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IVF/ ICSI in the natural or mildly stimulated cycle 

Fertility treatment in the natural or mildly stimulated cycle is very simple as your natural cycle mostly needs to be observed and only minimal intervention is required.

This type of treatment is particularly suitable for women who do not want to use high-dose hormone therapy, are afraid of injections or just want to follow their own natural rhythm.

Follicle maturation phase

In a fertility treatment using just the natural cycle no medication is necessary for follicular maturation because the ovaries are choosing the best oocyte. However, sometimes with a mildly supportive therapy, a low dose of hormone tablets might be prescribed to improve the outcome.

Cycle monitoring will be done by ultrasound examination and hormone analysis. The first check usually takes place on the day of 9th-11th of the cycle depending on your usual monthly cycle length. Most of the time, the time of egg retrieval can already be determined on this day, so that no second doctor appointment is required anymore.

If you have a longer journey to our fertility center, you can have the ultrasound examination and blood collection performed by your gynecologist and send us the result by fax. However, the results of the examination should be available no later than 12pm then we can plan your treatment. So you can have fertility treatments with us, even if you do not live nearby.

Egg retrieval (follicle puncture)

As part of a fertility treatment in the natural cycle usually no anesthesia is required for egg retrieval because as a very fine needle is used for egg collection. The procedure causes only minimal pain similar as if someone takes a blood sample from you.

Under ultrasound vision and guidance, the needle is inserted into the follicle via the vagina and the egg is aspirated. This procedure takes only about 2 minutes. After pick up, you can relax with us in your private recreation room or go directly to your home or work again.

Please bring along your partner for egg retrieval so that he can provide semen for the fertilization of the eggs. If your partner is traveling for work, it is possible to freeze sperm samples in advance.

Fertilization

After egg retrieval the oozyte (egg) is fertilized in the fertility laboratory. The method of fertilization depends on the sperm quality and your wishes as a couple. If sperm quality is good, fertilization can be done using the IVF method. Here, a drop of prepared seeds in a Petri dish is added to the egg and fertilization occurs more naturally. The chance of fertilization is 50-60% in this procedure. In the case of limited sperm quality, fertilization is performed with the help of ICSI in order to achieve an optimal chance of fertilization. The chance of fertilization is 80-90% in this procedure. One day after egg retrieval we know whether the oozyte has fertilized. One of our laboratory staff will personally inform you about the fertilization of your egg(s).

Embryo transfer

The embryo transfer can take place 1-5 days after egg retrieval. In the natural or mildly stimulated cycle, the transfer usually takes place between day 1 and day 3 after egg retrieval.

The embryo transfer is similar to a gynecological examination and not painful. On the day of the transfer you will be personally informed by one of our laboratory staff about egg and sperm quality as well as embryo development.

For embryo transfer, a thin guide catheter is inserted into the uterine entrance. Subsequently, the transfer catheter with the embryo(s) is gently inserted and transferred to the uterus. You can follow the process on the ultrasound monitor.

Einnistungsphase

The implantation phase is the period after egg retrieval. In this phase you should allow yourself rest and be pampered.You may have been prescribed progesterone capsules (luteal hormones), which you should introduce daily as a suppository into the vagina from the evening of egg retrieval. Please note that this type of application (vaginal ingestion) is NOT mentioned on the leaflet. In some women, it is not necessary to use luteal hormone.About 14 days after taking the egg, a pregnancy test is performed in the blood. Then we know if the treatment has been successful.

Success rates

The success rates of fertility treatment are highly dependent on the woman’s age, the reasons for the fertility treatment, and the type of therapy performed. Embryo transfer does not occur in every natural or mildly modified cycle.

The reasons for this are:

  • premature ovulation (about 10%)
  • egg is not found during egg retrieval (about 10%)
  • immature oocyte that can not be matured in the laboratory (2%)
  • unfertilized or abnormal fertilized egg (about 10%)

A pregnancy chance of 25-30% can be assumed in women < 40 years and a transfer of 1 embryo. Unfortunately, treatment success cannot be guaranteed because some couples do not become pregnant even after repeated embryo transfer.

Costs

The cost natural or mildly modified cycle IVF/ ICSI is generally much lower than that of classic treatments. Many costs are can be saved through a reduction or even complete avoidance of expensive hormone medication, lack of mandatory requirement of anesthesia for egg retrieval as well as reduced work load in the IVF labarotory for a smaller number of oocytes.Privately insured couples are reimbursed by the health insurance. Our publically insured patients receive a self-payer discount. If one of the partners is publically insured and the other is private, the physical reasons for the infertility must first be determined so that it can be clarified which insurance company is responsible for the reimbursement.Some of our private patients got offered reimbursements for several natural cycle treatments even if they already had 3x stimulated IVF/ ICSI cycles beforehand. We will gladly give you written individual cost estimate after the medical consultation.

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