IVM has proven to be a more effective treatment option compared to conventional fertility treatments with its safety record, reduced side effects and suitability for certain groups of patients
In vitro maturation, or IVM, is a new fertility treatment that is becoming popular among Thai women who have difficulties conceiving. It reduces the side effects usually associated with conventional forms of fertility treatment and is deemed much safer to perform for patients with certain medical conditions.
Dr. Boonsaeng Wutthiphan, an infertility specialist and gynecological surgeon at Samitivej Sukhumvit Hospital in Bangkok, Thailand, says that one crucial sign of fertility problems in women is endometriosis. This is a condition where the tissue lining, which is normally inside the uterus, grows outside of it, causing patients to feel pain during their periods or during sexual intercourse. Pain may also be felt in the bottom or anus.
Another symptom of infertility is the presence of growths in the uterus called fibroids. Patients may feel pressure on their bladders and rectums. Fibroids can also cause spotting or heavy periods if they enter the womb. Therefore, Dr. Boonsaeng advises women who encounter any of these symptoms to consult their doctor immediately.
Conventional forms of infertility treatment involve hormonal stimulation, which helps the ovaries produce more eggs. But it is inadvisable for women suffering from polycystic ovary syndrome (PCOS), a common endocrine system disorder that enlarges the ovaries and fills them with small collections of fluid known as follicles.
Patients with PCOS suffer from hormonal imbalance caused by the small cysts that grow in their ovaries, and hormonal injections could lead to the patient developing more eggs than desired.
“Usually we aim to get 12 to 15 eggs to achieve a good pregnancy to have the baby. But in some cases the patients may suffer from PCOS and develop 20 to 30 eggs,” says Dr. Boonsaeng.
Worse still, complications like ovarian hyperstimulation syndrome (OHSS) may occur. This causes the ovaries to become swollen and painful. Other symptoms of OHSS include rapid weight gain, nausea and shortness of breath.
IVM would then be the preferred treatment option for patients with PCOS as it negates the need for hormonal stimulation, preventing OHSS from occurring. Patients with fewer eggs than normal would still be able to develop two or three more mature eggs through IVM.
The fundamental difference between IVM and in vitro fertilisation (IVF) techniques is the maturation of the egg. In IVM, the egg is obtained from its immature stage and allowed to mature outside of the woman’s body, unlike in IVF where the egg is implanted in the uterus shortly after fertilisation.
Because the patient does not receive hormonal stimulation before her egg is taken from her body, the lining of the womb may become too thin to support the mature egg and embryo later on. To counter this, Dr. Boonsaeng says the patient would be given estrogen to make the lining of the womb thick again. But this may take time and in some cases, the egg would have to be frozen first before the womb is able to support it.
Another alternative in IVM treatment involves partial stimulation. Prior to the removal of her egg, the patient undergoes hormonal stimulation of no longer than five days to avoid OHSS from occurring.
According to Dr. Boonsaeng, the success rate of an embryo becoming a baby after fertilisation through assisted reproductive technologies (ART) is usually around 20 percent. But this falls to just 12 percent in IVM treatments.
But IVM also allows doctors to put more embryos in the patient with less risk of side effects – around two or three embryos compared to a maximum of two for patients who received full hormonal stimulation. “Patients with full hormonal stimulation usually only have one embryo in them… but those who undergo IVM may receive two or three embryos to achieve a success rate of about 30 percent,” says Dr. Boonsaeng.
According to Dr. Boonsaeng, IVM is the best form of treatment for the following groups of patients: women who develop complications like OHSS after hormonal stimulation; women who suffer from PCOS; and those with a low egg count.
About 50 percent of his patients at Samitivej Sukhumvit Hospital are Thai and the other half are foreigners. Dr. Boonsaeng has also treated patients who had previously undergone treatment for breast cancer or suffered from deep vein thrombosis (the formation of a blood clot in the vein, usually in the leg). IVM would be beneficial as patients would not suffer from the recurrence of their medical conditions due to exposure to high estrogen levels.
He adds that most of his patients who seek IVM treatment learn about it online before consulting him.
Interview originally published on www.globalhealthandtravel.com
M.D., Faculty of Medicine, Prince of Songkla University Faculty of Medicine Prince of Songkla University , 1979