Natural Cycle IVF (NC-IVF)
Tennessee Reproductive Medicine is one of the few centers in the Southeast to offer natural cycle in vitro fertilization (NC-IVF). Natural cycle IVF is a less expensive, nearly drug-free IVF cycle.
With NC-IVF, a woman grows an egg until it is likely to be mature. That egg is then harvested using an ultrasound-guided needle, and the egg is placed in a laboratory dish, where it is fertilized. The embryo grows in the incubator for several days and then is transferred with a small catheter back into the woman’s uterus.
Candidates for natural cycle IVF
The ideal candidates for natural cycle IVF are less than 35 years old, have a CD3 FSH <18 mIU/ml and E2 <75 pg/ml, and ovulate without the assistance of medicine.
Robin hates driving, but she often drove from Nashville to Chattanooga to be a mom.
Patients with isolated tubal or male factor are the best candidates; however, anyone wishing to avoid expense or frozen embryos could opt for this.
Eligible patients must be ovulating and one of the following:
- In need of IVF for male factor, egg factor, tubal factor infertility and/or
- Have failed a prior IVF stimulation (cancelled or poor egg quality or low egg yield) and/or
- Have evidence of diminished ovarian reserve based on FSH >10, E2 >75, AFC <10, or AMH <1.0.
How does NC-IVF work?
With NC-IVF, women develop their own egg without the assistance of medication. Careful monitoring with E2 and ultrasound is required to avoid missing an early ovulation.
Once the egg follicle is deemed consistent with egg maturity, ovulation is triggered with hCG and an egg is retrieved. Intracytoplasmic sperm injection (ICSI) is performed on the retrieved egg and the embryo is grown to the blastocyst stage prior to transfer back to the uterus.
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Advantages of natural cycle IVF
Practitioners of natural cycle IVF report that embryo quality is superior to embryos derived from stimulated cycles. There may be subtle ways exogenous gonadotropins (pharmaceutical hormones) negatively affect egg quality.
With natural cycle IVF, patients avoid the possibility of ovarian hyperstimulation syndrome, according to the journal Fertility and Sterility. Patients avoid costly medications and laboratory resources are not used at high rates, thus decreasing costs. If no egg retrieval is performed, a significant credit is applied to the next attempt.
If an egg retrieval is performed but an embryo transfer does not occur (due to no egg being obtained, no fertilization occurring or no embryo growing to the blastocyst stage) the patient also gets a credit for unused services.
About 80 percent of NC-IVF patients undergo retrieval, and the vast majority of these produce an egg. Unfortunately, not all of these embryos will make it to the blastocyst stage. Expected pregnancy rates per cycle start are about 10-20 percent, based on national averages.
Disadvantages of NC-IVF
Approximately 10-15 percent of patients will ovulate prematurely. Not all embryos will grow to the blastocyst stage, so not all patients will be able to have a transfer.
How is this type of IVF different from standard IVF?
To answer this, let’s first talk about how women make eggs. In each woman, every month, a batch of eggs comes out of storage. Typically, one egg matures and releases (ovulates) and the rest of the batch dies off.
The next month, a new batch emerges and the process repeats itself. The reason only one egg matures is because the hormones that cause eggs to grow are in short supply.
In standard IVF, we give injections of these hormones to cause all the eggs to grow. So instead of losing the entire batch, we can harvest all of them, fertilize them in the lab and see which ones turn into viable embryos.
We place the best one(s) back into the woman’s uterus and freeze the remaining embryos for later use. Standard IVF generally offers the highest chance of pregnancy because it allows us to transfer the best-quality eggs first.
Many people need IVF because of blocked tubes or low sperm counts. Some of these people won’t do IVF because of the cost, the time commitment needed, or because they don’t want to use a lot of hormone injections.
Natural cycle IVF is a good alternative for people looking for a less time-consuming, less expensive and less complicated solution. In NC-IVF, the woman grows an egg without any drugs. Generally only one egg develops, sometimes two.
When the egg is big enough to be mature, a single injection of hCG is given to the patient and approximately 1 day later, the egg is harvested.