in vitro fertilisation (ivf)

Difference Between Natural IVF Cycle and Stimulated IVF Cycle

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Medically Reviewed by Dr. Deepika Tiwari - MBBS on 20 Mar 2019 - Written by Dr. Devika Chopra - MBBS - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MBBS

Stimulated IVF treatment is an IVF cycle when a woman is given medications and hormonal drugs to encourage the growth and fertilization of multiple eggs. On the other hand, eggs from natural IVF cycle is retrieved during monthly ovulation cycle and do require any medications or injections.

During a normal reproductive cycle, when a woman goes through a change in her hormones, the mature egg is released and becomes available to be fertilized. A single sperm meets the egg through sexual intercourse and a single egg grows and matures inside an ovarian follicle. However, if a woman or in some cases a man is not able to help conceive naturally or through IUI treatment, the eggs from a woman are retrieved and mixed with sperms outside the uterus to achieve fertilization, which is termed as In Vitro Fertilization.

Generally, IVF treatment is aimed to be performed without any use of medications or injections to reduce overall physical, emotional, and financial burden on the patient, however, in many cases, stimulated cycles are required to encourage the release of eggs.

In this article, we will look at:

Stimulated IVF Cycle vs Natural IVF Cycle

In a stimulated IVF cycle or traditional IVF cycle, a woman is given medications for 9 to 12 days that stimulate both of her ovaries to grow and mature multiple egg follicles. (1) Follicle-stimulating hormone (FSH), a luteinizing hormone (LH) or a combination of both are given at first followed by Human Chorionic Gonadotropin (HCG) or other medications to help the eggs mature. During this stimulation phase, a physician will monitor the patient with ultrasounds and blood work to track the growth of the follicles until they reach a certain size. (2)

On the other hand, natural cycle IVF is a treatment similar to traditional IVF, but without the use of medications to stimulate the ovaries. During a monthly ovulation cycle, a single egg grows and matures inside an ovarian follicle. Since natural cycle IVF does not require medications to stimulate the ovaries, the cycle can only produce one mature egg at a time. Patients are monitored with ultrasounds and bloodwork to track the development of the single ovarian follicle so that it is not released by the body before it can be retrieved. 

After the mature egg is ready to be harvested and fertilized, the patient then undergoes the same type of egg retrieval procedure that is done in a stimulated IVF cycle to retrieve the egg. A physician will then perform an egg retrieval procedure under anesthesia to remove the eggs or egg from the follicles. They are then fertilized in the lab, where the embryos will grow it transfer back into the woman's uterus. Any high-quality embryos that are not transferred in the first cycle can be frozen for further use.

Natural cycle IVF and a stimulated IVF cycle are very similar in terms of the timeline and the procedures followed. The difference is just that the patient does not use medications to stimulate multiple egg development in a natural IVF cycle and in the number of eggs released. (3)

Stimulated cycle IVF will increase the number of available embryos for transfer. It increases the chance of pregnancy by preparing the ovary. The development of immature oocytes followed by in-vitro maturation (IVM) and IVF is an attractive option to stimulated cycle IVF. IVF treatment is a successful option to infertile women with polycystic ovaries and polycystic ovary syndrome. (4)

Natural Cycle IVF vs Stimulated Cycle

Reasons to consider Natural IVF Cycle

Normal Cycle IVF is generally for patients who:

  • Have high Follicle-Stimulating Hormone (FSH) levels
  • Are at high risk for developing Ovarian Hyper stimulation Syndrome (OHSS)
  • Are unable to produce a large number of eggs during a single cycle
  • Do not respond well to fertility medications
  • Have male factor infertility 
  • Are at a prime maternal age for fertility 
  • Are able to ovulate and do not want to use fertility medication
  • Do not want to absorb the expense of fertility medications
  • Do not want to produce multiple embryos for religious or ethical reasons
  • Reason to consider Stimulated IVF Cycle

Stimulated IVF Cycle is performed on patients who: (5)

  • Have blocked or damaged fallopian tubes
  • Are at an advanced maternal age for fertility
  • Have ovulation disorders, premature ovarian failure, uterine fibroids
  • Have had their fallopian tubes removed
  • Have a genetic disorder
  • Have hormonal imbalances
  • Unexplained infertility

Success Rate of Stimulated and Natural IVF Cycle

Pregnancy and live birth rates for traditional IVF cycles are higher than natural cycle IVF. In fact, one may have to undergo three to four natural cycles in order to achieve a successful pregnancy, compared to one or two stimulated IVF cycle. One important element that influences this success rate is the quality of egg and the egg retrieval process. The main reason low success rates in natural cycle IVF is that, without the use of medications, there is a much higher chance of a cycle being canceled as the exact time of ovulation is difficult to predict. Many patients going for natural IVF cycle usually prematurely ovulate, or sometimes the egg cannot be retrieved at the time of retrieval. Many infertile patients go through the entire cycle that doesn’t result in fertilization. The success rate per natural IVF cycle for women less than 37 years is 15 percent and 5 to 10 percent for women over 40 years. On the contrary, the success rate of stimulated IVF cycle is 70 percent for women under 35 years, and a 40 percent for women over 40 years. 
Many studies have previously compared stimulated and unstimulated IVF cycles. The study reports provided very different results with implantation rates varying from 0 to 33 percent in the natural cycles and from 7 to 24 percent in the stimulated cycles. (6) For women considered “poor responders,” natural cycle IVF affords the opportunity to continue with the IVF process, even when ovarian stimulation has repetitively failed to produce multiple embryos. However, natural cycle IVF is not necessarily the recommended treatment for a “poor responder” if multiple ovarian stimulation is still possible. (4) For couples with infertility due to male factor (low or poor quality sperm), natural cycle IVF can provide an opportunity for fertilization through ICSI and at the same time avoid multiple pregnancies and unnecessary stimulation for an otherwise fertile female partner.
Women who cannot tolerate or do not desire to take hormonal therapy in order to conceive can still benefit from the IVF process.

Pros and Cons of Natural IVF Cycle

Pros:

  • Reduces the risk of multiple pregnancies: As natural cycle, IVF creates only one embryo for implantation; the chance of multiple pregnancies is generally eliminated. (7)
  • Eliminates the expensive costs of stimulation drugs: Eliminating the expenses of medications and injectable can help save thousands per cycle, putting IVF in reach of more patients. (7)
  • Reduces the chances of side effects from drugs: Less use of medications means less pain and less risk of mood swings, headaches, and generally a more comfortable cycle. (7)
  • Much shorter and safer procedure: As only one egg is retrieved, the egg retrieval process is generally quicker, which further cuts the risk of rare post-procedure bleeding. Natural cycle IVF is patient friendly and offers patients the IVF process with fewer medications, low risks, and fewer office visits. (7)

Cons: 

  • Premature “LH surging” or ovulation: Ovulation in natural IVF cycle is not controlled by the use of fertility drugs, therefore, predicting the right time of egg retrieval is difficult. 
  • Egg may not develop into a healthy embryo: In natural IVF cycle, there is only one egg to use in IVF. If the egg is unhealthy or low in quality, there is no alternative.
  • No extra embryos for freezing: If the cycle is not successful on the first try, the patient will have to go through the whole process again, including the egg retrieval procedure.
  • Lower live birth rates and lower rate of pregnancy: Success rates in natural IVF cycle may be as low as 7 percent, depending on the clinic and the circumstances of each individual patient.

Pros and Cons of Stimulated IVF

Pros:

  • Has a safe track record with higher success rates: IVF with stimulating drugs is one of the most successful assisted reproductive technologies (ART) available. On average, the success rate of treatment is about 40 percent per cycle, depending on the patient’s diagnosis and age. (7)
  • Diagnosing genetic abnormalities: With multiple embryos, doctors have the option to perform preimplantation genetic screening (PGS) or diagnosis (PGD), which can help, select the healthiest embryos for transfer. (7)
  • Can help diagnose the cause of infertility: Having more eggs to examine can help doctors determine the specific issues that may be affecting fertility. When these cases arise, further procedures, such as assisted hatching or intracytoplasmic sperm injection (ICSI) are performed to increase the chances of success. (7)
  • Left-over embryos can be stored: Any embryos not transferred in the first cycle may be frozen to be used in future cycles, donated to research or to another patient.

Cons:

  • Risk of Ovarian Hyperstimulation Syndrome (OHSS): Some patients can over-respond to the fertility drugs, causing side-effects such as abdominal pain and bloating. The symptoms may also be severe in some cases. (7)
  • Administration of drugs during procedure can be painful: The multiple injections required for a stimulated IVF cycle can be arduous, especially for patients with a phobia of needles. (7)
  • Can result in multiple births: As multiple eggs are retrieved and fertilized, the embryologist may transfer 2 or more embryos according to the cause of infertility, which mean more possibility of multiple births. (7)
  • Can be costly: Any IVF cycle requires a huge sum of money. Moreover, the additional cost of fertility medications and advanced ART treatments may add to the expenses.

Choosing the Best Treatment 

The decision about pursuing fertility treatment depends on personal, medical, and financial factors. Ultimately, the decision is in the hands of the patients to go for the treatment recommended by the doctor. Before you make a decision about which treatment to pursue, investigate your case of infertility, by referring many clinics and doctors. 
You can find the infertility doctor or clinic yourself or you can take the help of Elawoman to find the best infertility doctor in the city. We have a vast list of reliable doctors and world-class clinics from which choose from. You can also get a free appointment with our verified doctor by calling us at +917899912611

Dr. Devika Chopra

Written by

Infertility Specialist, Infertility Evaluation and Treatments
Mumbai

Dr. Devika Chopra is a leading Obstetrician, Gynaecologist and IVF Expert in Tardeo, Mumbai. She provides services such as Intrauterine Insemination (IUI), Gynae Problems, Maternal Care/ Checkup and Infertility Evaluation/Treatment. Dr. Devika Chopra practices at Hope Clinic in Forjett Street, Mumbai. She holds an experience of almost a decade. She completed MBBS from Grant Medical College, Mumbai in 2002. Thereafter, she pursued DNB in Obstetrics and Gynaecology from NBE in 2009. She continued her studies further and did MSc from Oxford University, U.K. in 2012. For Contact details of Dr. Devika Chopra visit at elawoman.com

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5 Comments

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Mr. and Ms. Rao

I and my wife were childless for 5 years after our marriage. Then we got to know about natural IVF process through the Internet. My wife is now going through the treatment. Hoping to become parents soon.

Sept. 17, 2018, 5:43 p.m. 4.5

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Reshu Burman

My husband was glad that I did not have to take any fertility drugs during the treatment. Natural IVF is the best procedure to conceive without the help of medications. On my way to becoming a mother soon. So happy to share this with everyone.

Aug. 16, 2018, 9:57 p.m. 5.0

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Simran Sahu

Thank god we went through natural IVF cycle as suggested by a friend of mine. The cost of treatment was much low as compared to stimulated IVF cycle.

June 24, 2018, 10:29 a.m. 5.0

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Lipika Gore

Oh! An IVF is an IVF. I thought Natural cycle IVF vs. stimulated IVF cycle sounds a little more complicated. A lot to discover yet. Though this was a useful blog.

June 5, 2018, 11:11 a.m. 5.0

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Nihal Ahmad

May 25, 2018, 1:21 p.m. 4.5

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