Answer from: Raúl Olivares, MD
Natural IVF is successful but is not that successful. In our opinion, that’s something that should be limited to very specific cases, and unfortunately, the majority of natural IVF is done in cases in which the results are very poor. The first risk is that the chances of not getting an egg after a natural IVF are very high. Some groups describe up to 50% of their collections in which they don’t get eggs, or the eggs are not of good quality. We’re just working with one egg, you can go through different cycles and try to collect 5 or 6 eggs in 5 or 6 months without using any hormones, but once more, I can’t see the point because the eggs are not going to be of better quality compared to those that you can get in stimulation, and you need to keep in mind that the time goes on. In cases in which you invest 6-8 months, especially when you are over 40, the quality of the eggs that you can get in your 6th or 7th cycle can be really worse than the ones that you get in your first attempt.
Therefore, in my opinion, the natural cycle is only useful in young girls who do not respond to a standard stimulation. Giving them drugs is going to be a waste of time and money because in these cases, especially patients under 37-38, the quality of the egg and the chances of getting that egg can be good. They have time to invest, to go through different rounds.
A lot of studies confirm that the number of eggs that you collected are directly related to the accumulated success rate of the cycle, and then patients, for example, that produce over 15 eggs have up to six times higher chances of having a baby than those that produce 3 eggs.
In my opinion, there is no contraindication to try to stimulate the patients and try to get as many eggs. The more eggs we get, the more embryos we’re going to have, the higher the chances of that patient ending up with a baby.
Answer from: Harry Karpouzis, MD, MRCOG, DIUE
A variation of IVF is natural IVF. When we say natural IVF, we mean IVF in a natural cycle, which means that we monitor the development of a follicle, and when the follicle is ready, we trigger ovulation, and we usually collect one egg. The chances of success as a general rule in a natural IVF are lower than in a medicated IVF.
Does it make sense to do it? Yes, it does. Usually, of course, natural IVF plays a role when a person cannot take injections, medication to stimulate the ovaries for medical reasons. Sometimes a semi-natural IVF, which means that you just take some pills that provoke ovulation can be used in women with a very poor ovarian reserve. As a general rule in IVF, you cannot get more eggs than the number of follicles that you see on the second day of the cycle on the initial ultrasound.
Let’s say that a woman has got a very poor ovarian reserve and has got only one or two follicles. In this case, there is no point in paying for medication because even if a woman takes a very high dose of medication and pays for all this medication, she will not be able to get more than one or two eggs. So in cases like that, natural cycle or repeated natural cycles makes sense. You can slowly start collecting one egg or two eggs at the time with double stimulation, so IVF that is taking place one after the other until the end you may get several eggs that you wouldn’t be able to get if you had more medication in one IVF.
Natural IVF does make sense. First, it reduces and makes the chances of hyperstimulation zero, but in specifically selected cases, it may even have a benefit. It is not though a common thing that we would do for any case. In general, the chances of success with natural IVF in comparison to a medicated IVF in a woman that has a lot of follicles are higher when we talk about medicated IVF.
What is the average number of patients who succeed with natural IVF cycle?
The natural cycle is almost the same as stimulated IVF but without using medications that stimulate the ovaries to produce more eggs. What are the pros and cons of natural cycle IVF? Is the IVF cycle without stimulation something to consider? What may patients think about such a solution?