I need to undergo IVF because I have had a tubal ligation. Otherwise my partner and I are both fertile. I have reservations about undergoing the hormone therapy that would produce multiple eggs for harvesting all at once. Would it be possible instead for me to have one naturally developed egg harvested each month, and frozen until there are enough eggs for the IVF procedure? If so, how hard will it be for me to find a facility that will perform IVF that way?

J.

As you know, the usual process for egg retrieval involves a course of hormone therapy to encourage the woman's ovaries to produce several eggs, which are then harvested in a single procedure. We have several reasons for doing this, including reducing cost, minimizing risk, and increasing the odds of success.

Your chance for successfully having your own children is already compromised. The first step should be to perform a testicular biopsy and cryopreserve any sperm that are obtained. This can help you determine how to proceed. If you do have ICSI, I would suggest you only consider the usual process of ovulation induction and egg retrieval, which offers you the best chance of success given present technology.

Results from natural-cycle IVF have been notoriously poor. In fact, up to one-third of these cycles are cancelled during the monitoring phase because the timing of egg retrieval cannot be adequately predicted. Those who undergo natural-cycle retrieval frequently come up empty-handed -- that is, no good-quality eggs are retrieved. The cost of repeated egg retrieval procedures is far greater than the cost of the medications and monitoring involved in determining the appropriate time to retrieve an egg, and you would need several successful cycles to accumulate a sufficient number of embryos for transfer. Based on estimated charges of $2,000 for pre-retrieval monitoring and about $5,000 for retrieval and lab charges per cycle, you may well expect to spend close to $50,000 before even a single embryo is available to transfer.

Beyond financial consideration, there is also the medical risk associated with IVF. While studies have shown no long-term adverse effects when ovulation medications are used to stimulate the growth of eggs, there is still a small risk of complications associated with the egg retrieval procedure, as with any surgical procedure. With each egg retrieval procedure, you increase the risk of blood-vessel injury or pelvic infection. Limiting the number of egg retrieval procedures by harvesting the largest possible number of eggs at once significantly reduces your risk of medical complications.

Your question suggests that these eggs be frozen for a later time. But this too is not feasible, as the egg freezing process adds needless expense and greatly reduces the odds of successful fertilization and embryo development.

I can assure you that the reason so many IVF centers use drug regimens to stimulate multiple eggs is that this is by far the safest and most cost-effective way to for you conceive.