In vitro maturation (IVM) is a variant of in vitro fertilization (IVF) and thus a method of artificial insemination. In this procedure, previously retrieved eggs mature in a Petri dish until they are then artificially inseminated with the man’s sperm and implanted in the woman’s uterus.
What is in vitro maturation?
In in vitro maturation, the eggs are removed from the ovaries in an immature form and then mature in the laboratory. And are then artificially brought into contact with the man’s sperm. As a form of in vitro fertilization, in vitro maturation is also one of the assisted reproductive procedures. In assisted reproduction, also called artificial insemination, the attending physician combines the man’s sperm and the woman’s egg inside or outside the woman’s body. In in vitro maturation, the union takes place outside the female body, so that an already fertilized egg is inserted into the woman’s uterus. The procedure may be used in Germany if a couple regularly engages in unprotected sexual intercourse for at least one year and still fails to become pregnant. In vitro maturation is considered to be gentler than classical in vitro fertilization. In the latter, the woman is initially administered high doses of hormones with the aim of maturing several eggs at once in the woman’s body. In in vitro maturation, the eggs are removed from the ovaries in an immature form and then ripen in the laboratory.
Function, effect, and goals
In vitro maturation begins with an ultrasound and blood collection on the woman’s fifth, sixth, or seventh day of the cycle. During the ultrasound, the number and size of all the follicles are measured. In addition, the mucosal height of the uterine lining is checked. An optimally formed endometrium is relevant so that the fertilized egg can implant later. In addition, the hormones LH, progesterone and estradiol are checked in the blood. If these hormones are not in the normal range, problems may arise during artificial insemination and the desired result may not be targeted. In summary, these tests are used to determine whether in vitro maturation is at all promising in this cycle or whether further preparatory measures must first be taken. If all prerequisites are met, the eggs are retrieved on approximately the eighth day of the cycle. This requires the woman to be anesthetized. First, the retrieved oocytes of the patient are then examined for errors in the genetic material in order to minimize the risk of a hereditary disease. If errors in the genetic material have been ruled out, the eggs are taken to the laboratory where they mature in a test tube or Petri dish. One day after the eggs are retrieved, the sperm are released by the man. The sperm is then combined with the egg for fertilization. If fertilization is successful, the fertilized egg is then implanted in the woman either immediately or in the next cycle. To increase the likelihood of successful implantation of the embryo, special and standardized preparation of the uterine lining is performed prior to embryo transfer. In vitro maturation is particularly suitable for patients suffering from the so-called polycystic ovary syndrome (PCO). In these patients, there is a risk of hormonal overstimulation with classical artificial insemination. In addition, the method of in vitro maturation can also be used if pregnancy is not desired immediately after egg retrieval. Immature eggs, in contrast to mature eggs, can be obtained from frozen ovarian tissue. This offers cancer patients in particular who are being treated with chemotherapy or radiation therapy the possibility of fertility treatment once the cancer therapy has been completed.
Risks, side effects, and dangers
As promising as the benefits of in vitro maturation sound, it is a fairly new procedure that is still considered experimental. Worldwide, there are only about 400 children conceived with the assistance of IVM. Although IVM treatment is easier to perform and gentler on the woman than traditional in vitro fertilization, the success rate is much lower. Pregnancy actually occurs in only 10 to 15% of treated women. With IVF, on the other hand, fertilization is successful in 40% of cases.However, this usually requires several treatment cycles. Egg retrieval is an operation with all the usual surgical risks. Injury to the ovaries, uterus or other adjacent organ structures may occur. Infections of the abdominal cavity are also possible. During anesthesia, there is a risk of cardiovascular disturbances, including cardiac arrest. So far, IVM treatment does not seem to have a negative effect on pregnancy, birth, or postnatal fetal development. However, as mentioned above, this is still a very young procedure, so there are no long-term data on the development of children conceived with the help of in vitro maturation. In addition to the physical risks for the woman and the possible complications in child development, the psychological strain should not be underestimated. Couples who decide to undergo IVF have often been suffering from their childlessness for years and are often under pressure to make it work this time. If IVF fails, those affected often lose what they thought was their last lifeline, leading to depression and, not infrequently, to a breakdown in their relationship. In addition to the psychological burden, there is also a financial burden. IVM is a rather complex procedure that requires several costly pre-tests. Thus, there is a not inconsiderable material cost for the ultrasound, hormone measurements, egg puncture, anesthesia, laboratory and necessary medications. IVM treatment is not reimbursed by health insurance, so the couple bears all the costs alone.
