Question and answer session - IVM information

Dr Junk lent me his notes from a conference on IVM that he attended last year, and I will be returning them to him tomorrow at my visit to the clinic. I thought I should take note of some of the information that I found in the notes to share and also to keep for my own records should I have questions later.

IVM history

• 1935 - IVM in rabbits (Pincus & Enzmann)
• 1965 - IVM of human oocytes (Edwards)
• 1983 - First IVM baby (Veeck)
• 1993 - Further 4 IVM babies (Cha et al)
• 1995 - First IVM babys from PCOS (Trounson et al)
• 1996-2006 - Approx 500 IVM babies born worldwide
  

Traditional IVF versus In Vitro Maturation (IVM)

Traditional IVF

• Relatively many oocytes/embryos
• High pregnancy rate/OPU
• Down regulation
• Daily Hormone Injections
• hCG injection
• Emotional stress
• Long treatment time
• Potential side effects eg OHSS

IVM

• Fewer oocytes and embryos
• Lower pregnancy rate/OPU BUT
• No down regulation, no manipulation of hormone balance
• None or few hormone injections
• Reduced pyschological impact
• Reduced treatment time (2-3 weeks)
• Reduced interference with daily life
• No known side effects
• Lower cost than conventional IVF

Where are IVM and traditional IVF similar?

• Maturation rate of 70-80%
• Fertilisation rate 70-80%

Where are IVM and traditional IVF different?

• IVM has a lower pregnancy rate per OPU due to lower number of oocytes/embryos resulting lower transfer rate
• IVM has a lower pregnancy rate per ET due to lower number of embryos resulting in lack of selection possibilities, and possibly in a small number of embryos transferred
• IVM has a lower implantation rate due to lower number of embryos resulting in lack of selection possibilities
• Success rates are different. IVF has a success rate of around 30-50% (I was told around 50% for my age group - under 30), while IVM has success rate of anywhere from 15-30%.

The IVM Process

• Day 1/2 Screening ultrasound and endocrine assessment
• Day 3-7 low dose priming with FSH until the leading follicle is around 10-14mm and endometrium is at least 5mm thick. During an IVM cycle, priming with FSH (150iu for 3 days) is beneficial for women with PCOS, however it has not shown to be particularly helpful for non PCOS patients.
• OPU occurs, at the same time as sperm retrieval.
• While the eggs are matured in the lab, you will need to prepare your body for the transfer. Estrogen tablets are taken from OPU, and progestrone pessaries used from transfer.
• Egg transfer takes place anywhere from 2-5 days depending on clinics protocol (mine prefers to go to blastocyst so 5 day transfer)

IVM Pregnancies - what to expect?

• Gestational diabetes (7.5%)
• Hypertension
• Preeclampsia (17% - Quite scary!)
• Delivery by caesarian section (33-46%)

Sorry if that was just a huge amount of information to take in at one sitting but I wanted to make sure I took the time to record everything for future reference.