One of the most recent trends in the reproductive world is the use of the "new" low dose protocol IVF cycle. Actually, these protocols have been around for over thirty years and have resurfaced as a "low cost" alternative to typical IVF. Let's review the protocol, and the pros and cons.

Essentially these "soft protocols" are identical to typical IVF in that the patient needs to be monitored with repeat ultrasound treatments, an egg or eggs are retrieved by a surgical procedure, fertilization takes place in the lab, and then embryos are transferred from the incubator to the women's uterus. The key changes are the medications used: fewer injectable fertility drugs (which are expensive), oral medications sometimes are employed, and fewer or no drugs that suppress the pituitary like ganirelix, cetrotide, or leuprolide are used. The result is significantly fewer eggs.

What are the arguments in favor?

• Fewer injections make it easier on the patient.
• Fewer medications lower cost.
• Less medication reduces the chance of overstimulating the patient and causing Ovarian Hyperstimulation Syndrome (OHSS).
• There was even a recent publication that suggested the eggs produced by these protocols were of "better quality."

What do we really know about these protocols? The bottom line is that, while they lower the cost, they also lower the success rates by more than 50 percent. One group that actually trademarked their protocol published in June 2010 a pregnancy rate of 20 percent with fresh or immediate transfer, which is far lower than the "live birth rate" of the top 25 programs reporting to the CDC/SART. (Note: the latest data is always two years behind – i.e. the latest data available now is from 2008 – so that is why Fertility Partnership’s success rates do not appear and will not be officially reported until 2012.) It is hard to accept that, for the average patient, these protocols would provide "better quality eggs" if the success rates are so much lower.

Is the avoidance of OHSS a good argument? In my opinion, the answer is no, because the patients who usually hyperstimulate are Polycystic Ovarian Syndrome (PCOS) patients who so often are hard to stimulate. But, there are a few patients who are exquisitely sensitive to fertility drugs, and they might benefit.

Additionally, the thought that by reducing the amount of medications you are reducing the cost only works if the patient gets pregnant. If, because of the lower success rates, the patient must repeat the procedure, the costs add up. It is similar to Intrauterine Insemination (IUI), which carries a far lower cost but has a dismal success rate compared to IVF. I recently met a couple that had used up their entire $25,000 insurance allowance for fertility by undergoing 11 IUIs.

As far as these protocols being less traumatic emotionally and easier on the patient, no doubt that is true. But, compare the trauma of daily injections versus finding out that you are not pregnant, and I think that the average patient will take the shots religiously and with hope.

The main reason I am generally not excited about the low dose protocols is that at Fertility Partnership, we have the lowered the cost of typical IVF so much by increasing technological efficiencies to reduce the fees, as well as providing Intracytoplasmic Sperm Injection (ICSI) and Assisted Zonal Hatching (AZH) at no additional charge, that it just doesn’t makes sense for the average patient. The cost of IVF at Fertility Partnership is often lower than the cost of the low dose protocol in many clinics. Nevertheless, Fertility Partnership does offer a low dose protocol for the rare patient who may stand to benefit.