Is there a drug-free alternative to IVF?

A new fertility treatment called IVM may take over from IVF. Rachel Liddle reports

What is the story?

Women struggling to conceive could benefit from a rival method to IVF that is ‘better than nature’, the national press reported.

Women undergoing in vitro maturation (IVM) will not be pumped with drugs used in normal IVF, reducing the risk of side- effects such as ovarian hyperstimulation, said the papers.

This is because rather than promoting maturation of eggs in the ovaries before they are harvested, as in IVF, IVM involves the collection of immature oocytes that are matured in the laboratory. Few or no drugs are needed for this process.

The cost for assisted reproduction in Denmark fell from £1,400 to £140 per cycle. The technique there has resulted in 400 healthy babies and over 1,000 pregnancies. However, only an estimated 12 per cent of couples trying to conceive would benefit from the process. Women need to be younger than 35 and suffer from complications such as polycystic ovary syndrome that do not affect egg production.

What is the research?

The findings were presented at the First World Congress on Natural Cycle/Minimal Stimulation IVF held in London last month.

Professor Svend Lindenberg, from the Nordica Fertility Clinic in Copenhagen, presented the outcomes of more than 1,000 cycles of IVM.

It was associated with a conception rate of 30 per cent. This compares with a rate of 20 per cent for a reproductively healthy woman trying for a baby naturally. For IVM, women are given follicle-stimulating hormone (FSH) for three days early in the cycle for light ovarian stimulation. Up to 10 oocytes are then harvested. Over the next 24 hours, the collected oocytes are exposed to FSH at a dose 100 times smaller than that typically given to women during IVF. The eggs are then left to mature without FSH.

Only women younger than 35 years old, with polycystic ovary syndrome or multifollicular ovaries are eligible for the treatment. The highest pregnancy rates are in women with prior hyperstimulation syndrome.       

What do the researchers say?

Professor Lindenberg said: ‘We are achieving results that are better than nature and as good as high-stimulation IVF without the risk of potentially life-threatening ovarian hyperstimulation and of course saving thousands of pounds per cycle in the cost of drugs.’

The development of IVM has largely been driven by women reluctant to take IVF drugs because the fertility problem lies with the male partner, he explained.

‘Now we have the evidence that high-dose stimulation is unnecessary and the evidence that IVM works, there is no excuse to continue giving women high doses of stimulation that cost their health, financial and emotional well being.’

What do other experts say?

Geeta Nargund, consultant gynaecologist at St George’s Hospital London, is president of the International Society of Natural Cycle Assisted Reproduction, which hosted the conference.

‘IVF with high stimulation must be on its way out,’ she said. ‘It’s not in the interest of women or the children.’

Concerns that high-stimulation IVF can cause damage to the endometrium and the embryo have led to alternatives such as IVM being developed.

Clinics in Denmark, Canada, Hong Kong, Korea, Denmark and France have started to carry out IVM, said Mrs Nargund.

‘I’m hoping we would also start to offer IVM to women in the UK.’

Professor Bill Ledger, an expert in fertility medicine at the University of Sheffield, said that while IVM may be safer than IVF, it is unlikely to be more effective. The high success rate may be because patients are younger and more likely to succeed with any form of IVF.

‘The big advantage is much more to do with the safety and reduction in ovarian hyperstimulation for those high-risk women,’ he said.

But the cost of setting up laboratories capable of maturing eggs for IVM is a barrier to the procedure becoming widely available in the UK, added Professor Ledger.

Informing patients

  • IVM involves the collection of immature oocytes for maturation in the lab. 
  • It is only useful for women younger than 35 with polycystic ovary syndrome. 
  • IVM reduces the quantity of IVF drugs needed and the risk of ovarian hyperstimulation.
  • It is not currently available in the UK.

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