How to choose an in vitro maturation (IVM) program

A patient recently asked me to describe what training I had had in IVM. I related what I had done over the last two years to develop our IVM program, but realized that this patient's question was really the more difficult one of how to evaluate and compare the programs that perform in vitro maturation.

First of all, it is difficult to even find a program experienced in doing in vitro maturation. We have been doing in vitro maturation for only two years, yet I only know of two programs in the United States that have a larger experience than us. 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 caught on.

United States IVF data reporting (mandated legally and through the Center for Disease Control) does not differentiate between IVM and conventional IVF cycles.  There is no standardized reporting method in the United States that provides any information about IVM. (Europe is a bit better.)  Different programs use different criteria for choosing patients to undergo IVM, but the majority are younger women (ages under 30, 35 or 38 are the usual cutoffs) with a large number of visible small cysts in their ovaries on ultrasound (high antral follicle count).  Most of these patients have some variant of polycystic ovaries (PCO).

Success rates and other assessments with in vitro maturation should use similar patients undergoing conventional IVF as a basis for comparison.  Given the small number of patients undertaking IVM, this is very difficult to do.  Patients with PCO generally do better with conventional IVF than patients doing IVF for other reasons. They also have more side effects from the medications and are the subgroup of patients at greatest risk for severe ovarian hyperstimulation syndrome.

In our program (with patient numbers too small for statistical certainty), the ongoing pregnancy rate with IVM is slightly higher than the ongoing pregnancy rate for age matched patients undergoing conventional IVF. The "ovulation induction process" is much easier for patients with IVM than with conventional IVF. There are many fewer side effects of medications with IVM. The cost to the self-pay patient for each pregnancy achieved is about half of that for conventional IVF in our program.