In vitro maturation — the other in vitro?
When you hear “in vitro”, you most likely imagine hormonal stimulation, multiple injections and growing follicles. But there is another way. More sparing. More gentle. Different.
In vitro maturation (IVM) is an alternative in which eggs are collected in an immature state — and brought to full maturity in the laboratory, not in the woman's body.
When is IVM applied?
- In women at high risk of ovarian hyperstimulation syndrome (OHSS) — for example in polycystic ovaries;
- In patients in whom stimulation is contraindicated or undesirable;
- If necessary, a sparing protocol with minimal medication;
- In women with oncological diagnoses, when there is no time for standard preparation;
- In research or specialized clinical cases.
How is the procedure going?
1. Mild or no hormonal stimulation is performed;
2. The eggs are aspirated in an immature state (GV or MI stage);
3. In the laboratory, they are cultured in a special IVM medium — usually for 24—48 hours;
4. After reaching maturity (MII), the eggs are fertilized with ICSI;
5. Continue with cultivation and transfer/freezing in a standard manner.
What are the advantages of IVM?
- No risk of hyperstimulation syndrome (OHSS) — extremely suitable procedure for PCO patients;
- A sparing approach — fewer hormones, fewer injections;
- Faster cycle — often within 7—9 days;
- Ideal for fertility preservation when there is no time for stimulation.
What are the peculiarities?
- Not suitable for all patients — requires individual assessment;
- Not in all cases maturity or fertilization occurs;
- Requires high laboratory expertise and special environments;
- The success rate is still lower than the standard in vitro procedure (IVF).
The first baby from in vitro maturation in Bulgaria
In our clinic we have the honor and pride to be the first in the country to achieve pregnancy and childbirth after an IVM procedure. It was not just a medical success, but a hope for many women for whom classic invitro is not an option. On February 20, 2008, Danaya was born in Sofia — from the first experience with IVM to parents who have 2 years of sterility and male factor. The little girl was born just months after the first in Europe. In comparison, the first IVM baby in the UK was born in October 2007, and the first IVM baby in Germany was born at the end of 2006. At Danaya's birth, a total of 300 babies were born in the world using this method.
Conclusion
In vitro maturation is not the better or worse in vitro. This is the other in vitro. Created for those cases where medicine needs to be even more precise, even more caring, even more personalized.
IVM is a hope, beyond the standard protocol. And an opportunity that deserves to be known.