More natural IVF…
In a regular IVF cycle, we use GnRH-agonists and antagonists (e.g. Lucrin or Orgalutran) to suppress the LH surge that triggers ovulation, but in fact, one in five women do not have premature LH surges and could forgo the suppression drugs. Unfortunately, we have no way of predicting who will or will not have the premature surge, and with so much invested in an IVF cycle, most clinics suppress all patients just to be safe.
However, at Genea, we've found that some women who repeatedly fail to conceive with FSH/agonist/antagonist combinations may get pregnant quickly using a more "natural" cycle.
In a young woman this can mean a totally natural (no added hormones) cycle; in an older woman, a cycle helped by FSH injections but without any suppression. (In effect, we're stepping back to the late 1980s before the GnRH-agonists and antagonists were widely available.)
We've called this type of cycle IVF Lite.
Beating ovulation to the punch
IVF Lite requires very careful follicle tracking, starting several days before the anticipated day of ovulation. The aim is not to wait for the LH surge but to get in first. Once the ultrasound shows us that the leading follicle is 18mm in diameter or bigger, an injection of hCG (Pregnyl or Ovidrel) is given to trigger ovulation. A blood test is taken at the time of the injection and if that shows that serum estradiol has not yet fallen and serum LH has not yet started to rise significantly, we can reasonably assume that ovulation will occur 36 hours from the time of the injection. In practice, there is always a little doubt because serum LH fluctuates slightly all the time so, to be safe, egg collection is scheduled 34 hours after the trigger, rather than the 36-37 hours for normal IVF.
For women in their 20s and 30s who are close to premature menopause (with irregular ovulation and naturally high levels of serum FSH, IVF Lite may also be a viable solution, particularly if other infertility factors are present.