Natural Cycle IVF

The desire to write this short article appeared and took its final shape after, at the end of my consultations, I had heard half of my patients ask, in a breathy voice and in a careful manner, my opinion about the possibility of their having a natural cycle IVF programme. At some point, it seemed to me even that by using the word “natural”, patients were trying to dampen their fear of the word “IVF”…I suggest that we try to understand whether IVF is really so bad and whether “naturalness” is so good after all…

It should be noted right away that according to the recommendations of 2013, NC IVF as a means of infertility treatment is NOT recommended for patients suffering from some form of infertility. Does it mean then that NC is really that bad and should be forgotten about altogether?

In fact, this recommendation only reflects the labor intensity and the non-predictability that are characteristic of NC. Which means that getting to the “end of the road” in this cycle, i.e. obtaining a good-quality embryo, very often takes two, three, four menstrual cycles. Why is that, you may ask? There is but nothing “simpler” than monitoring a follicle in a natural cycle, puncturing it, obtaining an oocyte and then handing it over to embryologists. Yes, it is simple, and no, it is not…

First of all, let us not forget that a woman is a living being that is not obliged to produce a leading follicle in the middle of a cycle every month, at the first command of a fertility specialist. The ovaries can take a time-out for a month or two, and there is nothing so awful about it as far as a woman’s health is concerned. And in NC IVF, it is the first step where we can stumble. But even if we see a leading follicle at a US examination, there is yet another hardship awaiting us… Our pituitary gland is much smarter than any doctors and can “shoot” with a luteinizing hormone inducing ovulation as it sees fit, when the size of a follicle reaches 14, 16, 17 mm. Predicting the timing of such a “salvo” is virtually impossible in real life. First of all, LH is released in “peaks”, i.e. it does not rise gradually, which is why trying to detect the moment of hormonal release, especially with the aim of determining the time for ovarian puncture, is very much like coin-flipping.

That is why we largely try to set the time for oocyte collection with the help of an ovulation trigger, but we can miss the moment if the pituitary gland has done its part before us. I.e. coming to a doctor for an ovarian puncture in NS, one needs to be ready that the puncture may be called off. A follicle chooses its own destiny, and we have to respect that.

But even if a doctor has examined you before a puncture and has decided to inject you with the magical medication called Propofol, it will by no way mean that you have secured an oocyte. There may simply be no oocyte…It happens and not too rarely… This is not because a doctor was not persistent enough but simply because there was no egg cell. Alternatively, we may obtain an egg cell but it may prove immature or degenerative, or just be fertilized in a wrong way. This egg cell is the only one you have, so it does what it wants…

In summary of all of the above-said, I want to convey just one idea! IVF in NC is not a protocol of choice if we can obtain more than one oocyte. Trust me, although an embryologist may be akin to a wizard, he/she still needs some pumpkins, mice and shoes to be able to turn a fairy tale into reality. And their gaze dims when, having barely managed to “retrieve” an oocyte from a mother’s belly, we ask them to turn it into 3500g of happiness…

Does that mean that we should shelve this method of infertility treatment? By no means!!!! There are a lot of children born with the help of this ineffective and draggy natural cycle… But the decision to opt for this method of baby making was made by my patient and myself collectively, with us fully understanding and being conscious of the path that we dared to take together with the family. This decision was justified and explained to each other, and the time period was determined during which we were to fight for an oocyte. If we did not succeed, we went on and used alternative treatment methods with the understanding that we needed a baby, and not a compulsive idea of telling oneself and others that this fight with the disease would never end…