IVM, in vitro maturation, is a variation of IVF which uses all the laboratory components of IVF, but in addition matures eggs in the laboratory. With IVF, a woman undertakes an ovulation induction with gonadotropin medications to make eggs mature in her ovaries before they are harvested from her. With IVM, immature eggs are removed from the ovaries without having to execute an ovulation induction. The eggs are rather matured in the laboratory. They are then fertilized, cultured and transferred as in routine IVF. Injectable medications to stimulate the ovaries are either not used or used in small doses for IVM, which eliminates several side effects for the affected person along with decreasing the expense. IVM also eliminates the need for most of the ultrasound supervising which is schedule for IVF procedures. Blood tests to assess the progress of the ovulation induction are similarly eliminated, making the procedure more convenient and comfy for the patient.
In the normal menstrual cycle, an egg develops inside of a cyst or follicle over a two week period in response to the gonadotropin hormones FSH and LH that a woman produces. The follicle increases in diameter from about 2 mm to about 20 mm during this time period period. During this time, the cells around the egg multiply and generate estrogen. Ultrasound assessments are regularly performed to monitor the growth of the follicle and blood checks are done to monitor estrogen levels and other hormonal assessments. The egg is usually attached to the follicle wall until increased amounts of the hormone LH (or in medical cycles, HCG) induces enzymes that free the egg from the wall structure so that it is free floating in the fluid in the follicle. It can then depart the follicle after LH also induces enzymes to create a hole in the follicle wall structure. During this time, the egg increases extremely slightly in size and every one of the chromosomes are contained in a membrane in the cytoplasm. With the increase in LH as a result in, this membrane breaks down and the egg divides the chromosomes into two equivalent groups and movements one of these groups outside the egg (forming a polar body). An egg that has done this is referred to as a mature egg (or MII). Eggs that have not matured, cannot be fertilized to become a baby.
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In the natural routine, the egg, which has been freed from the follicle, is after that picked up by the end of one of the fallopian tubes. If the egg is lucky enough to end up being fertilized, it again divides its chromosomes into two equivalent groups and pushes one of the groups outside the egg to form a second polar body. The remaining chromosomes combine with the chromosomes from the sperm that entered the egg.
In 1935, it was observed that if rabbit eggs were removed from their follicles, many of them would spontaneously mature. In 1965, Edwards (one of the original scientists responsible for the first infant born from IVF) showed that the same thing occurred for individual eggs. The first infant born from IVF, Louise Dark brown, was not born until 1978. The first infant born through IVM had been reported in 1991 and came from an egg attained during a Cesarean section. IVM likely got off to a slower start because of failure to recognize the importance of maintaining the tissue surrounding the egg in that egg's normal growth. A commercial mass media for egg maturation is now available and the details that enable pregnancies to occur at a reasonable rate in appropriately selected patients have also been worked out.
Compared to IVF, the worldwide experience with IVM in humans is limited. Perhaps 10,000 to 20,000 IVM cases using current methodologies have been undertaken in the last decade. By way of comparison, about 60,000 instances of IVF are carried out in the United States alone each year. There is considerably more experience with IVM in non-human species. IVF had been an important tool in cattle breeding, but had been replaced by IVM about ten years ago. More than 100,000 cattle are born utilizing IVM each full year.
Most clinical reports suggest that IVM is currently less effective than IVF per case (25-35% clinical pregnancy rate per transfer). For many patients and physicians there are other reasons to prefer IVM to IVF or IVM before IVF in selected patients. For the patient, the process of doing IVM is no more complicated (at times less) than undergoing an ovulation induction with IUI. For self pay patients, the cost is about half the total cost of IVF. For the sufferers who are the best candidates for IVM, IVM poses less risk for the patient than IVF significantly. IVM also appeals to women who would prefer not to take many medications into their body, but nonetheless need to do IVF.
IVM is available across the world, but it is considerably less obtainable than IVF. For example, there are about 400 IVF programs in the United States, but the number of programs that offer IVM is likely under twenty. In the United States, IVF cycle reporting is legally mandated, but national reporting views IVM cycles as schedule IVF cycles and does not identify programs that offer it. Reporting that does not distinguish IVM from schedule IVF cycles, discourages programs from taking on IVM since IVM has a lower pregnancy rate than IVF.
Almost no one recommends IVM for all patients, and the subset of patients, for whom IVM is an excellent option, is still being defined. Everyone agrees that young patients with a large number of small follicles (antral follicles) visible in their ovaries on ultrasound are good candidates for IVM. They are also the subgroup of sufferers who are most likely to get pregnant with IVF.
This introduction to IVM has, perhaps, focused on the reason why a women might not choose to do IVM, namely:
• Doctors are less experienced with IVM than IVF • It is difficult to find programs that offer IVMa • There is a lower success rate (per routine) for IVM than with IVF.
This raises the obvious question of why a woman may choose to do IVM rather than traditional IVF and why an IVF program may choose to develop its ability to offer IVF (which is more complicated than IVF for the laboratory). The answers are all affected person centered, namely,
• IVM is vastly easier for the patient to do than traditional IVF (making it an especially good chose for females using a known donor) • IVM generally costs half as much as IVF (including the cost of medications) • IVM uses almost no medications; it is based primarily on a woman's natural cycle • There are almost no injections of medications required • There are almost no blood tests required • There are very few office visits required • There are few side effects associated with these cycles. The risk of severe ovarian hyperstimulation is eliminated.