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IVM(in vitro

maturation)
PRESENTED TO : DR AKHTAR RASOL
PRESENTED BY :
2013-VA-204
2013-VA-206
2013-VA-209
2013-VA-210

IVM
It

is a technique in which we mature oocytes


outsides uterus in any artificial media.

Alternative

to IVF

Successful

in many species including human

First

attempted at the Oxford Fertility Clinic in


the UK since its introduction in the 1990s, ,
IVM is considered a lower-risk alternative to
IVF. Its first trial resulted in healthy twins.

Medium
There

are two types of medium used:

TCM-199
Hams

(tissue culture medium)

F12

For maturation cultural medium is supplemented with cells


(granulosa and cumulus) and hormones (FSH, LH) to increase
efficiency of that to increase the maturation rate. Mineral oil is
used to provide some nutrition and check abnormality of oocyte.
It is called co culture technique.

BOEC: Bovine oviductal epithelial cells

Assessment of Oocyte

Criteria for assessment:

Continuity of zona pellucida (zona is double layered and its


diameter is 12-15 m)

.The arrangement of blastomeres in the zona: they should be


arranged in circular fashion and no extension of cells from the
zona.

Blastomeres should be of uniform size.

Presence of degenerative area: If degeneration present it will


appear as black area. It is in %age.

Presence of vacuole.

IVM

Excellent A: Ideal, spherical, symmetrical with uniform


blastomeres, no degenerative area and no vacuole formation.

Good B: Few extrusion of blastomeres, irregular shape, one


or two vacuoles

Fair C: Extruded blastomeres, vacuole formation with 19


% degenerative area

Poor D: Numerous extruded blastomeres, more variation in


size, more vacuoles, degeneration upto 25%

Unfertilized: There will be no cell and just spots present

Types of petri dish

1- glass

2- plastic

Types of culture drops


1- larger culture drops 500 ul
2- smaller culture drops 100ul

Culture Conditions For


Maturation

Temp 39 c

Humidity: 98-100 %

CO2 concentration: 2%

Upto morula stage 5% CO2 is required

Keep in incubator for 20 hrs

Types of maturation

1- cytoplasmic

2- nuclear

For staining; fixing of oocyte with acetic acid and staining with 1 %
aceto orecin to check nuclear maturation

How does IVM work?

The procedure for IVM is as follows:

Step 1.As in conventional IVF, eggs are collected, but at an


earlier stage, when they are immature. This means that you do
not need to take as many ovary-stimulating hormones before
your eggs are collected.

Step 2.The eggs are matured in a dish placed in an incubator in


the laboratory for one to two days.

Step 3.When the eggs are mature, they are fertilised with your
partners, or donors sperm. Embryos are cultured then
transferred to your womb, just as they would be with
conventional IVF treatment.

IVF vs IVM

ICSI

Huang et al were the first to suggest the application of IVM as a


fertility preservation method in Patients exposed to a risk of
premature ovarian failure. These investigators have reported that
for oocyte vitrification, the average number of oocytes retrieved
was 11.4, the IVM rate was 64.2%, and an average of 7.9 mature
oocytes were vitrified per patient.

Risk of IVM

The known risks of IVM are:fewer eggs are collected than in


conventional IVF

the usual risks involved in having a general aesthetic.

Larger size than normal

More chances of dystokia

Birth weight higher than normal

Longer gestation period

What Are the Benefits of IVM?

The most obvious benefit of in vitro maturation is the elimination


of hormone injections to force the production of mature eggs.
These hormone drugs require a serious time commitment and
frequently involve pain, discomfort, and the risk of injection-site
swelling and infection. IVM reduces those risks by harvesting
immature eggs rather than mature eggs. When a woman goes in
for IVM treatment, she only undergoes a single hormone injection
38 hours before egg retrieval.

IVM is less expensive and less time-consuming than traditional


IVF. It does cause an elevated risk of ovarian hyperstimulation
syndrome, which can be painful and potentially harmful to the
patient.

Reference

Trounson A, Wood C, Kausche A. In vitro maturation


and the fertilization and developmental competence
of oocytes recovered from untreated polycystic
ovarian patients

. Fertil Steril. 1994;62:353362. [PubMed]2. Cha KY,


Chian RC. Maturation in vitro of immature human
oocytes for clinical use.

Hum Reprod Update. 1998;4:103120. [PubMed]3.


Edwards RG. Maturation in vitro of human ovarian
oocytes. Lancet. 1965;2:926929.