This article brings up lots of interesting questions!
I wonder if lengthening your dosage of Clomid alone would help some? The only thing is, how long would you lengthen it, if you weren't being monitored? Perhaps to day 10-12? And then I wondered, some are using Soy Isoflavones as if it were Clomid - would it work the same, taking it for an extended time?
When patients contemplate IVF, their first reaction is often the fear of daily injections of hormones for months, the incredibly high cost of the drugs, the risk of multiple pregnancy and consequent prematurity, side effects related to high levels of estrogen resulting from large numbers of eggs, hyperstimulation syndrome, and the prospect of painful daily progesterone injections for a full ten weeks even after the IVF procedure. Mini-IVF is a very unique approach developed by our colleagues in Japan to circumvent these problems and to simplify IVF for patients, reducing the cost while maintaining comparable success rates.
Mini-IVF is designed to recruit only a few (but high quality) eggs, thus avoiding the risks of hyperstimulation, reducing the cost of drugs from an average of $4,000 to closer to $400, reducing the number of injections, and completely avoiding the painful progesterone injections. This approach is not just a simple-minded reduction in hormonal stimulation. It is an ingeniously conceived and completely different approach to IVF, that saves the patient much of the complexity and cost associated with more conventional IVF protocols. Here is how it works.
On Day 3 of the menstrual cycle, you start on a low dose of Clomid (50mg), but you don’t stop the Clomid in five days as is usually the custom. You just keep taking the Clomid until ultrasound monitoring shows the follicles to be ready for ovulation. A very low “booster” dose of gonadotropin (just 150 iu of FSH), is added on Days 8, 10, and 12. Clomid not only stimulates your own pituitary to release FSH naturally (by blocking estrogen’s suppressing effect), but also staying on the Clomid (a unique new approach) blocks estrogen’s stimulation of LH release, and so also usually prevents premature ovulation. Thus, with this simple change in protocol, the old-fashioned, cheap Clomid is able to stimulate the development of great quality eggs for IVF.
Another advantage of this protocol is that you did not have to go on Lupron first to suppress the pituitary. Staying on Clomid blocks estrogen from stimulating your pituitary to release LH, and this prevents premature ovulation without your having to be suppressed. This means that you can be induced to ovulate with just a simple injection or nasal sniff of Lupron. This causes a more natural LH surge, and avoids the luteal phase defect caused by HCG that would otherwise require months of progesterone injections.
The next step is to recognize that Clomid has a negative effect on the uterine lining (because it prevents estrogen from stimulating the endometrium). That is one reason why results in the past have been so poor with the use of Clomid for ovarian stimulation. The embryos are less likely to implant in such endometrium. But that problem is solved by using the Japanese protocol for embryo freezing, “vitrification,” which I discuss elsewhere. We can now freeze the embryos almost with impunity using this approach, with only a 1% risk of loss. Then these embryos are transferred the next month in a “natural cycle” with no need for taking any hormones at all.
The frozen embryo transfers can then all be performed in a later natural cycle (without hormones). Even if you don’t normally ovulate predictably, you can be given one injection of Lupron in the follicular phase (once your follicle reaches 1.5cm) to induce natural luteinization, and still have a natural cycle embryo transfer with no hormones. The Day 3 frozen embryo would then be transferred five days later, and there is no need for your taking any hormones at all.
Even for poor prognosis cases of older women with low remaining ovarian reserve, there is an advantage to mini-IVF over high dose stimulation. Such patients normally yield very few eggs anyway even with huge megadoses of gonadotropin. If they have any quality eggs remaining, mini-IVF is just as likely to yield as many eggs (very few, of course) as giving huge megadoses of gonadotropin. Even in the worst case scenario, if there are no good eggs left at all, at least they can discover this with only $400 spent on drugs instead of $7,100 (cost of maximum dosage).
Think of this simple parable: If you are sitting under an apple tree, and wish to eat the most ripe and ready apples, you have a choice. You can chop down the tree, and look at every apple on the fallen tree to see which ones were ready. Or you can simply try to shake the lower branches and eat the one or two that have fallen. That is the idea of mini-IVF. It may not work for everyone, but for many patients, it will remove much of the aggravation and complexity associated with IVF, and also dramatically reduce the cost.
Photo credit: Infertile.com
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A few women said that this was Dr. Zhang's protocol, as well as Dr. Silber
"Dr. Zhang and Dr. Silber are affiliated with each other, and also with the Kato Clinic in Japan, where these techniques were developed. The Kato Clinic is the largest IVF center in the world."
Dr Zhang works out of NYC - newhopefertility.com
Here is what my doctor told me. Most doctor's prescribe it 5-9 because that's what comes with the literature for the drug. Most doctors who have a lot of experience prescribing it choose days 3-7 because it has less effect on the lining. Clomid reduces cervical mucus and reduces the thickness of your lining. Taken earlier it gives a chance for estrogen to build up again before ovulation. My doctor said to take it 3-7 because he's seen too many chemical pregnancies taking it 5-9.
From the Clomid board on FertilityFriend.com
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