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Clinical applications of IVM
In vitro maturation is an assistive reproductive technique (ART) typically used in patients with fertility issues including polycystic ovary syndrome (PCOS), high antral follicle counts and ovarian hyper-responsiveness. However, more recently IVM has also become widely utilised in areas such as fertility preservation in cancer patient who have undergone treatment involving gonadotoxic therapies .There have been over 1000 live births recorded from mothers using IVM.

Polycystic Ovary Syndrome
PCOS is a common disorder involving dysfunction of the endocrine system associated with female reproduction. PCOS involves discrepancies in the Hyphophyseal-pituitary-gonadal endocrine axis which can result in hormonal dysfunction, excess androgens (e.g. testosterone) and frequent anovulatory menstrual cycles. Therefore, it is common for women suffering from PCOS to require assistance in order to conceive In these patients IVM can be used to mature oocytes and aid conception.

Comparison to IVF
The use of in vitro maturation in assisted reproduction has advantages over standard ART procedures. In typical IVF practice, supraphysiological levels of gonadotropins are administered to the patient in order to hyperstimulate the antral follicles and hence induce oocyte maturation to metaphase ii at a rate that is above normal physiological capabilities. This practice can be disadvantageous in several ways: It is very costly, can become complicated and may also predispose to several undesirable side effects, such as ovarian hyperstimulation syndrome (OHSS).

In IVM, immature oocytes are removed from the antral follicle of a woman and then are matured in vitro in a culture rich in gonadotrophins. This hence negates (or significantly reduces) the need for gonadotrophin stimulation.

IVM is not an entirely perfected technique. Pregnancy rates are lower in IVM than in standard IVF. There is also research required into whether or not babies born to mothers who have undergone IVM have any health concerns (e.g. developmental issues) later in life.

Ovarian hyperstimulation syndrome (OHSS)
The hyperstimulation of the ovaries in practices like IVF can result in mild ovarian hyperstimulation syndrome (OHSS) in more than 20% of cases. This same hyperstimulation can cause severe OHSS in up to 2% of cases. OHSS can have serious consequences, including respiratory problems, renal impairment and even stroke.

Patients with PCOS and younger women are at an increased risk of OHSS. In these women, it may be even more beneficial to employ IVM rather than conventional IVF treatment.

Oestrogen associated risk factors
Women with a personal or family history of an oestrogen associated thrombus, or of severe cardiovascular disease, may also benefit from IVM (2). This is because conventional IVF, with its hyperstimulation of the ovaries, has the potential to stimulate mass synthesis of oestrogen via the stimulation of granulosa cell oestrogen production.

Empty Follicle Syndrome
IVM may also be an important consideration for female patients diagnosed with empty follicle syndrome (EFS). In EFS, no oocytes are retrieved from mature ovarian follicles despite the application of supraphysiological levels of gonadotrophins. A woman can be diagnosed with EFS after she has undergone multiple rounds of IVF with total (or near total) failure in each round.

Rescue IVM
Rescue IVM is a variant of classical In vitro maturation that involves attempting to mature immature oocytes that have been removed from a patient secondary to ovarian hyperstimulation in standard IVF practice. Therefore allowing for more oocytes to mature to the developmental stage where they can be developmentally viable. However, rescue IVM has been considered  a controversial field: If oocytes have not matured sufficiently in vivo – despite exposure to significant levels of gonadotrophins- it may be indicative of dysmaturity and of a limited potential developmentally.