In the mid‑1990s a group at Monash University in Melbourne, Australia, reported the world’s first baby born from an embryo derived from an immature egg that had been matured in the embryology laboratory, and then fertilized and transferred to the uterus. The process has come to be known as In vitro maturation (IVM) of eggs. In so doing, these researchers in fact opened the door to retrieving numerous healthy eggs from women who had not received fertility drugs at all in advance of the egg retrieval, and so potentially transforming the entire IVF arena. More recently, Sean Ling Tan, MD from Mc Gill University in Montreal, Canada reported on impressive results using IVM, claiming success rates that are comparable to those being reported for conventional IVF. A few other centers are reporting a similar experience.
How is the IVM process conducted?
Within 6-8 days of a natural menstruation, an ultrasound examination is done to see how many early follicles have developed. A few days later, 10,000 units of hCG is administered, and approximately 36 hours after that, an egg retrieval is performed and eggs are aspirated from the follicles. These eggs are then allowed to mature in special media and under special conditions. Many of them develop into mature (M2) eggs. The eggs can then be fertilized in the embryology lab and transferred to the uterus as embryos/blastocysts (3-6 days after fertilization), or vitrified (frozen) as eggs or embryos and cryobanked for subsequent dispensation.
At SIRM we are in the process of undertaking a study that will combine IVM with CGH testing of all M2 (matured) eggs. We believe that by doing so we might be able to further improve success rates associated with IVM.
What are the possible benefits and advantages of IVM?
Immediate benefits of IVM would be seen in the arena of Fertility Preservation (FP) where women who for medical or personal reasons would bank their frozen eggs for future dispensation. This would be most applicable in cases where women who have certain types of cancer need to undergo chemotherapy or radiotherapy that could damage their eggs and/or launch them into premature ovarian failure. IVM could also be used to access large numbers of donor eggs for dispensation to women who require egg donor-IVF. It would definitely simplify the entire process to the benefit of all.
No doubt, the ability to generate and acquire viable eggs and embryos without using fertility drugs to stimulate multiple follicle development would constitute a major breakthrough in the field of IVF. It would reduce cost dramatically (for IVF drugs often constitute more than one third of the total cost). It would eliminate side effects from, and all risk of serious complications associated with, use of fertility drugs, and it would expand the reproductive choices available to women.
Simply stated, IVM is a much needed approach in view of the physiological, emotional, and financial costs associated with the administration of fertility drugs. Frankly, the widespread introduction of IVM could herald the end of the era of fertility drugs being required to perform IVF. Wouldn’t that be a blessing?