Australian researchers are leading the charge in the development of a fertility treatment that will be cheaper, safer, faster and less invasive than traditional IVF.
This new form of IVM, or In Vitro Maturation, functions in a similar way to IVF but differs in the time at which the eggs are extracted leading to, among other things, a 90 per cent reduction in the drugs a woman is subjected to.
How it differs from IVF
During IVF treatment, women undergo one to four weeks of hormone stimulation that encourages the production of a large numbers of eggs. This is followed by 12 to 15 days of injections to stimulate egg growth, and after reaching a mature stage, the eggs are extracted for fertilisation.
This process comes with an array of side effects as the hormones needed to induce a temporary menopause which can cause hot flushes, night sweats, mood swings and loss of libido.
Women also have to undergo multiple blood tests and unpleasant transvaginal ultrasounds to monitor egg growth, which increase costs and require patients to make several visits to their clinician, often during office hours.
Conversely, IVM treatment extracts the eggs at a much earlier, immature stage, and therefore requires only two or three days of hormone stimulation. Along with a significant reduction in the use of drugs, this method also means the woman is subject to fewer tests as the eggs are monitored through maturation in the laboratory rather than in the body.
This technique has been in existence for about as long as traditional IVF but hasn’t been as popular historically as it’s only about two thirds as successful.
However, in a joint effort between the University of NSW, University of Adelaide and the Free University of Brussels in Belgium, researchers are developing a new process of maturing the egg that greatly increases yield and quality according to recent tests.
The idea is that this improvement in the procedure will bring the rate of pregnancies via IVM – which is currently at around 30 to 35 per cent in women under the age of 35 – to very close to, or in line with, that of IVF – which is 40 per cent in women under the age of 35.
During a press conference, Professor William Ledger of UNSW states that although the initial goal isn’t to surpass the success rate of IVF treatment, he believes this improved IVM treatment will be a much more palatable option for women.
“This will be a lower cost option as well as an option that will be less stressful and unpleasant for patients and safer,” he explains, before adding, “The drug cost with IVM will be negligible in comparison to IVF”.
A major reason why women drop out of IVF after their first failed cycle is because of the “emotional and physical burden of the treatment” Professor Ledger says.
“It’s a hard thing to do IVF, and many people do it once and don’t have a pregnancy. We’d like them to come back and do it again because the prognosis is good for pregnancy if they persevere, but they’re just not able to do it a second or third time.”
This will be a lower cost option as well as an option that will be less stressful and unpleasant for patients and safer.
“In contrast, the IVM process is over with in just a few days, it’s much less emotionally and physically challenging, probably one or upmost two ultrasounds and blood tests to be done, so it’s less time off work and much more able for her to cope,” he explains.
An additional advantage is for women who suffer from polycystic ovarian syndrome (PCOS) which accounts for 7 to 15 per cent of Australian women of child bearing age.
The hormones needed to stimulate egg production and maturation in IVF can often overstimulate the ovaries of people with PCOS, creating too many eggs and potentially leading to a spike in oestrogen which, along with other factors, can cause ovarian hyper stimulation syndrome.
Similarly, young cancer patients who wish to undergo fertility preservation before chemotherapy would benefit from improved IVM, as in some cases women don’t have enough time to undergo a full cycle of IVF, or the necessary drugs could affect the status of their cancer.
The difference between the current IVM treatment and the improved one stems from the University of Adelaide’s discovery of a growth factor named cumulin. Cumulin can be produced in the laboratory and is added to the immature eggs in conjunction with cyclic adenosine monophosphate.
This addition to the traditional IVM process results in the improved quality of the eggs as well as a 50 per cent increase in embryo yield.
“We see when we treat pig eggs with cumulin we get a doubling in embryo yield,” explains Associate Professor Robert Gilchrist from UNSW.
“Whereas in humans, in the very small numbers at the very early stage that we have, we have a 50 per cent improvement in embryo yield above standard IVM,” he adds.
Having demonstrated that the results they were able to attain in animals can be replicated in humans, the procedure now needs to be tested on much larger numbers and on different types of patients before being approved for clinical use by regulatory authorities.
Safety tests are also currently underway in Brussels and Associate Professor Gilchrist says “the preliminary evidence looks like this procedure appears to be safe but we need to do more work on that.”
As testing in humans has been limited as yet, it is estimated that the availability of this improved treatment is still three to five years away.