it is fertilized and stored in a test tube for 3-5 days; after that, it is transferred into the uterine cavity. The administration of progesterone is possible to help the start of the pregnancy. If the level of a specific pregnancy hormone, human chorionic gonadotropin (hCG) rises, it means the successful IVF procedure without ovarian stimulation. Thus, it is possible to calculate how long time takes the IVF in the natural cycle. The exact time depends on the specific protocol and the individual characteristics of the woman. It takes about a month from the moment of follicle growth observation to the moment of cultivation and transfer of the embryo into the uterus.
Many women during conversation with the doctors of our clinic are interested whether IVF is painful. Unpleasant sensations occur only during the ovarian puncture; therefore, at this stage is used the intravenous anesthesia. Anesthesia does not affect the quality of the ovocytes, but allow to get rid of unpleasant sensations and provide the comfort procedure.
Women who have obtained successful IVF in the NC know that the maximum chance of success is provided if the procedure is performed by an experienced specialist, while the patient should follow all instructions and requirements throughout the protocol. The psychological background — it is also very important to believe in the success of the procedure and do not give up if it was impossible to get pregnant from the first attempt.