Saturday, February 28, 2009

My RE affirms IVM isn't beneficial, compared to IVF

Wouldn't you know that AFTER my husband and I thoroughly discuss the positives and negatives of IVM and decide that it's just not for us, I ran across a show produced by the infertility radio show I listen to discussing new infertility technologies and one of the subjects was IVM. The guest on the show was none other than my own RE, Dr. Peter Ahlering. What's funny is that his position on IVF vs. IVM is pretty much the exact reasoning we arrived at - that ultimately it's not effective enough, or cheap enough, to be sensible. We were worried that if we went down that road and didn't end up with a baby, we'd have no money left to try what I call the "end-all-be-all" for infertility - IVF. Anyway, it was just good to hear a trusted medical opinion on this topic and I wanted to share it with the rest of the world.

As usual, below are my notes from the show. Live

Disclaimer - Please note that the information below is my personal synopsis of the free online radio program hosted by Kim Haun, founder of Conceive Magazine, with guest Dr. Peter Ahlering, an ob/gyn and medical director of the Sher Institutes for Reproductive Medicine in St. Louis. It is in no way meant to quote the either of the parties mentioned above.

Listen for Yourself

Scroll down in the archive to:
Date: 1/29/09
Title: "New Fertility Technology".

Dr. Peter Ahlering's thoughts on In Vitro Egg Maturation (IVM): IVM is where you stimulate the ovaries with drugs when they are very small. Egg retrieval of immature eggs, probably two steps behind where you'd be with IVF. In order to be competent for fertilization, they have to mature these immature eggs in the lab. This procedure has been around for many years and it's an extremely complex process still that involves maturing an egg to the point that it's capable of being fertilized. With the process of IVF, you wonder if people really need to do IVM. Yes, successes have been reported, but not that many because it's not that applicable to that many people.

Is IVM safer for PCOS patients?
People talk about how it's safer for women who have polycystic ovaries because they can avoid hyperstimulation... this is true, but there are other ways to avoid this through IVF and still have very high outcome. Prolonged coasting and other types of protocal medication alteration to avoid hyperstimulation. In Dr. Ahlerings opinion, less than 1% of patients would suffer from hyperstimulation.

Is IVM more affordable than IVF?
What about cost? Isn't it more affordable? Isn't it easier on the woman? Yes, the process itself is cheaper, but if you're trying to save money on the goal of having a baby, it just won't work because you'll have to try more times, so the cost goes up and is most often higher. Do we even know how the eggs will respond to this outside of the body? You have to get a lot of eggs to make a baby with IVM (25-30 mature eggs), compared to IVF (10-12 mature eggs) because a lot of them are lost through the process. An article about IVM where success rates are in low teens. That same young PCOS patient would have a 50-60% single cycle chance.

Egg retrieval for IVM

How do you retrieve the eggs given they're so small? It's just like IVF in a lot of respects. A mature follicle at the time of ovulation is 18-22mm, whereas an immature follicle is much smaller - more like 5-6mm because it's an immature egg. Those immature follicles are always there in a PCOS patient. You can go get eggs and you retrieve just like you would during IVF. During an IVM retrieval you might get 30 immature eggs. And after 24-48 hours you would have a certain number of mature eggs.

Genetics of the egg following IVM
Have we seen enough babies yet to know if we're harming the baby? There haven't been enough studies done. It's doubtful that the process itself would increase birth defects. The problem is that most eggs won't make it to the point of baby.

Is hyperstimulation deadly?
Can women die from hyperstimulation? Maybe that's why a lot of women find IVM appealing. No, practically speaking I don't know how it's possible where you would run into a circumstance where hyperstimulation would be so bad that she would end up in the hospital and be close to death. People who have lots of follicles and eggs are prone to a condition called ovarian hyperstimulation syndrome. For all women who undergo IVF, to a large degree we create a controled hypersimulation of sorts in the sense that they are creating lots of follicles (not just one like you would during a typical non-IVF cycle). The common rule of thumb is that you get a lot of follicles and there is no illness from it.

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