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IVM: other opportunities and considerations
Endometrial Lining: overcoming and implantation problem
Managing the development of endometrial lining is more of an issue for IVM than it is for IVF and is often done directly. The ovaries produce many hormones in addition to estrogen and progesterone. In large amounts as may occur with traditional IVF, some of these hormones may impair the ability of the lining to accept an implantation. With programmed IVM, the only ovarian hormones present in very large amounts are estrogen and progesterone. Hormonal treatment with IVM may also suppress androgen production which may further help the endometrial lining. For some patients, this may produce the best lining that they are capable of developing. (There are other relevant details here.)
Related Egg Donors
From a practical viewpoint, IVM is likely the best procedure to use for a related egg donor. Many patients find that they need to use donor eggs and have a younger relative who could be a potential donor. However, asking the donor to give up so much time and undergo the discomfort and stress of multiple shots and frequent monitoring is just too much to ask. This is especially true when the donor has small children to care for, which is often the case. IVM really requires only one day of the donor's time for a significant procedure done under IV sedation. It potentially can also be scheduled months in advance. Ideally the donor should have a PCO pattern in her ovaries to present the best chance of success. However, the donation process is easy enough that is is reasonable to do it with donors who are likely to produce relatively few eggs and repeat egg harvesting at another time if necessary.
Cancer
The treatment of some cancers may or will result in sterilization. Patients often wish to preserve their fertility using advanced reproductive technologies. However, a traditional IVF cycle requires some time. An IVM retrieval can be done anytime after an induced period. Eggs can then be matured in vitro and cryopreserved. There are IVM pregnancies from both traditional slow freezing cryopreservation of embryos and from vitrified oocytes. Egg vitrification is still viewed as experimental, but does not differ much from embryo vitrification (our preferred method of embryo cryopreservation). Unfortunately, data on this approach to fertility preservation is extremely limited.
It is possible to do multiple IVM retrievals in a single month and to even do retrievals after someone has ovulations. This is not feasible with traditional IVF.
New or Expanded Indications to do IVM
(Cheaper or Quicker)
Infertility differs from many areas of medicine. For the vast majority of of patients, the only important issue is getting pregnant quickly (as opposed to why infertility exists). For some patients, the higher probability of getting pregnant quickly may be a reason to omit a traditional work-up or less aggressive therapies and go directly to IVM.
Many patients have no insurance coverage for infertility therapy. Some have no insurance coverage to pay for an infertility work-up. Patients who are good candidates for IVM (which can be determined with a very minimal work-up), may find it cost effective to do IVM as opposed to a traditional infertility workup or more traditional lower probability infertility therapies such as clomid or gonadotropins with IUI. If male factor is involved then the average cost of achieving a baby will be lower with IVM compared to IUI with clomid or gonadotropins.