How to choose an in vitro maturation program (IVM)

Recently, a patient asked me to describe what kind of training I had in IVM. I talked about what I have done in the past two years to develop our IVM program, but I realized that the question of this patient was indeed more difficult in how to evaluate and compare programs that perform in vitro maturation.

First of all, it is difficult to even find a program that has experience in in vitro maturation. We have been engaged in in vitro maturation for only two years, but I know only two programs in the United States that have more experience than we do. In the context of the world, there are a number of programs that I can name, but in the United States, IVM has not yet done so.

US reporting on IVF (legally authorized and through the Center for Disease Control) does not distinguish between a ventilator and a conventional IVF cycle. There is no standardized reporting method in the United States that provides any information about IVM. (Europe is slightly better.) Different programs use different criteria to select patients for IVM, but most of them are young women (less than 30, 35 or 38 are normal circumcisions) with a large number of visible small cysts in the ovaries on an ultrasound high content of antral follicles). Most of these patients have some variant of polycystic ovary (PCO).

Success indicators and other in vitro maturation assessments should use similar patients under conventional IVF as a basis for comparison. Given the small number of patients taking IVM, it is very difficult to do. Patients with PCO usually do better with conventional IVF than patients performing IVF for other reasons. They also have more side effects from drugs and are a subgroup of patients with the highest risk of ovarian hyperstimulation syndrome.

In our program (the number of patients is too low for statistical certainty), the constant frequency of pregnancies with IVM is significantly higher than the current frequency of pregnancies for patients matched for age undergoing traditional IVF. The “ovulation induction process” is much easier for IVM patients than with conventional IVF. There are far fewer side effects of drugs with IVM. The cost for a self-paying patient for each achieved pregnancy is about half that for conventional IVF in our program.

The doctor friend asks: “What is the secret?” There are no secrets. The general scheme of IVM is well known because it uses the components of conventional IVF. Patient management details are still evolving, but there is not a single detail of immense importance.

When I learned that IVF, Sage, had commercially available in vitro maturation carriers that it received from the group at McGill, I was interested in IVM. My initial interest in IVM was to try to find a cheaper IVF method that I could use for my patients.

Sage offered an individual course on the use of his media, which was taught by Dr. Jared Robbins of Brown University. I noticed that Dr. Robbins searches for IVM, watched as the lab did IVM, and Dr. Robbins introduced the IVM approach to me. Then I took Dr. Robbins. a very structured approach to IVM in solutions for infertility, PC and our first pregnancies rather quickly.

I had the opportunity to spend a week with Dr. SL Tan's group at McGill in Montreal. McGill has been with IVM for over a decade. Many doctors and embryologists who conduct IVM in other countries of the world have spent time there, and it remains one of the main institutions that need to be trained. Their clinical results are excellent and they widely publish information about IVM. I spent time with doctors dr. SL Tan and Dr. H. Holzer and with embryologists Dr. WY Son and Dr. R. Chian (the main media developer created by Sage.) They generously shared information about ICM both formally and unofficially in the laboratory and in the operating room. I returned to Allentown and found ways to incorporate their ideas into my patient management, and our program improved.

My next opportunity for academic improvement came when I attended the second international IVM conference in Milan, Italy. This conference welcomed physicians, embryologists and founding scientists to share the latest information on in vitro maturation.

The conference presented me with a number of new ideas, and also introduced me to many major IVM programs around the world. I realized that, as a reproductive endocrinologist, my education in the physiology of the ovaries focused on a two-week period of time during which selective follicles were developed, eggs became mature, and eggs were ovulated. This is a time of key intervention in infertility and IVF therapy. However, I knew almost nothing about the five months during which the eggs evolved from the primary follicle to the selected follicles. I returned home to understand this period of time in the physiology of the ovaries in ways that I could apply to the clinical part of maturation in vitro.

Our program continued to improve. One of the goals that I had long been harboring was to increase the yield of eggs during the extraction of eggs. I learned that Dr. Peter Hans-Steiner developed a very fine needle that used a new technique that allows washing of very small follicles used for in vitro maturation. He invited me to visit him in his office in Ganz, Austria, and was watching his corrections using this Steiner-Tan needle. It was a great innovation. I found that the IVM search process became easier, and with a lot of flash media used, it also made it easier to find eggs in the lab. We have not made enough cases to compare, but it looks like we have improved our egg harvest, which should improve the pregnancy rate.