'mild' ivf

[ariane5]

I am looking into ivf and have been reading about mild ivf as opposed to standard, apparently it has less side effects? (especially for those with pcos)

Has anybody got any experience of mild ivf? did it work?

[Pocket1]

I've never heard of that - but you could post on the conception thread also as its a bit busier than here. And lots of ivf-ers live over there...

[PicaK]

Do you mean the short protocol?

You miss out the down regging (where basically you slam your face into the menapause - hot flushes, mood swings and for me alarming clumsiness) phase.

But you still take drugs.

It's quicker - but it takes as much of a toll emotionally as the long protocol.

[ariane5]

yes I think that is what I mean PicaK, I have pcos and have heard theres less chance of ohss, also I have dcs already (looking into ivf after sterilisation) and I have to think about what could potentially be less of an impact in their lives too as if I am unwell with menopause symptoms etc like you describe it would make it difficult looking after them etc.

Is the success rate much different to the standard ivf and do many clinics offer this type of ivf ?

[jumpingjackhash]

Tbh I didn't find the down-regging a problem (I barely experienced any side effects), it was the stimming that had the bigger physical and emotional impact for me (emotional impact on the back of how I was physically feeling though).

IVF is tough on you whichever route you take, but if it works it's worth it!

There are loads of us on the conception / infertity boards talking about the various processes and supporting each other. Pop on over!

Good luck whatever you choose!

[ariane5]

Thankyou-it's all so confusing ! I have been trying to read up about it but there's so much involved.

I know whatever type I finally decide on it will be hard (and have to save up first!), Really never thought I would be in this position but after making a huge mistake re:sterilisation it is now my only hope of adding to our family.

[DiffedAgainDachs]

All my rounds of IVF were short protocol and out of three rounds of IVF I've got pregnant successfully twice, even when I responded poorly to the drugs and only got 3 mature eggs... (I lost the twins I got pg with the first successful IVF at 20 weeks but that was unrelated to the IVF).

There is also another form of IVF which is sometimes called natural cycle IVF where they monitor your natural cycle and don't stimulate the follicles at all so you don't need to take drugs, then harvest the egg from the naturally maturing follicle and then fertilise that one in the lab. The benefit is that you don't take any drugs and it's therefore cheaper and less hard on your body, but the down side of that one is that if there are less eggs then it is less likely that you will have something to put back. But you only need one! I know someone who had IVF with lots of drugs and still only managed to get one egg, and her little boy is about 2 weeks younger than my little miracle girl...

[KnackeredCow]

Ariane there are three IVF protocols, excluding "natural cycle" IVF that I'm aware of, but I've not heard of mild IVF.

There's a short and long protocol and an antagonist protocol, which is confusingly often called a short protocol because it doesn't take as long as the long protocol.

The antagonist protocol has been developed more recently than the long protocol, and many clinicians are set in their ways in the mistaken belief that the long protocol gives a better egg yield, or still strongly believe it's better and so I believe it might still be the most prevalent. It may well give a better egg yield but a recent Cochrane review found that the LIVE birth rate between the two protocols was not statistically significantly different. I guess this is because you need good quality eggs and quality doesn't necessarily correlate with quantity.

The advantage of the antagonist protocol is that the same Cochrane review found that rates of OHSS were statistically significantly reduced.

I know the clinic I'm with uses the antagonist protocol as default unless there are indicators to use an alternative protocol such as the long or short.

Down-regulation still occurs with the antagonist protocol, but an antagonist drug is used to stop premature ovulation rather than an agonist (as used in the long protocol). In the long protocol the agonist is introduced a couple of weeks before stimulation and throws your body into a sort of menopause. A full IVF cycle then takes roughly 6 weeks. With the antagonist protocol you start the antagonist drug to stop you ovulating on day 5 of stimulation (roughly day 7 of your natural cycle) and you start stimulation around day three of your natural cycle. This means a full cycle takes around 4 weeks.

From what I understand (but may well be wrong here), the disadvantage of the antagonist cycle is it's difficult for clinics to manage work loads and work flows as it totally depends on when women naturally start their period, which means some weeks might be super busy for clinics and some quieter. I understand it's difficult for smaller clinics to offer it, especially those that only run a five day service. Could be wrong there too.

I wasn't aggressively stimulated on the antagonist protocol - my clinic likes to get between 8 and 12 eggs - I know the doctor doing my first egg collection said more than 12 and they start to worry about the risk of OHSS.

What I don't know is if it can be used with a woman with PCOS - I guess it's impossible to predict day one of the cycle so have no idea how it might work or whether they can create an artificial day one. Also, I don't know whether stimulation is still mild enough and whether mild IVF is something completely different. All my clinic said to me was they didn't aggressively stimulate, but that could be very different to mild stimulation.

Anyway I've done three IVF rounds on the antagonist protocol. First cycle got pg but had an early m/c which I think was simply bad luck and nothing to do with the IVF. Third cycle got pg and am 11+1 with twins.

I guess it might be worth contacting clinics local to you and asking for more information on how they treat women with PCOS?

[KnackeredCow]

Just Googled "mild IVF" and it does appear that it's a variation on the antagonist protocol, but lower levels of stimulation drugs are used or stimulation is undertaken over a shorter period.

So you're possibly looking for a clinic that offers the antagonist protocol as a starting point.

Good luck! Hope all goes well for you.

[sleb1]

Have a look at the centre for health in London. They seem to be the forerunners of bot natural and mild ivf.

Hope that helps and good luck

[sleb1]

Sorry that was meant to the create health clinic

[GinSoaked]

Hi ariane. I did mild ivf (icsi actually) at Create last April. Sadly it was unsuccessful but that was nothing to do with the protocol! The main difference is that there's no down regging and the doses of stims are much lower. I think they normally collect about 4 eggs, but I responded well to the sims and we ended up with 12, of which 10 were mature! It's all done within one month. You start stimming on day 2, add an antagonist once the follicles are a certain size to stop you ovulating and then have a trigger shot and egg collection. The fact that you use less drugs, means it's a bit cheaper than conventional ivf. At create they're open 7 days a week, so do egg collection on the day they think your eggs are the perfect size. Other than Create, I can't find any other clinic that does mild.

For me, it was definitely the right decision. I felt comfortable during the stimming and am pretty sure I would have over stimmed with conventional. I think success rates are slightly lower and obviously the surgery etc is exactly the same as conventional. I think you have to decide what you want and where's local/convenient for you (create is out nearest clinic).The Create open days are really informative.

Hope that helps! Do ask if you have more questions and good luck with it all.

[Kafri]

Hi,
I had the short cycle over Easter. I was til I didn't need the down regging as I had no cycle to suppress due to PCOS. It isn't really a choice as such-your consultant will make a medical decision based on the results of all your ongoing tests.
I made sure I followed every instruction to the letter, just so I couldn't look back if it didn't work and think 'what if'?
I got my BPF a few weeks later and am expecting my little bundle of joy on Xmas Eve!x