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Dr. Sherman Silber

Mini-IVF is often the best option for women over 38 who want to become pregnant

It's widely known that as women age, their chances of becoming pregnant decrease. Women older than 38 in particular often have fewer and lower quality eggs and don't respond as well as younger women to conventional efforts to produce eggs for in vitro fertilization (IVF).

But plenty of women in this age group want to become pregnant. And they do have options.

Conventional IVF is one of these options, but it involves large doses of hormones and can cost $18,000 or more per cycle for older women with poor results. Many IVF programs turn them down anyway. Some women choose to use donor eggs, but many want to become pregnant with their own eggs. The best solution for such patients is mini-IVF.

Mini-IVF aims to use smaller numbers of higher quality eggs. It requires fewer fertility drugs than conventional IVF, producing the best quality eggs possible and reducing the cost of drugs from an average of $5,000 to just $500. The procedure is minimally invasive, so women experience little to no pain afterward. And it doesn't involve huge hormonal swings or ovarian hyperstimulation syndrome, a complication involving swelling of the ovaries that about one out of ten conventional IVF patients experience due to certain fertility medications.

The success of mini-IVF is enhanced by a new method of embryo freezing called vitrification, or essentially "flash-freezing," which avoids the damage caused by ice forming inside the cell during slow freezing. It is also enhanced by specialized air purification systems that give the eggs the best environment in which to develop.

Think of this simple parable: If you are sitting under an apple tree and wish to eat the most ripe and ready apples, you have a choice. You can chop down the tree and look at every apple on the fallen tree to see which ones were ready. Or you can simply try to shake the lower branches and eat the one or two that have fallen. That is the idea of mini-IVF. It may not work for everyone, but for many patients, especially older women, it will remove much of the aggravation and cost associated with conventional IVF.

Dr. Sherman Silber is the director of the Infertility Center of St. Louis at St. Luke's Hospital. Call 314-576-1400 or visit infertile.com .

This article was published in the St. Louis Post-Dispatch on July 1, 2010.