In vitro maturation is a safe and effective treatment offered in fertility centers for assisted reproduction. With IVM treatment no hormone therapy is taken to produce large numbers of mature eggs at egg retrieval, instead immature oocytes are retrieved from the women’s ovary and are matured in the lab for 24-48 hours. The main advantage of this procedure is the exclusion of hormonal stimulation drugs or gonadotropins before collection as in a conventional IVF cycle. Therefore, side effects, particularly ovarian hyper stimulation syndrome (OHSS), and the associated costs for medication are eliminated. The eggs are retrieved and after they have matured, fertilization is performed and then, fertilized eggs are transferred to the uterus as in conventional IVF treatment.
IVM treatment is initially considered for young women, under the age of 40, who have many follicles in their ovaries. Women with polycystic ovaries (PCO) or polycystic ovarian syndrome (PCOS) are the best candidates for this kind of treatment. In addition, in some individual cases, IVM is also considered for women that have repeatedly produce poor quality embryos or are poor responders to hormone therapy. Moreover, women undergoing stimulation for IVF may be advised to switch to IVM if they show sings of OHSS and have very high blood estrogen levels. The change of treatment in the middle of the cycle is an effort to salvage the cycle and protect the patient’s health. Moreover, IVM treatment is also suitable for egg donors in order to eliminate the number of injections involved in the ovarian stimulation protocol and theoretically reduce the risk of ovarian cancer. Last but not least, IVM followed by embryo freezing, is the most effective option for women undergoing chemotherapy in order to preserve their fertility.
Procedure of IVM treatment
IVM treatment is very easy and requires little time commitment compared to conventional IVF. The whole treatment consists of two or three ultrasounds, the first performed during day 2 or 3 of the patient’s menstrual cycle and the second between days 6 and 9, in order to assess the endometrium and measure the size and number of growing follicles. The oocyte retrieval is usually performed between days 9 to 14 of the cycle. An injection of HCG (Human Chorionic Gonadotropin) to mature the eggs is given approximately 36 hours prior to egg retrieval.
Oocyte collection is performed under ultrasound guidance with a specially designed needle and the entire procedure takes up to 30 to 40 minutes. Then the immature oocytes are culture in maturation mediums for 24 to 48 hours. The matured oocytes are fertilized using the ICSI technique. Embryo transfer is usually performed 2 to 5 days after the immature oocyte collection. After egg retrieval and embryo transfer some medication treatment for endometrium support and implantation enhancement is required.
The success of this pioneering treatment depends mainly on the number of ovarian follicles and the number of immature oocytes retrieved. The success rate of this procedure can reach 35 to 40%
IVM versus Cryopreservation for Cancer Patients
An increasing number of women is being diagnosed with invasive cancer over the past few years. Until recently these women had few options in terms of preserving their fertility potential for the future. The most common alternative suggested in these women is cryopreservation of their embryos, which are produced in a conventional IVF cycle. However, cryopreservation is not always applicable in all cases. There are several reasons why these women may not be able to choose cryopreservation of their embryos including:
- Many women of reproductive age, about to start chemo/radio therapy may not have the time to undergo assisted reproductive technologies before starting treatment.
- Many women are diagnosed with cancer and do not have partners to fertilize eggs and create embryos for fertilization.
- Women with breast cancer, who have a hiatus between surgery and chemotherapy, are not usually good candidates for oocyte or embryo cryopreservation due to concerns of high estrogen levels.
- Several women are against embryo cryopreservation due to religious or ethical reasons.
With the advancement of in vitro maturation (IVM) and oocyte cryopreservation the number of options for these women has significantly increased. With IVM oocytes can be collected from the ovaries without ovarian stimulation and then they can be matured in the laboratory. Until recently the pregnancy rate associated with IVM and oocyte cryopreservation were significantly lower than those seen with cryopreserved or fresh embryos. However, recent studies have shown that this is not the case anymore. In fact, success rates for both IVM and oocyte cryopreservation are significant enough to argue that they are alternative options for all women wishing to preserve their fertility in the future.
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