New trends in assisted conception

 Although initial efforts at IVF in the 1960s attempted to mature eggs in the laboratory, these techniques were largely unsuccessful. The first live birth from IVF obtained a single egg that was matured inside the ovary.  This was a natural cycle where no fertility medications were used.  Since then, with the advent of newer drugs, injections which stimulate ovaries to produce eggs are used regularly during an IVF cycle.

What is IVM?

IVM stands for In Vitro Maturation of oocytes (maturation of the oocytes outside the body).  The difference between IVM and conventional IVF is that the eggs are immature when they are collected.

What does IVM treatment involve?

Immature eggs are collected from unstimulated or minimally stimulated ovaries under ultrasound scan guidance.

The immature eggs are then matured in the laboratory for 24-48 hours using a special culture medium with added small quantities of hormones.

Intracytoplasmic Sperm Injection (ICSI) is used for fertilisation of the matured eggs. Laser Assisted Hatching (LAH) is performed on these embryos before transferring them into the woman’s womb.

Who benefits from IVM treatment?

*Women who are extremely sensitive to the effects of fertility medications can produce a large number of oocytes, resulting in a potentially life-threatening condition known as ovarian hyperstimulation syndrome (OHSS).  These women have polycystic ovaries and IVM can be used as an alternative to IVF for them. 

*As an alternative to IVF for younger women with normal menstrual cycles, IVM being less costly.

*Fertility preservation in young women with cancer who are going to receive chemotherapy or radiotherapy.

*Salvaging immature eggs collected during a standard IVF/ICSI when, unexpectedly, a significant number of eggs collected are immature.

*Ideally, women under the age of 30 or 35 would be expected to have the greatest likelihood for having many eggs.

What are the risks of IVM?

As IVM is a new technique, the number of children born is very few — about 400 worldwide — and those that have been born are still very young.  Long-term safety records are still lacking.  Clinical pregnancy rate of 30-35 per cent for women aged 35 years or under having IVM have been reported.  There have been reports which show an increased risk of miscarriage after IVM compared with IVF and ICSI.

What are the advantages of IVM compared to IVF?

*IVM eliminates the risk of the potentially life-threatening condition of OHSS because it does not involve intense ovarian stimulation.

*IVM is less expensive than IVF because it does not involve taking costly gonadotropin injections. It also involves less monitoring.

*IVM is a shorter treatment regimen compared with IVF. 

One must consult an IVF clinic to decide which would be the best method —  conventional IVF/ ICSI or IVM technique, where the doctor would explain the advantages and disadvantages in detail. 

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