• In vitro maturation (IVM) is a novel fertility treatment that allows multiple eggs to be harvested from a woman’s ovaries with little to no medication.
• Women with irregular anovulatory cycles, those with PCOS or hormone-sensitive cancers, or those who have experienced ovarian hyperstimulation syndrome are good candidates for IVM.
With IVM, immature eggs are collected from smaller follicles in the ovary and then matured in the laboratory under specially designed culture conditions. Several embryos can be created without exposing women to high doses of stimulating injections and possible side effects.
In conventional IVF, the ovaries are hyperstimulated and several mature oocytes are produced. Until recently, IVF laboratories could only work with mature oocytes, and the immature oocytes would be discarded.
IVM is an ideal procedure for women who have irregular anovulatory cycles, like PCOS. It is also recommended for women who have had negative side effects from previous hormonal therapy, such as ovarian hyperstimulation syndrome (OHSS).
Women who have been diagnosed with cancer may be advised to avoid hormones that may stimulate tumor growth. Those who want to preserve fertility for the future for any reason would benefit from the IVM procedure of egg removal and then cryopreservation.
The procedure for IVM is as follows:
Step 1. As in conventional IVF, eggs are collected, but at an earlier stage, when they are immature. This means that you do not need to take as many ovary-stimulating hormones before your eggs are collected.
Step 2. The eggs are matured in a dish placed in an incubator in the laboratory for one to two days.
Step 3. When the eggs are mature, they are fertilised with your partner’s, or donor’s sperm. Embryos are cultured then transferred to your womb, just as they would be with conventional IVF treatment.
The chances of a successful pregnancy with IVM are similar to those with conventional IVF, with the following additional risks:
• because the eggs are immature when they are collected, it is likely that fewer eggs will be collected than in a conventional IVF cycle
• there is also a risk that not all the eggs will mature sufficiently to be fertilised with your partner’s or a donor’s sperm.
Patients who have been diagnosed with Polycystic Ovarian Syndrome (PCOS), a metabolic disorder, are at an increased risk of developing Ovarian Hyperstimulation Syndrome (OHSS) as a result of FSH therapy. OHSS can cause cysts, abdominal bloating, nausea, and excessive weight gain. In severe cases of OHSS, ovaries become swollen, causing dangerous amounts of excess fluids to move from the blood vessels to the stomach and chest, which can result in kidney and respiratory problems. Often, these complications can require extensive medical treatment, hospitalization, or surgical procedures, and the termination of the cycle.
Because IVM requires a much shorter course of FSH therapy (3 days as opposed to 10-14+ days for traditional IVF), the risk of OHSS is lessened. This shortened FSH therapy cycle is beneficial not only to patients with PCOS, but to cancer patients as well. If a patient has been diagnosed with cancer, especially breast cancer, she will likely have an extreme sensitivity to estrogen, making a long course of FSH therapy difficult, if not impossible. In the past, a patient who wished to have eggs extracted before cancer treatment damaged her fertility would need to delay cancer treatment 10-14+ days in order to extract mature eggs for cryopreservation. With IVM, the shorter course of FSH therapy allows the patient to begin cancer treatment sooner.