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In Vitro Maturation: IVM

July 18th, 2019 by Brown Fertility

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The eggs a woman is born with are kept in an immature state, meaning a sperm cannot fertilize them, until ovulation.  Most medications used in IVF are intended to enable the patient to develop multiple eggs that are mature.  It is now possible to take eggs from a woman’s ovaries and mature them in the laboratory.  This means it is not necessary to treat women with high doses of stimulating hormones for two weeks before retrieving eggs.  Technically, eggs can be retrieved at any time. These eggs can be matured in the laboratory (IVM). They are then capable of being fertilized and embryos can be created using the normal IVF tools.

This was always the dream of the creators of IVF, but it proved to be more difficult than IVF.  It was not until 1991, that the first birth occurred using IVM, by Dr. Cha in Korea.  He obtained a donor egg from a woman during her Caesarian Section and used it to help a couple have a baby.  Once IVM was shown to be possible, physicians and scientists in IVF programs throughout the world began working on the details of how best to use this technology.  Several thousand babies have now been born using IVM, but there is no uniform agreement on how to best use IVM techniques in humans.

Although IVM is practiced in centers throughout Europe and Asia, it has limited availability in the United States.  IVM is easier for the patient than IVF, but is harder on the physician and laboratory.  Dr. Bruce Rose at Brown Fertility has one of the larger experiences with IVM in the United States, having performed more than 200 IVM cycles and published a half dozen papers on related topics

IVM is not a replacement for IVF, but it is a more gentle approach to high tech reproduction than IVF, which in selected patients has almost as high a pregnancy rate as IVF.  Traditionally, physicians treat medical problems by using the least invasive, lowest side effect treatment first and then moving on to more aggressive treatments if they are needed.  This is the way we should view the relationship between IVM and IVF.  Patients at high risk for significant side effects with IVF, could use the simpler, safer IVM approach; and if that fails them, then turn to IVF.

The best candidates for IVM are those patients with a large number of small cysts or antral follicles (2-10 mm) in their ovaries.  These patients are at highest risk for the most severe common complication of IVF- ovarian hyperstimulation syndrome OHSS.  Even without development of OHSS, patients with a large number of resting follicles in their ovaries will experience significant bloating and abdominal discomfort for several weeks after IVF as the ovaries and the pelvis return to normal.  Patients with polycystic ovaries are the candidates most likely to benefit from IVM, but most young women will also have a large number of small follicles in their ovaries.  A subset of older women not meeting the clinical criteria of PCOS will also be good candidates.  The only way to determine who is a good candidate is to perform a transvaginal ultrasound and evaluate the ovaries.

The cost of this procedure is lower than IVF in that limited medications are used and IVF medication costs usually consititute about 40% of the cost to undertake IVF.  Laboratory and physician costs are similar.  Except for egg harvesting (the same setting as IVF), IVM is minimally disruptive to our patients.  It even works for patients who either struggle to ovulate or fail to ovulate with clomid, femara, or gonadotropins.  We have performed IVM in patients a week before their getting married or while breast feeding.  Brown Fertility offers an effective, more natural alternative to conventional IVF.

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