Mini IVF: How It Works, Success Rates, Pros & Cons & Treatment Costs

In vitro fertilization (IVF) may be the most widely-known fertility treatment protocol, but there are actually three variations: conventional IVF, reciprocal IVF, and mini IVF. In this guide, an expert compares the typical IVF protocol to its more mild counterpart, known as "mini" IVF.

In this article:

• What is mini IVF?
• Mini IVF Success Rates
• Comparing Conventional IVF, Mini IVF & Natural IVF
• How many eggs are expected with mini IVF?
• Is egg quality better with mini IVF?
• Who is a good candidate for mini IVF?
• How much does mini IVF cost?
• How long is a mini IVF cycle?
• What are the benefits of mini IVF?
• What are the disadvantages of mini IVF?
• Is mini IVF right for me?

What is mini IVF?

Mini IVF, also referred to as minimal stimulation, low-dose, micro, mild, or "gentle" IVF, is a less aggressive approach than conventional in vitro fertilization (IVF).

It involves using lower doses of the injectable medications used in a conventional IVF cycle, or using less powerful oral medications (such as Clomid or Letrozole). As a result, the benefits of this method include a less intense medication protocol and almost no risk of ovarian hyperstimulation syndrome (OHSS). 

However, while a mini IVF protocol is gentler and can be more cost-effective, it also generally results in fewer eggs (1-3) and resulting embryos. This requires some patients to undergo multiple treatment cycles in order to achieve a successful pregnancy, which can actually increase the overall cost.

Mini IVF Success Rates

For women under 35 with normal ovarian reserve, mini IVF success rates are slightly lower than with conventional IVF. One 2016 study published in the American Journal of Obstetrics and Gynecology revealed the average birth rate among mini IVF patients to be 49%, compared to 63% for conventional IVF patients.

However, for women over 40 or those with low ovarian reserve, mini IVF may offer comparable (or even higher) success rates than conventional IVF. Minimal stimulation tends to produce similar results to conventional IVF at half the cost and with literally no medication side effects.

What the research says:

In women under 35, results were slightly higher in the conventional group (50.2% vs 41.2%) and in women 43 or older, the results were much higher in the mini-IVF group (22.0% vs 5.5%). Pregnancy rates per egg retrieved were twice as high with minimal stimulation compared to conventional.

In women under 35, results were slightly higher in the conventional group (50.2% vs 41.2%) and in women 43 or older, the results were much higher in the mini-IVF group (22.0% vs 5.5%). Pregnancy rates per egg retrieved were twice as high with minimal stimulation compared to conventional.

The American Society for Reproductive Medicine (ASRM) reported on a novel mini IVF protocol for poor responders (which included women over 43 and younger women with low ovarian reserve).

This cohort study compared the live birth rates of low responders using mini IVF with the results of women with normal ovarian reserve who underwent conventional IVF, and uncovered some interesting results.

In women under 35 with low ovarian reserve:

• 50.2% of the conventional IVF group delivered a child
• 41.2% of the mini IVF group delivered a child

In women over age 43:

• 22% of the mini IVF group delivered a child
• 5.5% of the conventional IVF group delivered a child

In short, for older women and those with very low ovarian reserve, mini IVF was actually superior to conventional IVF. For younger women, it was slightly worse. In all cases, the pregnancy rate per egg retrieved (i.e. the chance of a retrieved egg resulting in a clinical pregnancy) was higher with less stimulation. 

The bottom line: Outcomes for mini IVF will vary due to several factors, including your age, underlying diagnosis, ovarian reserve, and your fertility clinic's expertise.

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Comparing Conventional IVF, Mini IVF, Reciprocal IVF & Natural IVF

Aside from a few variations, conventional IVF and mini IVF typically follow the same process.

The biggest difference between conventional IVF and mini IVF is the amount of fertility medications used in the ovarian stimulation phase of the process and how that reduction in medication usage affects each patient's results.

Reciprocal IVF is a unique process that involves biological participation from both partners, and "natural" IVF involves no stimulation medications. More on these treatment types below.

Conventional IVF

The classic approach to in vitro fertilization (IVF) is to 'feed' all of the follicles in your ovaries so the eggs inside can grow at the same time, resulting in multiple mature eggs. This is accomplished with high-dose fertility medications that stimulate follicular development.

Note: The majority of fertility patients need high-dose medications to be successful.

Conventional IVF has the highest success rate out of the three variations, but is also the most expensive and requires the most time and effort. You will need to make multiple visits to your fertility clinic for frequent blood tests and ultrasound monitoring.

Reciprocal IVF

Reciprocal IVF (RIVF) is a variation on conventional IVF treatment for same-sex female couples (or a cis woman and trans man) who wish to share in the biological process of having a baby together.

In an RIVF cycle (also sometimes referred to as partner-assisted IVF or co-IVF), oocytes (eggs) from one partner are retrieved and fertilized with donor sperm to create embryos. These embryos can subsequently be transferred into the uterus of the other partner.

This allows both partners to personally participate in the same pregnancy, since one partner supplies the eggs to create the embryos, and the other partner carries the resulting pregnancy.

Mini IVF

With mini IVF, the goal is to use a less intense treatment protocol (with low-dose fertility medications) in order to focus on the growth of just a few eggs. This can be beneficial for those with low ovarian reserve, sensitivity to stimulation medications, or a desire to only create a small number of embryos.

However, the success rates for natural IVF are significantly lower than with conventional or mini IVF. This method also still requires multiple office visits for monitoring.

How many eggs are expected with mini IVF?

While there are some exceptions, a mini IVF cycle usually produces fewer eggs than a full stimulation (conventional) IVF cycle. One mini IVF cycle typically results in the retrieval of only 1–3 eggs, whereas conventional IVF aims to retrieve as many eggs as possible.

The number of embryos that develop from the retrieved eggs will vary.

Is egg quality better with mini IVF?

While some doctors and clinics who promote "natural" or mini IVF protocols claim that lower doses of medication will result in higher quality eggs, there is no scientific evidence to support this claim. 

In a 2016 study published in the Journal of Fertility and Sterility, researchers concluded that embryos produced in "natural" (unmedicated) IVF cycles were not, in fact, of a higher quality than those produced through conventional IVF.

What they found was that the ratio of normal to abnormal embryos was essentially the same in both types of cycles, and there was no evidence that unmedicated IVF improved egg quality.

Who is a good candidate for mini IVF?

If you have lower anti-Müllerian hormone (AMH) levels, have undergone conventional IVF cycles without good results, feel like your treatment protocol isn't being adjusted to fit your needs, or are frustrated by a lack of explanation from your doctor about why IVF isn't working for you, mini IVF may be worth exploring.

Individuals and couples who want to reduce the costs associated with IVF, avoid higher doses of medication, or who are looking to reduce the time commitment associated with conventional IVF treatment may also want to consider a minimal stimulation cycle.

Other factors to consider:

Ovarian Response

When there are only a few eggs in the ovaries to begin with, either due to age or diminished ovarian reserve, the full dose of fertility medications is not going to produce the high number of eggs (10-15) we need through a conventional IVF cycle.

These patients may do just as well (or better) with mini IVF, as it only involves a small amount of medication and typically leads to the development and maturation of around 1-3 eggs.

Excess Embryos

One big difference between mini and conventional IVF is the number of embryos that are left over at the end of a cycle. Keep in mind that if your goal is to have more than one child, you'll want to end up with multiple embryos.

Conventional (high-dose) IVF is more likely to produce additional embryos, increasing your chance of having embryos to freeze for future use, while mini IVF frequently only results in one embryo per cycle.

Medication Tolerance

Another medical reason for considering mini IVF is that some patients cannot tolerate the amount of fertility medications used in conventional IVF treatment, with some being prone to develop ovarian hyperstimulation syndrome (OHSS). 

What the experts say:

According to the American Society for Reproductive Medicine (ASRM):

"In patients who are classified as poor responders and pursuing IVF, strong consideration should be given to a mild ovarian-stimulation protocol (low-dose gonadotropins with or without oral agents) due to lower costs and comparable low pregnancy rates compared with traditional IVF stimulation protocols."

How much does mini IVF cost?

Note: The following information only reflects self-pay pricing. If you have insurance coverage or other financial assistance for fertility treatment, these costs may be considerably lower.

Conventional IVF treatment can cost anywhere from $15,000 to $30,000+ per cycle, with medications accounting for up to 35% of the total cost. These medications can range from $50 or less for Clomid to $1,000 to $2,000 for injectable hormones.

Since mini IVF treatment involves fewer medications, the average cost per cycle is usually lower. At Illume, this type of protocol (when paid for without insurance) costs around $5,800. That said, it's important to understand that the exact cost of mini IVF can vary widely based on several factors, and it may not be the most cost-effective option for you.

No insurance coverage?

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Cost Considerations for Mini IVF

As you explore your options, keep the following factors in mind:

• Clinic costs: Every practice has a different pricing structure, but the amount you pay to your fertility clinic likely won't change much with mini IVF, as all the same medical procedures are being performed. If you are paying out of pocket and utilizing one of your clinic’s self-pay pricing plans, note that the cost of medication is typically not included.
• Your location: Costs can vary depending on where you live.
• Medications: Because you'll be using fewer medications, the amount you pay to a pharmacy will generally be lower. Medication type and dosage still impact overall cost.
• Add-ons: If you need additional procedures (such as ICSI, assisted hatching, or preimplantation genetic testing), this will increase the cost of treatment.
• Number of cycles: Low-stimulation IVF can require more cycles to achieve a successful pregnancy, meaning you may need to undergo multiple mini IVF cycles in order to get a similar amount of embryos to conventional IVF or be able to cryopreserve (freeze) embryos for future use.

How long is a mini IVF cycle?

A typical mini IVF cycle lasts around two weeks and follows the same general structure as a conventional IVF cycle. While your personal protocol and timeline may look different, below is an idea of what you can expect:

Days 1-10

Oral medications are taken to stimulate the ovaries to produce eggs. Low-dose injectable medications may then be added in to promote egg growth and maturation. Progress is monitored through blood work and ultrasounds over 2-3 visits to your fertility clinic.

At the right stage of development, you take an injection called a "trigger" shot to promote egg maturity, and an egg retrieval is scheduled for 36 hours later.

Day 11

A minor, outpatient surgical procedure called an egg retrieval is performed to remove the mature eggs from the ovarian follicles (the tiny fluid-filled sacs that contain the eggs). Egg retrievals are performed under anesthesia to ensure you remain 100% comfortable. 

Days 12-16

Any mature eggs that were retrieved during your procedure are then fertilized in the IVF lab in one of two ways: 1) Allowing sperm and eggs to "mingle" together in a petri dish or 2) through a process called intracytoplasmic sperm injection (ICSI), in which a single sperm cell is manually injected into each egg.

Optional: Embryo Testing

Preimplantation genetic testing (PGT) can be performed to determine which embryos are chromosomally normal and free of specific inheritable genetic conditions. PGT is also able to reveal the biological sex of each embryo, if the patient wishes.

Embryo Transfer

There are two options: A fresh embryo transfer (performed around five days after egg retrieval) or a frozen embryo transfer (FET). If you opt for PGT, your embryos will be biopsied then cryopreserved (frozen) while you wait for those test results.

During the embryo transfer procedure, a doctor will carefully deposit your designated embryo into the uterus under ultrasound guidance, using a very thin, flexible tube called a catheter.

What are the benefits of mini IVF?

• Up to 50% fewer visits to fertility clinic (3-4 versus 8 appointments)
• If you have a regular period, you can typically start treatment right away
• Medication only taken once a day, instead of twice a day
• May be less physically and emotionally taxing
• Can be more affordable than conventional IVF 
• Fewer side effects from medications
• Reduced risk of ovarian hyperstimulation syndrome (OHSS)
• Minimized risk of twins or higher order multiples

What are the disadvantages of mini IVF?

While mini IVF is an attractive (and beneficial) option for some prospective parents, there are also some potential downsides to this protocol, including:

• It isn't suitable for everyone
• Typically results in far fewer eggs retrieved
• Not ideal for egg freezing cycles
• May require multiple cycles to achieve success
• Higher chance of cycle cancellation due to unexpected ovulation

Note: Your fertility specialist may have additional reasons to not recommend mini IVF, depending on your particular diagnosis or family-building goals. 

Is mini IVF right for me?

The answer is - it depends. However, the first step to finding the best treatment protocol for you is choosing a reputable fertility clinic and undergoing fertility testing. 

After diagnosing any underlying fertility issues and evaluating your current ovarian reserve (the number of eggs in your ovaries), your doctor will have a more complete picture of your fertility and be able to make the best recommendation for you.

Mini IVF offers a promising option for those seeking a more natural and potentially less expensive route to achieving pregnancy through IVF. However, it's important to remember that each fertility journey is unique, and decisions about treatment should always be made in collaboration with your doctor.

To learn more about mini IVF or other fertility treatment options, reach out to our team!

Disclaimer: This information is for educational purposes only and should not be taken as medical advice. Please consult with your doctor to discuss your individual situation.