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From natural to mild IVF cycle

From natural to mild IVF cycle. Prof Tomaz Tomazevic Universitty Clinical centre Ljubljana Slovenia. ISMAAR : renewed the interest for natural cycle and mild approaches in asssisted reproduction.

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From natural to mild IVF cycle

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  1. From natural to mild IVF cycle Prof Tomaz Tomazevic Universitty Clinical centre Ljubljana Slovenia

  2. ISMAAR : renewed the interest for natural cycle and mild approaches in asssisted reproduction .

  3. In the frame of this terminology we are presenting and discussing our experiences with modified natural and mild IVF • Our data on 1167 IVF / ICSI attempts in modified natural cycle ( only HCG)- 1994-2004 • Our data on 2068 frozen thawed embryo replacements (FER) in natural and in modified natural cycle - 1994 -2008 • Our data on 246 mild stimulated cycles 2009 -2011

  4. What are live birth rates in a modified natural IVF cycle-Ljubljana IVF : Ljubljana IVF 1994- 2004 . (avg. 4-5 previous stimulated cycles) No of Cycles 1167 • Oocytes retrieved 943/1167 80% • ET/positive puncture 613/943 65% • Optimal ET / positive puncture 411/943 44% • Live birth / cycle 86/1167 7% • Live birth / ET 86/613 14% • Live birth / optimal ET 71/345 21% • Live birth / suboptimal ET 15/255 6% • Live birth / woman 86 /522 16%

  5. Factors associated with success Indications ? Female vs. male infertility in modified natural IVF cycle P<0.001 ICSI for severe male Clinical Pr./212 cycles 3%, Live birth / cycle 3%

  6. Factors associated with success. Influence of maternal age on embryo development, clinical pregnancy and live birth rate . From RBM Online 2007,15:230-236

  7. Poor responders ? Normal vs. poor response in previously stimulated cycles and success in a modified natutral IVF cycle ? From data published in RBM Online 2007,15:230-236 p<0.05

  8. First or last line treatment? Number of previous IVF attempts and success of modified natural IVF cycle for female infertility ? p<0.05

  9. Natural cycle for endometrial preparation ?Live birth / FER in 1077 natural cycles and 991 modified natural cycles for endometrial preparation. 375 deliveries after 2068 frozen thawed blastocyst transfers in the natural cycle - Ljubljana IVF 1997- 2009

  10. Characteristics of natural cyle monitoring ? Very important individual variability of hormonal,and ultrasonic monitoring variables just before HCG in 248 modified natural IVF cycles and one day before spontaneous LH surgein 223 natural FER cycles has been noticed.

  11. Influence of E2 concentrations on the day of HCG administration on embyro development, clinical pregnancy and live birth rate . From RBM Online 2007,15:230-236 Low vs high NS

  12. Summary of recent data on modified natural cycle IVF - presented by Jehoshua Dor. * Use of hCG only, * *use of gonadotropins (day 7) and antagonists

  13. Mild stimulation a compromise between conventionally stimulated and modified natural cycle Modifiednaturalcyclestim. starting on day 7 +antag Conventional stimul. starting on day2 +antag Mildstimulationstarting on day 5 + antag

  14. Our experience with mild stimulation -2009-2011 • Mildstimulatedcycles 246 • Positivepuncture 236 96 % • ET /PP 200 85 % • EmbryoFreeezing / ET 32 16 % • Pregnant 68 34.5 % • Livebirth&ongoing pr. /ET 54 26.5 % • Livebirth & ongoing pr. /Cycle 54 21,5 % • LB/Day ET day5 ( 182- 91%) 52 28,6% • LB/Day ET day 3 ( 18 - 9% ) 2 11 % • LB/Blastocyst ET day 5 ( 150 -82% ) 51 34 % • LB/Morula ET day 5 ( 32 -18% ) 1 3 % • Twins / Livebirth & ongoing preg. 9 17 %

  15. Conclusions • The use of natural cycle IVF with respect to appropriate indications female infertility and age <36 years could provide relatively good results with low costs of treatment. Dilemma of using it as a first or a last line treatment is still open • Complementary use of stimulated and unstimulated cycles could possibly reduce costs in allow better cumulative success rate. In the modern ara it is difficult to implement natural cycle . • Natural and modified natural in our hands represent a gold standard for transfer of frozen thawed embryos • Dilemma between conventionally stimulated and natural cycle can sucessfully be solved by a compromise i.e by using a mild stimulation protocol starting on day 5.

  16. ThankYou

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