There has been a lot of buzz in the media lately about what is known as “Mini-IVF”. Some practices have even made these cycles the mainstay of their business. On the surface, a low cost IVF cycle is very appealing. But let’s focus for a minute on the cost of a baby rather than just the cost of an IVF cycle. In an effort to keep the cost low, these “mini-IVF” cycles are generally performed using oral medications such as Clomid, rather than expensive (but more effective) injectable fertility agents (gonadotropins). As a result, they typically produce birth rates per cycle of at best 15-20% per attempt. The reason is simple. In a 30 year old, less than half of a woman’s eggs are chromosomally normal. This decreases to 1/10 in a 40 year old. When a mini-IVF approach is offered to an older woman with decreased ovarian reserve, it is usually the least cost-effective option because she would have to do multiple cycles to “hit” a chromosomally normal egg that will not lead to an aneuploidy-related condition such as Down syndrome or result in a miscarriage.
When used in the right age group, mini-IVF involves the use of injectable gonadotropins and aims at producing around 10-15 eggs. This ends up being far more effective than oral medications because it increases the chance of finding that “healthy egg” on the first try. When used in younger women (under 36 years) with normal ovarian reserve (AMH≥2.0) and in the absence of male infertility, it is likely to yield a 55-60% success rate per IVF cycle. This is about three times as effective as “Mini-IVF” and about five times as successful as a cycle of intrauterine insemination (IUI) which, as I discussed in a previous blog post, has questionable benefits in someone with normal ovulation and sperm parameters. Again, when viewed in terms of the cost of a baby rather than the cost of treatment, IVF becomes a much more efficient approach.
In reality, Mini-IVF was devised to serve women who otherwise might be regarded as candidates for IUI treatments. Mini-IVF is much more cost-effective from a “dollars per baby” perspective than injectables cycles with IUI.
Few people recognize that IUI is relatively unsuccessful in women over 35 (and it gets progressively worse after age 40). This is also the case with moderate to severe male infertility, endometriosis (regardless of its severity), and in women (of any age) who have diminished ovarian reserve. In all such cases IVF is far more likely to succeed because it bypasses the “unexplained infertility” factors.