Oocyte in vitro maturation (IVM) is a technique used in assisted reproductive technology (ART) to mature oocytes outside of the body. Typically, during natural ovulation, only one follicle with one oocyte becomes dominant and fully matures, while the others undergo atresia and are lost. In IVM, immature oocytes are retrieved from the ovaries and are then matured in a laboratory setting.
The IVM process involves several steps. First, the patient is given medication to suppress their natural menstrual cycle. But the doses of hormones that are used in IVM are rather lover then in regular IVF cycle and there is absence of trigger of ovulation. This is followed by medication to stimulate the ovaries to produce multiple immature oocytes. Once the oocytes are retrieved, they are placed in a specialized culture medium to mature. This culture medium contains hormones and other factors that mimic the natural environment of the female reproductive tract.
After a period of maturation in the culture medium, the oocytes are then fertilized using either traditional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). The resulting embryos can then be transferred back into the uterus to achieve pregnancy.
IVM has several advantages over traditional IVF. It can be performed more quickly and with fewer medications, making it a more cost-effective option for some patients. Additionally, IVM may be a better choice for patients who are at risk for ovarian hyperstimulation syndrome (OHSS), a potentially dangerous condition that can occur as a side effect of traditional IVF medication.
IVM has special indications and can be beneficial in some cases:
Cost-effectiveness: IVM may be a more cost-effective option compared to traditional IVF because it requires fewer medications and monitoring appointments.
Reduced risk of ovarian hyperstimulation syndrome (OHSS): IVM does not require the use of high doses of ovarian stimulation medication, which is associated with an increased risk of OHSS. This can be particularly beneficial for patients who are at high risk for this condition.
Shorter treatment time: Because IVM requires less medication and monitoring, the treatment timeline may be shorter compared to traditional IVF.
Improved safety profile: IVM has been shown to have a similar safety profile to traditional IVF, with a low incidence of complications such as infection or bleeding.
Alternative for cancer patients: IVM may be a viable option for women who need to undergo chemotherapy or radiation therapy for cancer, as it can be performed quickly before treatment begins.
It’s important to note that not all patients may be good candidates for IVM and individualized treatment plans should be developed based on a patient’s specific needs and medical history. Additionally, success rates with IVM may be lower compared to traditional IVF, although ongoing research is exploring ways to improve outcomes with this technique.
There are several types of IVM in deafferent situations:
Cappa-IVM. It is more complex procedure than traditional IVM but has higher success rates and can be beneficial in fertility preservation protocols.
Cappa-IVM, or “cumulus-enclosed oocyte IVM,” or “capacitated IVM”, is a variation of the traditional IVM technique that involves keeping the cumulus cells surrounding the immature oocytes intact during the maturation process. Cumulus cells are a type of follicular cell that plays an important role in supporting the growth and development of the oocyte and for its competence for fertilisation.
In traditional IVM, the cumulus cells are removed from the immature oocyte before it is placed in the culture medium for maturation. However, in cappa-IVM, the oocyte is left surrounded by its cumulus cells during the maturation process. This is providing a more natural environment for the oocyte and regulation of cytoplasmic maturation. Sometimes it is possible to add special inhibitors to oocyte and resump it’s myosis after that inhibition. This additional step may help to improve oocyte maturation and developmental potential.
Several studies have suggested that cappa-IVM may lead to higher rates of oocyte maturation, fertilization, and embryo development compared to traditional IVM. One possible explanation for this is that the cumulus cells provide important signals and nutrients to the oocyte during maturation that are lost when the cells are removed.
OTO-IVM, or “ovarian tissue oocyte IVM,” is a technique that involves removing and culturing a small piece of ovarian tissue to mature oocytes in vitro. The technique is often used in cases where traditional ovarian stimulation is not possible, such as in women with premature ovarian failure or those undergoing cancer treatment. This procedure can be particularly important for patients with low ovarian reserve or those who have undergone chemotherapy or radiation therapy, which can damage the ovaries and reduce the number of viable oocytes.
However, IVM is still a relatively new technique and more research is needed to fully understand its benefits and limitations. Additionally, not all patients may be good candidates for IVM and individualized treatment plans should be developed based on a patient’s specific needs and medical history.