Due to the financial burden of IVF treatments, easier and cheaper methods are being tried to be applied in addition to standard practices. One of these is drug-free (natural) in vitro fertilization.
One of the main expenses in in vitro fertilization treatment is the medications used to develop eggs. Although these drugs vary from patient to patient, the average cost is between 1000 - 2000 TL. In patients who develop more than one egg by using high doses of medication, the number of embryos that can be transferred increases. In this way, although the risk of multiple pregnancy increases, pregnancy rates also increase. For this reason, high doses of drugs are used as standard treatment methods all over the world.
However, there are also patient groups that do not respond well to these treatment protocols, no matter how high doses are used. While one egg develops in natural cycles in women with normal menstruation, in this group of patients, despite all our efforts and all the drugs used, no more than one or two eggs develop. Additionally, the quality of these eggs is often not as good as desired. As a result, fertilization rates remain low and pregnancy rates in patients who can be transferred also remain low. These are especially patients close to menopause and patients with premature ovarian aging.
It is useless to apply standard treatment in this patient group. In these patients, removing the egg that develops spontaneously, without using any medication, when it matures and fertilizing it with the microinjection method is called natural cycle in vitro fertilization treatment. It is a more reasonable option for this group of patients since it has no or minimal drug costs.
However, since the body's own egg hatching system works in the natural cycle, it is very difficult to determine the moment when the egg is ready for fertilization. Sometimes, during the planned egg retrieval process, ovulation occurs earlier. This means that eggs cannot be collected for the microinjection process.
In order for the egg collection process to be carried out and a healthy usable egg to be obtained, the egg must have reached a certain level of maturity but not have hatched.
In the natural cycle, when the egg reaches a certain size, the level of LH hormone, which stimulates ovulation, rises, allowing the egg to reach its final maturity and crack. However, it should be closely monitored when the LH hormone rises. In an ideal follow-up, after the egg reaches a size of approximately 17 mm, the egg collection process can be scheduled by giving hCG medication before the LH hormone rises. If the LH hormone rises spontaneously before, then egg collection should be performed before the end of 24 hours by determining when the hormone reaches its highest level. If egg collection is done early, an immature egg will be obtained and the chance of success in treatment is significantly reduced. Conversely, if collection is delayed, the egg will hatch.
The chance of pregnancy in ICSI applications in the natural cycle remains only at a certain level. Pregnancy can be achieved with a rate of up to 15% with ICSI application in the natural cycle. However, this rate is the pregnancy rate achieved for patients who underwent embryo transfer. Eggs can be obtained in approximately 60-70% of patients who start treatment. In addition, not every egg is fertilized because it is not of high quality. However, transferable embryos can be obtained in approximately 40-50% of patients who start treatment.
As a result, although ICSI application in the natural cycle has a limited chance of success, it is an easy and less expensive treatment alternative for couples who want to maintain their chance of treatment. The natural cycle alternative should be considered in patients with low ovarian reserve.
Natural cycle treatment trial is tried as a last option in our center if no results are obtained from moderate protocols after high dose protocols.