In vitro maturation of oocytes.
IVM (in vitro maturation) involves the aspiration of immature eggs from small, antral follicles and/or ovarian tissues and their maturation outside the body of a woman, under laboratory conditions. Unlike the traditional IVF method, in IVM, eggs are immature when collected. Immature cells, in addition to smaller, antral follicles, can also be found in ovarian tissue, so in addition to aspirations of small follicles, an aspiration biopsy of ovarian tissue is performed.
The specificity of early aspiration of follicles and tissue is the attempt to mature the eggs in standard ideal laboratory (in vitro) conditions, in special media. Egg development and differentiation is a complex and long process (it takes several months to a year). The most delicate part of the maturation process occurs during the last few weeks before ovulation. Early aspiration or aspiration biopsy produces cells of varying degrees of immaturity. In vitro maturation (IVM) allows you to overcome the problems of the late, most delicate phase of differentiation.
Patients who do not have high-quality eggs are characterized by the fact that:
a) there is no final follicle growth or
b) mature follicles are empty follicles,
c) the eggs are not normal in shape,
d) have maturation delay (GV or MI),
e) cannot be fertilized, or
f) embryos have poor morphology/morphodynamics, or
d) have a cessation of growth and development (Embryo arrest).
This technology was developed decades ago to avoid overreactions to drugs. In recent years, IVM has been used in patients who have reduced ovarian function, with the inability to produce mature eggs, as well as in those with cell quality problems or embryos or in empty follicles. In these cases, IVM technology allows the final, most important parts of the cell development (differentiation) process to occur under standardized, laboratory conditions.
WHAT DOES THE IVM PROCEDURE LOOK LIKE?
After a short preparation, lasting several days, immature eggs are collected using specific techniques and instruments from small follicles or tissue. Tissue and cells continue the process of maturation in laboratory conditions. The maturation of the egg from immature form to mature is a very complex process and depends on several factors. Eggs that are prevented from maturing for different reasons (genetic, immune or metabolic) can be acted on by autologous or synthetic maturation enhancers during the IVM procedure, which can help maturation. The aspiration of the contents of the follicles or tissues is followed by incubation in specific mediums, enriched with growth factors that promote maturation. The incubation period is very different, depending on the degree of immaturity of the cells. This period ranges from a few to ten days. Once they reach the proper stage, the cells can be used for IVF or frozen for future use.
reduced ovarian function / ovarian insufficiency (advanced reproductive age, POF);
poor quality eggs or embryos,
delay in the development of follicles;
problems in the final maturation of the ovum;
polycystic ovary syndrome (PCOS syndrome);
fertility preservation before other, aggressive methods of treatment (such as cancer treatment)
greater success of IVF processes in these indications, without adverse effects on the embryo
shorter duration of the procedure
no side effects of drugs (eliminated developing OHSS syndrome)
without risk affecting the potential of cells.
The first results of our team from 2019, included 28 patients 44.5 years of age (26-60) with POF and aged over 45 years. 55% of patients received eggs during the IVM process. 62% of the cells obtained via IVM reached full maturity. 85% of IVM cells were successfully fertilized.