In Vitro Maturation: IVM - Allbodies

In Vitro Maturation: IVM

In Vitro Maturation: IVM
How do you like your eggs? Scrambled? Over easy? Omelet style with a little salsa? How about matured outside of your uterus and then placed back inside? Well, that’s IVM, aka in vitro maturation. (Sorry, couldn’t help ourselves).

What is IVM?

IVM is short for in vitro maturation, not to be confused with IVF, which is very much related to IVM. IVM is an assisted reproductive technology (ART) process where a person’s eggs are collected and then matured outside of the body (4).

 

Once the eggs are taken out of the uterus, they’re matured with hormonal injections (2). You see, before a uterus-haver is born, all of their eggs are already formed. They are merely in a resting state in the ovaries until they ripen and mature each month once puberty has begun (4).

 

When a person goes through the IVF process, eggs are taken from the body in hopes that they will be fertilized, but not all of those eggs are mature enough at the time. IVM is the process in which those immature eggs are then matured outside of the body (4). They can either be frozen and used later, or matured, fertilized and placed back into the uterus for pregnancy (4).

What are the differences between old and new IVM procedures?

The old and new IVM procedures are pretty much the same, but there is one main difference between the two processes: The old method uses hormones to mature the eggs, whereas the new method uses a protein dimer, or two protein molecules, called cumulin (2). According to American Pregnancy, the old method didn’t produce very healthy matured eggs, but the new method produces about 50% more healthy mature eggs (2).

 

The protein dimer cumulin was discovered by Associate Professor Robert Gilchrist of UNSW’s School of Women and Children’s Health and his team of researchers (2). Gilchrist and his team discovered that cumulin did the same thing as the old method of using hormones to mature the eggs (2), and, getting a little science-y here now, cumulin combined with cyclic AMP (c-AMP) modulators (which are cell signaling molecules) produces healthier mature eggs (2).

What’s the difference between IVM and IVF?

Now, with IVF people get multiple hormonal injections in order to retrieve the eggs. These IVF injections mature the eggs while they are still in the ovaries, versus IVM where the eggs are matured once they’ve been removed from the body (2). The lack of hormones in IVM is pretty good news for those with Polycystic Ovarian Syndrome (PCOS). PCOS is a condition where the eggs do not release completely from the ovaries and form many (poly) cysts. The lack of hormones in IVM is also good news for those with other reproductive issues or recovering from cancer, because they will not have to deal with any issues or side effects from the increase in hormones from treatment (2).

 

People undergoing IVF treatment will have hormone injections, around three ultrasounds and five blood tests within a one-month period (2). IVM patients, on the other hand, will have a few blood tests and transvaginal ultrasounds in less than a week’s time (2). Even if hormones are used in IVM, they are scaled back to about 90% from what IVF patients would typically take, and are usually a pill or suppository (2). 

 

With both processes, after the egg retrieval and maturation, the eggs are mixed with sperm in a dish or they are manually fertilized with intracytoplasmic sperm injection (ICSI) (2).

What are the steps for IVM?

(1.) Initial tests, like ultrasounds and blood work, are done to determine the best time to retrieve the eggs. Patients may be asked to take a small dose of hormones via pill or suppository (2) for this step. 

 

(2) When the timing is right, the eggs are retrieved through a minor surgical procedure. This is done by placing a hollow needle through the pelvic cavity using ultrasound imaging for guidance. Medication is administered to lower and/or remove any potential discomfort (2).

 

(3) In the old IVM procedure, immature eggs are then placed in cell culture and stimulated with hormones until matured. In the new IVM procedure, immature eggs are placed in a cell culture or petri dish, (you know, that little clear round dish we’ve seen in the movies) and stimulated with cumulin and c-AMP until matured. Both take about 24 to 48 hours. (2)

 

(4) Eggs are fertilized using ICSI (most of the time), which means a small needle is placed into the mature egg, placing one single sperm into each egg (2)

 

(5) After the eggs start growing, the doc will insert between one and four embryos into the carrier through a minor surgical procedure. Twelve days later it is determined if implantation was a success (2).

 

(6) If successful, the pregnant person will move on to their OB/GYN or midwife for care. If not, they can decide on whether or not to do another cycle of IVM (2)

Side effects and risks

Due to there being little to no hormone stimulation with IVM, there is a lower chance of developing ovarian hyperstimulation syndrome (OHSS) as compared with IVF patients. The use of hormone stimulation can cause overproduction and release of eggs or OHSS, which can lead to serious complications or even death (2). However, OHSS is a risk that people with PCOS still face when going through IVF (2). 

 

Additionally, as with any type of ART, there is a chance of becoming pregnant with multiples (aka twins, triplets, etc.) if more than one embryo is successfully implanted (2).

Who could benefit from IVM?

People who have cancer can benefit from IVM! They may not be able to wait around for eggs to mature, so it is best to have the eggs removed from the body before cancer treatment begins (4). Those who have estrogen-sensitive cancers can benefit as well, since conventional ovarian stimulation using this hormone is not necessary when retrieving the eggs (4), and IVM is a great way for these people to be able to have children later. 

 

People with PCOS are more prone to OHSS, which can actually be fatal, so they can benefit from IVM since there is no stimulation of the ovaries in the process (2). Younger women seeking ART can benefit because the cost is much less than that of IVF (and we’ll talk more about that below) (2). Someone who has already undergone IVF, but has eggs that did not mature would benefit from IVM, too (2). 

 

Typically, people who would benefit from IVF could also benefit from IVM such as: someone with blocked fallopian tubes, a patient who had their fallopian tubes removed, male factor infertility, like low sperm count or motility, people with ovulation disorders, premature ovarian failure, uterine fibroids, people with genetic disorders, and those with unexplained infertility (2).

What are the success rates of old and new IVM?

Success rates for the old way of IVM (using hormones) is around 32% as compared to IVF which is about 40% for a single cycle. Clinical rates have not been determined for the “new” IVM success yet (2).

Cost for one round?

IVM appears to be much cheaper than IVF since there are little to no hormonal injections, fewer exams, fewer labs, and a shorter time span (1). IVM currently costs between $5,000 and $7,000 whereas IVF ranges from $15,000 to $20,000 per cycle (2). Nowadays, some insurances cover some of the costs of fertility treatments to include medication, donor sperm, donor eggs, and procedures like IVM. Some doctors offer in-house financing, too! There are even financing companies out there for people to use. Be sure to speak with a financial counselor at your doctor’s office for all of your options.

Problems with IVM

IVM has not yet become widely used in the ART field. This is due to pregnancy rates remaining lower than conventional IVF and miscarriage rates being higher (1). There is very little follow up because IVM has not quite entered mainstream ART technique despite its benefits of being cheaper and better for the those mentioned above (1).

Who is a candidate for IVM?

Candidates for IVM are pretty much the same people who would benefit from IVF:

  • People with PCOS
  • Cancer patients who are sensitive to hormone therapy
  • Those at risk of OHSS
  • Young people who produce a large number of egg follicles

Does IVM effect birth?

As previously stated, there is an increased risk of multiple pregnancy with any type of ART, including IVM. This is because doctors usually transfer one to four embryos into the uterus. And with multiple pregnancy comes an increased risk of prematurity, low birthweight, and perinatal morbidity (1). 

 

There were also reports of higher rates of chromosomal abnormalities in embryos following IVM that were linked to longer periods of maturation in vitro, which, in part, explains the higher rates of miscarriage in IVM pregnancies (1).

Any special considerations for people of color?

Fibroids are an issue that affects African Americans 2 to 3 more times than Caucasians (3). Fibroids can lead to infertility and miscarriage depending on where they are located. They can block the fallopian tube which won’t allow the egg or sperm to pass through (3). If located in the uterus, it can make implantation difficult, resulting in miscarriage (3). Patients with fibroids may require more cycles of treatment, making IVM a better option cost wise. Some docs may even suggest removing fibroids in order to increase the success of implantation.

Any special considerations for queer folks?

When it comes to queer folks, there are many ways to become parents including IVM. Depending on the state you live in, having a child (for same sex parents) can cost more because chances are, one parent may still have to adopt the child. For those who are transitioning, IVM is a better choice because there is no need for hormone injections since the eggs are matured outside of the body. There are times when the eggs are left over from people who will no longer use them, and matured eggs can be used for others who need donor eggs. People can also adopt fertilized embryos and use them for themselves or with a surrogate.

 

To sum this all up, in vitro maturation is a less invasive and more affordable way for people to reproduce. Eggs are matured outside of the body which reduces complications from hormones and overstimulation and release of eggs, however, there is a risk of developing multiples during pregnancy. It costs significantly less than IVF and can be covered by insurance or financed through the doctor’s office. The cool thing is fertilized embryos can be adopted by others who are trying to conceive! 

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+ References

(1) Basatemur, Emre, and Alastair Sutcliffe. “Health of IVM children.” Journal of assisted reproduction and genetics vol. 28,6 (2011): 489-93. doi:10.1007/s10815-011-9561-5

(2) https://americanpregnancy.org/infertility/ivm-in-vitro-maturation/

(3) https://www.ivf1.com/fibroids-infertility/

(4) https://www.newhopefertility.com/ivf/ivm/

(5) https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-in-vitro-maturation-ivm/

(1) Basatemur, Emre, and Alastair Sutcliffe. “Health of IVM children.” Journal of assisted reproduction and genetics vol. 28,6 (2011): 489-93. doi:10.1007/s10815-011-9561-5

(2) https://americanpregnancy.org/infertility/ivm-in-vitro-maturation/

(3) https://www.ivf1.com/fibroids-infertility/

(4) https://www.newhopefertility.com/ivf/ivm/

(5) https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-in-vitro-maturation-ivm/