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Variations on IVM

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IVM: More Information

Variations on IVM

We use a number of variations for IVM.   Infertility Solutions, P. C.  individualizes the approach to each patient based on her history and how (if) she has responded in prior IVM cycles.  Knowing the appearance of her eggs, how difficult it is to obtain eggs during retrieval, and how her eggs mature enable us to better help her in subsequent cycles.

The eggs in a women's ovaries used for IVM were released from their protected state 4 to 5 months earlier and have grown to form an antrum (cyst cavity) that can be seen on ultrasound.  Eggs are best harvested from medium size antrum cavities.  This is before these follicles become fully responsive to FSH.  Success with IVM is partly related to obtaining an adequate quantity of eggs.  This is more easily done if the antral follicles are not too small.  We often used medications to optimize antral follicle size for retrieval.

Nutritional issues are a major concern to us in the months preceding the cycle and during the cycle.   We also actively manage the endometrial lining as part of the cycle

One common type of augmented cycle is a hyperstimulation IVM rescue.  This is where the patient intends to do IVF, but early in the ovulation induction it becomes clear that she is at high risk of severe ovarian hyperstimulation.   Many programs manage hyperstimulation with "coasting" which involves delaying the egg retrieval while withholding gonadotropins.  Other programs proceed with the egg retrieval, but freeze all embryos for transfer in a later time period.  We believe that conversion to IVM is a better approach.

 

Other Opportunities and Considerations

Endometrial Lining

Managing the development of endometrial lining is more of an issue for IVM than it is for IVF.  The ovaries produce many hormones in addition to estrogen and progesterone.  In large amounts, some of these hormones may impair the ability of the lining to accept an implantation.  With IVM, the only ovarian hormones present in large amounts are estrogen and progesterone.   For some patients, this may produce a significantly better endometrial lining then they would with IVF.

Managing the lining for IVM is also important since embryos may be produced on up to three different days.  Different programs optimize outcomes in different ways with respect to this issue and management is likely to undergo changes as more research is done on the issue.

Related Egg Donors

From a practical viewpoint, IVM is likely the best procedure to use for a related egg donor.  Many patients find that they need to use donor eggs and have a younger relative who could be a potential donor.  However, asking the donor to give up so much time and undergo the discomfort and stress of multiple shots and frequent monitoring is just too much to ask.   This is especially true when the donor has small children to care for, which is often the case.  IVM really requires only one day of the donor's time for a significant procedure done under IV sedation.  It can also be scheduled months in advance.  Ideally the donor should have a PCO pattern in her ovaries to present the best chance of success.  However, the donation process is easy enough that is is reasonable to do it with donors who are likely to produce relatively few eggs and repeat egg harvesting at another time if necessary.

Cancer

The treatment of some cancers may or will result in sterilization.  Patients often wish to preserve their fertility using advanced reproductive technologies.  However, a traditional IVF cycle requires some time.  An IVM retrieval can be done anytime after an induced period.  Eggs can then be matured in vitro and cryopreserved.  There are IVM pregnancies from both traditional slow freezing cryopreservation of embryos and from vitrified oocytes.  Egg vitrification is still viewed as experimental, but does not differ much from embryo vitrification (our preferred method of embryo cryopreservation).  Unfortunately, data on this approach to fertility preservation is extremely limited.

New or Expanded Indications to do IVM (Cheaper or Quicker)

Infertility differs from many areas of medicine.  For the vast majority of of patients, the only important issue is getting pregnant quickly (as opposed to why infertility exists).   For some patients, the higher probability of getting pregnant quickly may be a reason to omit a traditional work-up or less aggressive therapies and go directly to IVM. 

Many patients have no insurance coverage for infertility therapy.  Some have no insurance coverage to pay for an infertility work-up.  Patients who are good candidates for IVM (which can be determined with a very minimal work-up), may find it cost effective to do IVM as opposed to a traditional infertility workup or more traditional lower probability infertility therapies such as gonadotropins with IUI.  Our multi-cycle discount program makes it even more affordable.

 

Experiences of Patients who have done IVM