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Is In Vitro Maturation (IVM) a Better Alternative to IVF?
March 7, 2013
Updated guidelines by the American Society for Reproductive Medicine (ASRM) say in vitro maturation (IVM) is a fertility treatment option for women who otherwise have a contraindication to in vitro fertilization (IVF), though the benefits and risks must be thoroughly considered. Because few babies have been born to date as a result of IVM and there is little data on the health outcomes of these children, ASRM considers IVM an experimental procedure that does not surpass the safety or efficacy of IVF.
IVM differs from IVF in that follicles are aspirated and eggs are retrieved before they have reached maturity. This can be done with or without the use of ovarian stimulation fertility drugs, though exposure to Human Chorionic Gonadotropin (hCG) is essential. Eggs are then matured in a medium within a laboratory setting. Kim Thornton, M.D. of Boston IVF explains: “[Eggs] are placed in a similar liquid that we use to grow embryos in routine IVF, however we also add in the hormones that they need to see before they can become ready to fertilize.” Traditional IVF involves the retrieval of mature eggs and is most often performed after fertility drugs have been used for ovarian stimulation.
IVM has been indicated for patients with Polycystic Ovarian Syndrome (PCOS) and those expected to develop Ovarian Hyperstimulation Syndrome (OHSS) with the use of ovarian stimulation drugs. It has also been an option for cancer patients looking to preserve their fertility before chemotherapy, or women with a history of tumors or other medical condition that should not endure elevated levels of estradiol (estrogen) for extended periods of time.
Eric Widra, M.D. of Shady Grove Fertility Center in Washington, D.C., says that despite these indications, very few fertility patients are candidates for IVM. “IVM was a way to get eggs from a woman without ovarian stimulation. Women at risk of ovarian hyperstimulation or women who needed to freeze their eggs urgently would have been candidates for IVM. But, other IVF techniques have developed that dramatically reduce the risk of OHSS and for patients with an urgent case, these IVF protocols make it so they can cycle immediately,” he says. Glenn Schattman, M.D., of The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at Weill Cornell Medical Center in New York City, agrees that IVM is not the most viable option for fertility patients. “If you look at the results, proper stimulation is critical for success. IVM tries to manipulate what should be happening in nature and much of the data that shows successful cases of IVM were only achieved when the patient had a mature egg retrieved simultaneously.” Instead, fertility doctors can work with patients to develop an IVF protocol that will provide the maximum chances of success with minimal risks.
Because of the low birth rates and sparse data, IVF is considered a stronger fertility therapy option that can be modified to treat most fertility patients. “Although it has been used quite extensively by some overseas clinics, it has not become widely used in the USA and is still treated as an experimental technique. The determination [of where attempting IVM is appropriate] should be considered depending on the patients’ clinical history and any prior experience with IVF,” says Thornton. Being that IVM is not widely practiced in the United States, there is little data to show it is a safe and effective alternative to traditional IVF. The decision to perform IVM should be made on a case by case basis where the benefits of IVM outweigh potential risks of modified IVF protocols.