The Doctor Is In!
Dr. Cookingham discusses Traditional & Minimal IVF
Lisa Marii Cookingham, M.D.
Columbia PREG Facility
What is traditional IVF in a nutshell?
Traditional IVF is what most people think of as the gold standard for treating patients with fertility issues. We stimulate the ovaries with fertility medications to try to get a large number of follicles (eggs). Once the eggs are mature we retrieve them and fertilize each of them in the IVF lab to obtain several embryos to freeze or transfer at a later time. If the patient ideally wants 2-3 children there might only have to be one egg retrieval instead of multiple stimulations which are more aggressive and costly to the patient. Any remaining embryos are frozen for future treatments, if necessary, or when the woman decides to have more children. A lot of people choose traditional IVF for many reasons such as severe male factor, ovulatory disorders, a tubal blockage, or diminished ovarian reserve.
What is minimal IVF?
Minimal IVF is an alternative to traditional IVF in the sense that the ovaries are stimulated to produce more than one follicle for retrieval, but the stimulation is not as aggressive using less medication, and therefore, fewer monitoring appointments for ultrasounds and lab work. The same procedures such as ICSI, assisted hatching and others take place in the IVF lab just as with traditional IVF. Minimal IVF is a less expensive and more conservative approach. Less medicine, fewer appointments, and labs, it makes it a more affordable option for many patients.
Who are the best candidates for minimal IVF?
Minimal IVF is a great option for those who may want only one child or may have had a previous tubal ligation and don’t want to worry about birth control after having another child. I would also recommend Minimal IVF for same-sex female couples if not successful after one or two donor sperm inseminations. Single women using donor sperm that only want 1 or 2 children are also good candidates.
I generally don’t recommend Minimal IVF for patients with multiple fertility issues, those wanting to do genetic testing, or patients wanting more than 1 or 2 children. In those cases, we like to have a good number of embryos to choose from in order to give the highest likelihood of success.
What are the pregnancy rates of minimal V.S. Traditional IVF, or are they incomparable due to variables like age of the patient, egg production, etc.?
It is hard to compare directly because you have different people with different biological framework and potential. A less aggressive stimulation with fertility medications will produce fewer follicles to be retrieved. By having a lower number of oocytes to fertilize, and a lower number of embryos to transfer, there may be a reduced chance of success by 10-20%, but, again that depends on the specifics of each individual case.
What’s the difference between fresh v.s. Frozen transfers? Does one have a better outcome than the other?
Fresh transfer occurs immediately after the creation and culture of the embryo to the blastocyst stage, which essentially means we go from stimulating their ovaries to egg retrieval to immediately prepping the uterus for embryo transfer. This occurs five to six days after the egg retrieval. The number of embryos we transfer depends on the grade and stage of the embryos as determined by the embryologists in the IVF lab. Our practice policy is to transfer a single, high-quality embryo for one healthy baby at a time. Transferring multiple embryos at a time does not significantly increase the likelihood of success, but it does increase the likelihood of multiple gestations like twins or triplets which is definitely not our goal.
And why is that important?
Women who have multiple have an 8-10 fold times risk of pre-term labor, miscarriage, or a nonviable baby. Our goal at PREG is to transfer one embryo that will grow into one healthy baby at a time.
Minimal IVF is just one of the many treatment options offered at PREG. We are always looking for the most effective, efficient means of helping our patients have the families that they so desperately want.
What do you love about being a fertility specialist and is there one treatment that you’re passionate about?
I truly love helping all of my patients get pregnant and have families. The desire to conceive can be overwhelming for women and to be able to be there to guide, support, and advocate for my patients are really important to me.
I’m also very passionate about fertility preservation both for cancer patients and women that are pursuing education or careers and the timing isn’t right. The cure rates with modern cancer treatments are very high and I think it’s important for women and men to consider their life after the cure. Having the conversation prior to chemo or radiation can be the difference between being able to have a biological child or having to go other routes to have a family.
On a personal note Dr. Cookingham, what is your favorite movie and song?
My favorite movie is “The Usual Suspects” and my favorite song is “Better Together” by Luke Combs.
PREG has centers in Greenville, Spartanburg, Asheville, Columbia, and the Lowcountry where we offer highly personalized fertility care and management. Dr. Cookingham sees patients in our Columbia center. For more information on your reproductive options contact us today at 866.725.7734, or online at www.pregonline.com/contact-us.php
Dr. Lisa Cookingham, M.D.
PREG, Columbia, SC