Conceiving and giving birth to a child is a natural function of the female body. But not everyone succeeds. For many women who are unsuccessfully trying to get pregnant, the only hope can be given only by assisted reproductive technologies. In vitro fertilization (IVF) is one of them.

To conceive a child outside the mother's body, you must have two gametes: an egg and a sperm. How they are received also matters. An egg can be taken from a woman after ovulation is stimulated, but there is another way when it matures on its own in a normal cycle.

The essence of the technique

It should be noted that IVF in a natural cycle is a fairly “old” technique - it was first used 30 years ago. But recently it has been regaining its position by improving safety and efficiency. This method of artificial insemination is the most gentle, since it is carried out without the use of hormonal stimulants. That is, no one interferes with a woman’s menstrual cycle. The egg needed for conception matures in the follicle, which ovulates on its own.

Advantages and disadvantages

This technique has a number of advantages over other methods. Compared to standard protocols, IVF in a natural cycle produces a lower percentage of negative consequences, which include the following:

• Ovarian hyperstimulation.
• Multiple pregnancy.
• Uterine bleeding.
• Inflammatory processes.
• Tumors of the uterus and mammary glands.

Such phenomena are caused by the use of hormonal drugs to stimulate ovulation. They can be observed both in the early and late periods after taking them. In addition, in the natural cycle, the quality of the uterine mucosa - the endometrium - is much higher, which increases the chances of successful implantation. Since there is no intervention in a woman’s menstrual function, the procedure can be carried out even for several months in a row. The aspect of reducing material and time costs for artificial conception is also important.

Despite all the advantages, the procedure for fertilization in the natural cycle also has disadvantages. And perhaps the most significant of them is considered to be lower efficiency compared to IVF with stimulation. But the use of modern treatment protocols can increase the chances of a successful conception. Therefore, artificial conception in the natural cycle can be considered as a good alternative to standard methods.

The selection and fertilization of eggs from the natural menstrual cycle has a number of undeniable advantages over IVF with stimulation.

Indications

Only those women whose physiological processes in the ovaries are not impaired can hope to undergo IVF in a natural cycle. We are talking about regular menstruation with normal ovulation (confirmed by research results). The duration of the menstrual cycle should not go beyond the average values ​​(26–32 days). The procedure shows the greatest effectiveness among women of young and middle reproductive age (from 18 to 35 years). It is indicated for those who wish to avoid hormonal stress on the body, as well as in the following cases:

• Poor response to ovarian stimulation.
• High risk of overstimulation.
• Failure of previous embryo implantation.
• Tubal and male infertility.
• History of oncological problems and thrombotic conditions.
• Pathology of the liver, pancreas and heart (artificial valves).
• Tumor processes in the pituitary region.

Even when a woman does not ovulate for several cycles or it shifts in time, this is not a contraindication to manipulation. This phenomenon can happen even in a completely healthy body. But the patient should still exclude the influence of external factors on the menstrual cycle.

Carrying out

Before the procedure, it is necessary to monitor the ovaries using ultrasound (folliculometry). The growth and development of germinal vesicles is assessed. Puncture of the dominant follicle is planned based on the results of echography and laboratory tests (rapid urine analysis). Then the egg is collected from the woman and sperm from the husband.

The next stage is fertilization itself. This is accomplished in several ways. The first is no different from a natural process. That is, the sperm itself penetrates the oocyte membrane. The second is ICSI in the natural cycle. Manipulation involves the introduction of sperm into the cytoplasm of the egg using miniature instruments under the control of a microscope. Using a special needle, the reproductive specialist selects the most active specimen and places it into the female gamete. This way, several eggs can be fertilized at once (for example, if there were several ovulated follicles).

After this, the embryos are cultivated to the blastocyst stage, carried out in special incubators. After 3–5 days, the most viable one is implanted in the uterus of a woman whose endometrium is already ready to receive the fertilized egg (secretory transformation has occurred).

But when carrying out IVF in a natural cycle, you can encounter a number of problems that reduce the likelihood of pregnancy. These include:

• Most often, only one embryo is obtained, which may not be viable.
• The procedure is canceled if ovulation occurs prematurely (due to a spontaneous surge in the luteinizing hormone of the pituitary gland).
• Sometimes the egg does not reach full maturity or is completely absent from the follicle.

Therefore, artificial insemination often requires several attempts. Much also depends on the medical experience, equipment and quality of materials used by reproductologists. Sometimes the procedure is preceded by drug support, which allows the egg to mature, prevent spontaneous ovulation and obtain several dominant follicles. Modified protocols significantly increase the effectiveness of in vitro conception.

Fertilization in the natural cycle occurs in several stages. Each of them requires responsibility and careful compliance with the necessary conditions.

Thus, natural cycle IVF is a good choice for many patients who want to overcome the problem of infertility. It has a number of advantages, but is not without its disadvantages. Sometimes you have to perform the procedure several times. However, it is worth it - a woman will still be able to conceive a child and in the future experience the long-awaited joy of motherhood.

IVF in a natural cycle is a method of artificial insemination that allows you to achieve pregnancy without additional stimulation of the ovaries. The procedure is carried out with minimal use of drugs and interference with the formation of a mature egg.

To participate in the program, you need a mature follicle containing an egg. Follicle maturation occurs naturally during a woman's menstrual cycle.

On the day of expected ovulation, a follicle puncture is performed, an egg is collected, and then it is fertilized in a test tube. Then, after 2-3 days of culturing the embryo in a test tube (in vitro - outside the body), the embryo is injected into the woman’s uterine wall.

A mature egg is formed in almost every menstrual cycle in a woman aged 18-35 years. Over the years, the likelihood of receiving a mature egg decreases, and anovulatory cycles occur more and more often, without maturation of the egg. Cycles without egg maturation also occur in young, healthy women. In rare cases, two eggs mature at the same time.

The in vitro fertilization method is suitable for women with a regular menstrual cycle. The IVF method in a natural cycle is intended for women of reproductive age who are unable to become pregnant due to obstruction of the fallopian tubes or infertility of the spouse.

Participation in the protocol allows women who have undergone surgery to install an artificial heart valve, thromboembolism, or were treated for cancer to become pregnant. IVF in a natural cycle is suitable for women with contraindications to ovarian stimulation and the risk of hyperstimulation.

The program allows women suffering from chronic diseases of the heart, kidneys, and pancreas, which can be aggravated by hormonal stimulation during classical IVF, to become pregnant.

The protocol is intended for couples who have unsuccessfully participated in an IVF program due to the body's lack of response to ovarian stimulation or the inability of a high-quality embryo to implant into the uterus.

Necessary tests

A woman must have confirmed ovulation, for which studies are carried out to evaluate:

• concentration of progesterone in the second phase of the menstrual cycle;
• formation of the corpus luteum - according to ultrasound data;
• luteinizing hormone level - a urine test is performed.
• the amount of follicle-stimulating hormone and estradiol;
• ovarian reserve - the number of follicles capable of producing an egg is determined using ultrasound.

Disadvantages of the program

The disadvantages of the procedure include a lower likelihood of pregnancy compared to the classic IVF protocol. Without preliminary stimulation, only one embryo is formed and transferred, this reduces the likelihood of pregnancy. When the cycle begins, it is 7%; after embryo transfer, the probability of having a child increases to 16%.

In each menstrual cycle, without preliminary stimulation, only one egg matures and in 20% of cases it turns out to be defective and incapable of fertilization. The disadvantages of the IVF method in a natural cycle include the impossibility of selecting a high-quality embryo. The only embryo obtained in this way may not be viable.

The possibility of an egg being released prematurely also reduces the chance of pregnancy. However, with enough patience, the positive aspects of the method outweigh the disadvantages.

Advantages of the protocol

The advantages of the method include such points as:

• no risk of ovarian hyperstimulation syndrome;
• eliminating the possibility of multiple pregnancy;
• the possibility of repeating the procedure multiple times each subsequent cycle until pregnancy;
• more affordable cost of the procedure.

Main stages of the protocol

Eco in the natural cycle is carried out in stages. Spouses begin to prepare for participation in the program a month before the procedure. To participate in the program, a partner must have a spermogram and undergo a general examination for past infectious diseases. The woman undergoes a trial embryo transfer, and on days 5-7 of the menstrual cycle, an ultrasound of the genital organs is performed.

Monitoring follicle growth

Follicle growth is monitored from the 7th day of the menstrual cycle using transvaginal ultrasound monitoring. Estimated ovulation is determined by the level of luteinizing hormone. The puncture is prescribed by monitoring the dynamics of follicle growth.

Puncture, collection of eggs and sperm

Sperm collection from a partner is scheduled on the day of follicle puncture and egg collection. To remove the egg, ovulation can be preliminarily stimulated with hCG preparations containing human chorionic gonadotropin.

After which, under the control of transvaginal ultrasound, the egg is collected. The procedure is painless. To collect the cell, a very thin needle is attached to the ultrasound sensor, with which the follicle is pierced and the egg is collected.

Fertilization of the egg

The selected mature egg and the prepared sperm of the partner are placed in a test tube and placed in a thermostat, in which the necessary conditions for fertilization are created.

In vitro fertilization takes place without intervention, but under the supervision of a reproductologist. The first test is done 20 minutes after placing the sperm and egg in the test tube. By this time, the fusion of the egg and sperm should have occurred to form a zygote.

Contents of an embryo in vitro

The resulting zygote is cultured in vitro for the next 1-3 days. At the 2-8 cell stage, the embryo is transferred to the woman's genitals.

Introduction of a fertilized embryo into the uterus

The embryo is painlessly transferred into the uterine cavity using a thin catheter. 20 minutes after the procedure, the woman is able to do normal activities.

After implantation of an embryo using IVF in a natural cycle, it is not recommended to exercise for the first 2 weeks. After 2 weeks you can take a pregnancy test.

If pregnancy occurs, you should strictly follow all doctor’s recommendations and lead a normal lifestyle. If there is no result, the procedure is repeated in the next cycle.

Reasons for possible failures

The IVF method in a natural cycle may not produce results for the following reasons:

• premature release of the egg;
• poor sperm and egg quality;
• lack of fertilization;
• abnormalities in development or death of the embryo at the in vitro stage;
• inability of the embryo to implant in the wall of the uterus.

A negative result can be caused by excess or insufficient body weight of a woman; it is necessary to ensure that the weight index is in the range of 20-25. For pregnancy to occur, several attempts to obtain and implant a high-quality embryo are often required.

What increases the chance of pregnancy

To increase the chance of success of the procedure, it is necessary to lie still for an hour after the procedure. It is advisable to eliminate physical activity and put off all household chores. There should be no negative emotions or stress. A woman needs good sleep and fresh air.

Another very important condition for pregnancy is quitting smoking, including passive smoking. Toxic tar and nicotine, which are part of tobacco, cause thickening of the egg shell and serve as an obstacle to fertilization.

The natural cycle IVF method is being improved. A method is being developed that makes it possible to ripen an egg obtained during the menstrual cycle in vitro.

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IVF in a natural cycle - what is it?

In vitro fertilization protocols (EC) are a kind of alternative to standard artificial insemination schemes. They are characterized by low effectiveness, maximum proximity to natural conception, and relatively low, at first glance, cost.

Considering that the first or second protocol will not always be successful, the cost of the fertilization procedure in the EC is quite high. IVF in a natural cycle - what is it? and why does it have the right to exist? Is affinity with really his only advantage?

• The essence of classic IVF briefly
• Why is stimulation performed?
• Difficulties and disadvantages of IVF in the European Center
• Features of training schemes
• Efficiency
• Conclusion

The essence of classical in vitro fertilization

Classic IVF provides for independent fertilization in a balanced prepared environment and in conditions as close as possible to natural conditions. Under favorable circumstances, the resulting 1–2 are returned to the woman’s body – to the uterus. It is called . Then, when pregnancy occurs, everything happens naturally.

Why is stimulation performed?

Stimulation is needed in order to have a choice of eggs, and later embryos. Only the highest quality ones are selected. The tactics are aimed at increasing.

What is IVF in a natural cycle?

In IVF protocols in a natural cycle, full stimulation is not used. There is a scheme in which stimulation drugs are not prescribed at all.

In the natural menstrual cycle, the growth of one follicle is ensured by the influence of two main hormones - luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are produced in the woman’s brain (in the pituitary gland) and released into the blood. The most complete follicle with active receptors for FSH and LH responds to the “hormonal release”. The egg grows and matures in the follicle.

When the oocyte reaches the required size, the ovaries receive a “command” from the brain in the form of a large dose of LH (peak concentration). As a result, the egg finally matures, detaches from the wall and the follicle ruptures - ovulation. But before this, the reproductive specialist needs to have time to obtain the egg and prevent it from ovulating. It is important not to rush, because an immature egg will be unsuitable for fertilization.

Now there are cultivation media that allow an immature oocyte to mature and progress to a mature one, suitable for fertilization.

IVF in the European Center: difficulties and disadvantages

Unlike classical IVF protocols, in a natural cycle, reproductive specialists do not have the ability to fully control:

• egg maturation;
• the occurrence of an LH peak;
• final maturation of the oocyte;

As a result, a number of situations may arise during puncture, which lead to the ineffectiveness of IVF in the EC:

• Only follicular fluid is obtained without the egg. The reason for this is incomplete maturation of the oocyte. He did not have time to move away from the wall of the follicle. And the doctors were unable to get it into the needle during the puncture.

• The resulting egg is unsuitable for fertilization due to insufficient maturation or degeneration. The entry of an oocyte into the follicular fluid does not guarantee its full maturation.

• At the time of puncture, the follicle will be empty - ovulation has already occurred.

Ideally, only one mature, full-fledged oocyte is obtained, which will be subjected to the fertilization procedure.

With hormonal stimulation (in standard protocols), it is possible to artificially “provoke” final ripening and “slow down” ovulation before puncture.

What does IVF mean in a natural cycle?

In order to prevent cycle inefficiency, reproductive specialists develop an individual IVF scheme in a natural cycle. And it selectively uses hormonal drugs, for example:

• To inhibit spontaneous ovulation and slow down premature ovulation, a group of drugs is prescribed - GnRH antagonists. The beginning of their introduction coincides with the achievement of the follicle size – 14 mm or more.

• For final ripening, hCG preparations are used, for example, Pregnil. The time of puncture is calculated from the time of drug administration.

Attempts to influence the ovary do not always lead to the desired result. Full control over their operation is possible only when using standard schemes. This means that the effectiveness of IVF in a natural cycle is low, since spontaneous ovulation and immaturity of eggs is present, despite the administration of drugs.

More details about the schemes of IVF protocols in the natural cycle can be found in this.

Features of IVF in the EC:

• for fertilization, a technique is often used that increases the effectiveness of fertilization;
• follicle puncture takes place without anesthesia;
• embryo transfer (embryo transfer) is performed more often on the 3rd day.

The importance of IVF protocols in natural cycles

IVF in a natural cycle is significant despite the difficulties of its implementation. There is a specific niche for its use.

Consider the possibility of conducting protocols in a natural cycle under the following conditions:

• The combination of young age, sufficient ovarian reserve, high risk of complications of stimulation, puncture and causes of infertility, consisting of or.

• Depletion of ovarian reserve (decreased reserve). With this option, IVF in a natural cycle allows “nature” to choose the strongest and healthiest follicle, which theoretically contains a genetically complete egg.

The advantage is a reduction in risks (in conventional regimens, in patients with a low supply of oocytes, increased doses of drugs are used for simulation, therefore, the risks of their use increase).

• Concomitant diseases that are a contraindication for hormonal stimulation: oncological pathology (even cured), benign processes in the mammary glands (under the influence of drugs, their growth and degeneration into a malignant formation is possible).

For some patients, this may be the only option for conceiving a genetically “own” child.

• Lack of ovarian response to stimulation in previous cycles. In such cases, there is no point in prescribing drugs that stimulate ovarian function - one follicle grows.

The IVF program in a natural cycle is used for transfer (with repeated attempts) or for cryopreservation of eggs. A possible chain of IVF protocols in a natural cycle is possible, the purpose of which is to “accumulate” embryos and transfer several units at the same time. It is also possible to use donor sperm and eggs.

Efficiency

is low, it varies from 2 to 10%. In addition, it is impossible to predict when pregnancy will occur. But the complication rate is low. Therefore, IVF in a natural cycle is always a choice that is made based on the characteristics of the patients.

Conclusion

What is IVF in a natural cycle? This is an artificial insemination option that is not suitable for everyone. The possibility and feasibility of its implementation is discussed with a fertility specialist. With protocols in natural menstrual cycles, it is possible to use the technique of maturing eggs in vitro.

Modern reproductive technologies and methods do not stand still, so there are quite a lot of them. The doctor decides which option to choose for a particular infertile couple, because each method has its own indications and contraindications. Increasingly, women undergoing IVF are interested in artificial insemination, as close as possible to natural conception– IVF in a natural cycle. You will learn about what the method is, how it is implemented and whether it is considered successful by reading this article.

What it is?

In vitro fertilization in a natural cycle is a procedure that is carried out without hormonal stimulation.

With the standard scheme of the stimulated IVF protocol, a woman receives medicinal support before ovulation - she takes hormones that promote the maturation of follicles. Then the eggs are collected using the puncture method. The oocytes are fertilized with the sperm of the husband or donor, then only the most successful embryos are selected and transported to the uterus. After the implantation, the woman again receives hormonal treatment, the purpose of which is to increase the chances of embryo survival.

With IVF in a natural cycle, there is no drug stimulation. This method is as close as possible to natural conception, with the only difference that fertilization of the egg by the sperm does not occur in the ampullary part of the fallopian tube, as provided by nature, but outside the mother’s body.

The unstimulated IVF program involves the use of frozen eggs, if they are already available in the woman’s cryobank, frozen embryos, if there are any, and the use of native oocytes (obtained immediately before fertilization).

This type of IVF is more gentle and less traumatic, because there is no hormonal “shock” to the female body. However, the effectiveness of this method is also reduced. If we focus on statistics, we can note that the success rate of the IVF protocol with preliminary and subsequent stimulation is at the level of 30% on the first attempt. The chances of a healthy couple getting pregnant naturally the first time are about 7%. The effectiveness of IVF in a natural cycle without hormone stimulation is also about 7% at the initial stage, about 16% after embryo transfer.

Considering the statistics, it is not difficult to guess that with a natural cycle, significantly more protocols may be required than with IVF with stimulation, hence the considerable price and sometimes a rather long planning period. Unstimulated IVF differs not only in its protocol design and effectiveness, but also in possible “complications”: the likelihood of multiple pregnancies with this method is lower than with IVF with hormonal support.

Indications

IVF without hormonal stimulation is not suitable for all women who, for a number of reasons, cannot conceive on their own. A prerequisite for recommending this form of artificial insemination is that the woman has a regular menstrual cycle with ovulation.

If a woman’s infertility is caused by anovulatory cycles, or if she has serious problems with the functioning of the ovaries, then IVF in a natural cycle will not suit her. But this method can be recommended for women with normal ovaries, but tubal obstruction.

IVF in a natural cycle is allowed for women who do not have endocrine disorders and whose levels of all hormones (according to the results of a hormonal profile analysis) are normal. Considering that endocrine infertility is one of the most common, natural IVF without stimulation is not suitable for a fairly large proportion of women.

A woman 40 years of age and older will not be able to use the method even if she has a normal menstrual cycle and hormonal balance is in order. The method has a strict age limit - from 18 to 35 years. If the patient is of the right age and everything is fine with ovulation and hormones, then IVF in a natural cycle is recommended for:

• obstruction of the fallopian tubes, which could not be eliminated surgically;
• male infertility;
• anatomical absence of one ovary;

A woman, of course, can also choose IVF in a natural cycle at her own request. If doctors identify contraindications or do not find direct medical indications for this method of getting pregnant, then they will not recommend the method.

How is the procedure done?

To carry out the procedure in a natural cycle without hormonal stimulation, a woman will need constant ultrasound monitoring. The first ultrasound as part of the preparation is scheduled almost immediately after the end of menstruation: usually on the 6-7th day of the menstrual cycle (a day or two after the end of menstruation). In addition, the woman will have to donate blood several times to check the level of LH (lutenizing hormone).

Doctors determine the approach of ovulation based on the results of an ultrasound of the ovaries and LH levels. When the concentration of the hormone in the body reaches its peak, a procedure is prescribed to remove the egg from the follicle. It is performed under anesthesia in a hospital setting.

During IVF in a natural cycle, it is important not to be late and not to rush with the puncture, because an immature egg cannot produce a normal embryo, and being late can lead to the puncture not yielding anything. There will be no egg in the fluid pulled from the follicle. That is why this method requires a highly qualified doctor and extensive experience.

After receiving an egg (usually one cell, rarely two), it is fertilized by a sperm. Sometimes (given the small number of oocytes) doctors try to do ICSI - insert the selected reference sperm under the membrane of the egg using an ultra-thin needle.

They try to do the embryo transfer as early as possible. If in the stimulated protocol doctors choose the implantation window (6-8 days after ovulation), then with unstimulated IVF the transfer usually occurs 2-3 days after fertilization. There is no medicinal maintenance stimulation after the transfer. The embryo must implant naturally.

If IVF is carried out in a cryoprotocol, then the procedure is completely identical (with one exception - there will be no puncture and collection of eggs). Cryotransfer is carried out during the implantation window or a little earlier. With cryotherapy, 2 or 3 embryos can be implanted into a woman to increase the chances of success. This means that cryo increases the likelihood of having twins.

14 days after the transplantation, the woman must donate blood for hCG (human chorionic gonadotropin). With successful implantation of a fertilized egg into the wall of the uterus, chorion cells begin to produce this hormone immediately, its concentration increases every two days. When a multiple pregnancy occurs, the level of hCG is doubled, and if all three embryos implanted in the cryoprotocol survive, the level of the hormone in the blood will be three times higher than normal.

If pregnancy does not occur, and this is very likely in a natural cycle, then the woman can make the next attempt already in the current cycle by consulting a doctor immediately after the end of the next menstruation.

What to do after replanting?

Every woman who intends to undergo an IVF protocol in a natural cycle or has already completed the embryo transfer stage wonders whether she can somehow influence the likelihood of implantation and increase it. The processes that begin in the female body after the implantation of fertilized eggs into the uterine cavity are so complex and occur at such a subtle level that neither existing modern medical advances nor the woman herself can have much influence on them.

At the same time, a woman may well disrupt such processes if she does not take into account all the doctor’s recommendations. After embryo transfer, it is recommended to lie horizontally and motionless for about 2 hours. Then the woman is recommended to have bed or semi-bed rest at home.

Every day she must monitor the level of basal temperature. To do this, a thermometer is inserted into the rectum in the morning, after waking up, without getting out of bed. After 5-6 minutes, you can evaluate the result and write down the thermometer readings in a separate notebook or notebook.

A woman should eat well; she can take multivitamins, but only those approved and recommended by her doctor. Alcohol (even in negligible doses) and nicotine are completely excluded.

You should not take any medications without your doctor’s permission, especially antibiotics, painkillers, anticonvulsants and hormonal medications.

A woman needs to get enough sleep and protect herself from any stress and worries. Stress hormones disrupt the production of sex hormones; often worries and fears are the reason that implantation either does not take place at all, or will take place, but the fertilized egg will begin to be rejected and die.

Sex and hot baths are contraindicated. It is also not worth doing household chores for two weeks after replanting - one of the family members will be able to wash the floors and peel potatoes for dinner.

We must not forget that IVF in a natural cycle was initially the only method of artificial insemination; all protocols were just that. Doctors began stimulating the ovaries with hormones later, when the question arose about increasing the efficiency of in vitro fertilization. For this reason, you should not place too high hopes on the attempt, so as not to be in a state of constant stress.

Advantages and disadvantages

An undoubted advantage of this IVF method is the absence of harmful drug effects on the woman’s body. With this IVF, there is no likelihood of ovarian hyperstimulation or exacerbation of chronic diseases, which often accompany stimulated IVF. This method is more likely to guarantee a singleton pregnancy.

Premature birth, which quite often occurs in women after stimulation with a positive result in one of the protocols, occurs much less frequently with natural IVF. Without the influence of hormones, the chances of forming a complete placenta (without abnormalities) are also higher.

A small amount of biomaterial reduces the likelihood of successful fertilization in the laboratory, and also practically does not give the doctor a choice as to which embryo is better and stronger. They will plant what they have. In a natural cycle, there is a fairly high risk of not “catching” ovulation if it happens earlier or later. Reproduction doctors, given all these disadvantages, are not too fond of this type of IVF. As a result, it can be quite difficult for a woman to find a specialist who will take on a method with low expected effectiveness.

The cost of such IVF is slightly lower than the cost of stimulated fertilization, but this can result in a large amount, because there can be many attempts. If natural IVF without stimulation were several times cheaper, perhaps more women would agree to it. In the meantime, one can often hear refusal of artificial insemination in the natural cycle, based precisely on the financial side of the issue. Women feel sorry for spending money on a method that is less likely to produce positive results.