Mild IVF works, so why aren't more women offered this treatment?

Tracy Sant was told she couldn't have children, but a 'mild' fertility treatment worked. Why aren't more women offered this option?

For someone who was told she'd never have her own biological children, 40-year-old Tracy Sant, who has an 18-month-old daughter and is now expecting a son, is doing well.

Like many other women, the former RAF pilot was turned away from fertility clinics as a matter of course because her levels of Follicular Stimulating Hormone (FSH) were considered too high.

"A well-known clinic in Wimpole Street turned me down because my FSH was 12," Sant says. "Four months later we went to another fertility centre in Cambridge. By then my FSH levels had risen to 22.

"The consultant told me this meant I was approaching the menopause and wouldn't be able to have a child naturally. Egg donation, he said, would be my only option. Well, we weren't ready to hear that and were absolutely devastated."

FSH is linked to egg quality and quantity. When levels exceed 10 to 15, it is widely believed a woman's eggs aren't good enough quality for fertilisation. There is another hitch. The IVF industry relies heavily on fertility drugs to guarantee success rates. And patients such as Sant, who have high FSH and are medically known as "poor responders", do not respond well to fertility drugs.

Yet there is now more evidence than ever to show that mild or natural-cycle IVF – which uses a woman's natural cycle and minimal or no ovary-stimulating drugs – does work for these women.

Several studies have shown this gentle approach leads to better-quality eggs and improved rates of implantation in the womb lining, exactly what women need if egg numbers and quality are hanging in the balance.

The outcome is significant. In a study at the Centre of Assisted Reproduction in Rome on "poor responders" with high FSH levels, natural-cycle IVF led to a pregnancy rate of 18 per cent each cycle in women under 35. In those aged 35 to 40, pregnancies were achieved at a rate of 11.7 per cent per cycle.

Dr Geeta Nargund, medical director of Create Health Clinic and president of the International Society for Mild Approaches in Assisted Reproduction (ISMAAR), says that might not seem like a high percentage. But it is significant when the only other option might be egg donation, she says.

"Although natural-cycle IVF success rates are lower than conventional stimulated IVF in young women with normal egg reserve, it can be equally or even more successful in older women who have high FSH and low-egg reserve," Dr Nargund says. "Also, the treatment does not upset the body's hormones, so you can fit around twice the number of treatments into the same time period."

Vitally for women with low egg reserves, mild IVF is known to lead to fewer genetic abnormalities in developing embryos. One study in Human Reproduction that compared embryo quality had to be abandoned on ethical grounds when researchers discovered that standard IVF led to almost double the rate of genetic abnormalities in embryos than those produced using low-dose IVF. Another study, also in Human Reproduction, found that low-dose IVF had double the rate of embryo implantation in the womb lining, compared with standard IVF, which required twice the number of embryos to get the same results.

"Forcing eggs to mature using high-dose medication in women with low egg reserve may not be in the best interests of egg quality," Dr Nargund says. "Instead, evidence suggests it is best to work with nature where the egg is selected naturally and matures in its own time."

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