IVM, An Alternative to IVF
Attempts to mature eggs (oocytes) outside the body started a quarter of a century ago and the concept of oocyte in vitro maturation (IVM) was introduced by none other than 2010’s recipient of the Nobel Prize, R.G. Edwards, in 1965. There are advantages and disadvantages in implementing this method for fertility treatment, but definitely there are indications for its use in certain patient populations. The road has been bumpy so far, but nonetheless, more than 2,500 children have been born worldwide, seven of them by patients treated at DVIF&G.
The method implements little or no medication and requires very few visits to the doctor’s office for ultrasound monitoring and blood tests prior to extracting the eggs from the ovaries. This is the main advantage of this method! It reduces the cost of medication and necessary tests and speeds up the process of treatment.
DVIF&G had an interest in developing this method for two patient populations — those that have polycystic ovaries (PCO) and are at risk of developing ovarian hyperstimulation syndrome (OHSS) with dreadful consequences, and patients with cancer. Cancer patients need to initiate treatment as soon as possible as most of the chemotherapeutic agents have a devastating effect on the eggs inducing sterilization to women and in some instances early menopause. Also, some of the cancers are sensitive to estrogens and respond to them by increasing tumor size or advancing the current stage of disease; therefore, high levels of estrogen produced during regular in vitro fertilization (IVF) must be avoided. Another group includes those patients that have leukemia and the only treatment of choice in order to preserve their reproductive potential is IVM.
Ten years ago an experimental IVM program was established at DVIF&G under Institutional Review Board (IRB) approval and was implemented in patients that were at imminent risk to develop OHSS due to the excessive amount of follicles present or those that sought an alternative treatment due to their previous experience with severe ovarian hyperstimulation. The initial program was met with success. Seven healthy children were born to the participating parents and the results of the program were comparable to those from other European institutions. In October 2006, we shared our experiences in IVM procedure with our colleagues from 12 countries at a special meeting in Copenhagen, Denmark.
Most of the “IVM Children” have been born in Asia where financial constraints make this type of treatment accessible to those patients that need IVF and cannot afford it. Another reason for undergoing this treatment is the law of the land. In 2004 in Italy, the law provided that only three oocytes fertilized could be inseminated in each treatment cycle and all resulting embryos must be transferred. This stipulation removed the need to maximize the number of oocytes recovered and consequently lead to IVM procedure. Also, it gave an impetus to have the eggs (oocytes) cryopreserved, a method also available at DVIF&G.
The health of children born so far as a result of the IVM treatment approach have comparable results to those obtained by IVF and intracytoplasmic sperm injection (ICSI) procedures and all children born at DVIF&G are entirely normal.
For the past seven years IVM has become an integral part of the Sperm, Embryo, Egg Depository and Storage (SEEDS) program at DVIF&G that preserves the fertility potential of both male and female cancer patients. So far ten children have been born to cancer survivors through a variety of cancer fertility preservation modalities.
IVM as a method is at its embryonic stage and as the technology improves, the basic science expands and as our understanding of the reproductive physiology improves, it will acquire its proper position in the armamentarium of fertility treatment.