Your Trusted and Caring
Fertility Doctor in St. Louis

Natural cycle IVF / Mini IVF/ split cycle IVF

Natural cycle IVF or mini IVF or split cycle IVF is recommended when there is minimal ovarian reserve
confirmed by low AMH values (usually less than 1) and low antral follicle count (AFC < 6). In this mini IVF
cycle/ split cycle IVF, there are not many follicles (fluid filled sacs which contain an egg) put out by the
ovaries in a given month because the ovarian reserve of eggs is very low. This usually happens with
advancing age, destruction of eggs in the ovaries by radiation or chemotherapy or by toxins, destruction
of the ovaries by disease like endometriosis. With split cycle IVF, there is now hope for women with very
low AMH and AFC.

Split cycle IVF usually takes 2 to 3 months to complete. In the first IVF cycle the ovaries are stimulated
using rFSH (GonalF or Follistim) and hMG (Menopur) to grow the very few follicles recruited by the
ovaries. The growth of these follicles is monitored by serial ultrasound scans and estradiol level checks.
Once the leading follicles are more than 18 mm in size the maturation of the eggs in the follicles are
triggered by the trigger shot. At 36 hours after the trigger shot, the eggs are harvested and then
fertilized using a procedure called ICSI at our CAP certified lab. Then they are incubated in complex
tri-gas incubators where the PH, CO2, O2 levels are closely monitored. Next day (e.g. day 1) the eggs are
checked to see if they are fertilized normally. These are called 2PNs (2 pro-nuclei eggs). These normally
fertilized eggs are frozen.

Once the period starts the second split cycle IVF is done. This is repeated until a total of six 2PNs are
available for culture to day 5 blastocyst stage and then 1or 2 blastocysts are transferred back to the
uterus based on medical condition and patients preference.

Prior to starting mini IVF treatment, the patient has to be evaluated with blood work, ultrasound and hysteroscopy. Semen testing may be needed on the male partner. These tests can be completed within 14 days of the start of your period. Please call us at
314-473-1285 or Click here to make an appointment.

Most likely your disease has returned. The best treatment option is robotic assisted laparoscopic resection of endometriosis. This will give you significant pain relief. In addition, you may consider pre-sacral neurectomy, a procedure where the nerve supplying the pelvis is cut, thus reducing pain sensation. These procedures may be followed by long term continuous contraceptive pills or Lupron therapy up to 6 months.

IVF – In Vitro Fertilization
ICSI – Intracytoplasmic sperm injection
OCR – Egg (Oocyte) Retrieval
FET – Frozen embryo transfer
OCP – Oral Contraceptive Pill
IUI – Intrauterine Insemination
PGT A – Preimplantation Genetic Testing – Aneuploidy
FET – Frozen Embryo Transfer
ET – Fresh Embryo Transfer