In Vitro Maturation
What is In Vitro Maturation (IVM)?
Also known as a natural cycle or minimal stimulation, in vitro maturation (IVM) patients undergo a procedure whereby immature eggs are retrieved from the ovaries and matured in the laboratory in only one or two days. Eggs that reach maturity in the lab are then fertilized with sperm using the Intracytoplasmic Sperm Injection (ICSI) procedure. After the eggs are fertilized, the embryos are grown in the laboratory for two to five days before being transferred to the mother's womb.
IVM of human oocytes was first demonstrated in 1965 by R. G. Edwards. The first human birth resulting from an oocyte matured in vitro occurred in 1991. Since that time, many modifications and refinements have been made to the process of IVM in an effort to improve the efficiency and ultimately the outcomes of the technique. To date, there have been approximately 500 live births worldwide as a result of IVM.
Am I A Candidate for IVM?
At present, there are three broad patient categories for which IVM might represent a viable alternative to traditional hormonal stimulation of the ovaries and subsequent in vitro fertilization (IVF).
Women with polycystic ovarian syndrome, (PCOS), who are at significant risk of severe ovarian hyperstimulation syndrome (OHSS) - these women represent a population which tends to be exquisitely sensitive to the medications required for ovarian stimulation in typical IVF protocols. Because IVM entails retrieving immature oocytes, little or no stimulation of the ovaries is required which virtually eliminates the risk of OHSS.
The second patient category which stands to benefit from IVM for reasons mentioned above is the group of women who have undergone IVF previously and developed ovarian hyperstimulation syndrome (OHSS).
Finally, women who have received a cancer diagnoses and need fertility preservation prior to receiving chemotherapy are candidates for IVM. These patients could benefit from this technology as it would decrease the amount of hormones to which they are exposed as well as decrease the amount of time necessary between diagnosis and the initiation of treatment.
What is the IVM Process?
Typically the IVM process requires minimal to no hormonal stimulation of the ovaries. An initial ultrasound is performed to determine if ovarian cysts are present early in the woman's natural cycle. Several days later, a follow-up ultrasound will be performed to assess follicular and endometrial development. Once a follicle reaches an appropriate size, the patient undergoes a procedure where the immature eggs are retrieved and then matured in the laboratory in only one or two days. The eggs are then fertilized with spermusing Intracytoplasmic Sperm Injection (ICSI). After the eggs are fertilized, the embryos are grown in the laboratory for two to five days before being transferred to the mother's womb.
What is the Success Rate for IVM?
In 2009, the Cochrane Collaboration performed an exhaustive review of all known trials (published and unpublished) involving IVM in order to specifically compare live birth outcomes from IVM to that of IVF. The result was that there was no study identified which was deemed suitable to adequately compare the two techniques. Therefore, data evaluating IVM success rates are limited to prospective and retrospective observational studies.
Generally speaking, in these observational studies, maturation rates of retrieved immature oocytes tend to be 60 – 70%, fertilization rates (generally by ICSI) 65 – 75%, implantation rates around 10%, and clinical pregnancy rates 20 – 30%. Particular note should be made that due to the lower implantation rates associated with IVM, most studies report replacing more embryos on average than is currently recommended by ASRM guidelines for patient age.
How Safe is IVM?
IVM technologies are still evolving and the technique is still considered experimental. IVM appears to offer some clear advantages over traditional IVF in some selected patient populations. However, before IVM becomes standard of care, continued investigation is warranted in order to ensure its safety and efficacy.
What is the Cost of IVM?
Because IVM does not require hormonal stimulation, the IVM cycle can easily cost $3,000 - $5,000 less in medications alone. The IVM process varies between fertility centers, but since the process requires fewer ultrasounds and blood test, the clinic costs are typically lower than a traditional IVF procedure. However, because the IVM process does require an additional two to three lab days, patients will save the most by eliminating medications.
To learn more about the IVM procedure and its cost, click here to schedule your appointment or call us at 954-247-6200.