体外成熟（IVM）：比体外受精（IVF）更便宜、更安全的替代方案

The most important well-recognised danger to the women undergoing IVF treatment is ovarian hyper stimulation syndrome (OHSS). The most severe form occurs in 1 % of women undergoing treatment especially those with polycystic ovary syndrome (PCOS). Those with ovarian hyper stimulation syndrome as results of daily injections with medications will produce too many eggs which may be associated with ovarian enlargement, abdominal distension, accumulation of fluid in the abdomen and blood in the body to be concentrated. These conditions if severe can be fatal. It is more likely to happen in young women with polycystic ovary syndrome (PCOS), a leading cause of infertility. Women with polycystic ovary syndrome (PCOS) are usually obese, have irregular menstrual cycle and infertile.

In IVM all the risks associated with IVF are being minimised. It is presently a useful procedure for two groups of women: those who are fertile, with normal cycles, who don’t need stimulating hormones to help them to become pregnant, but who are undergoing IVF because their partners have impaired sperm, and for women with polycystic ovarian syndrome (PCOS) who are at an increased risk of developing ovarian hyper stimulation syndrome (OHSS) during IVF hormone treatment.

In IVF, one of the main factors affecting the success rate is the age of the women. This is likely to be the case in IVM. Generally women who are less than 35 years tend to respond better. The other important factor is the number of immature eggs collected. The more number of eggs collected, the more embryos are produced, and therefore the greater the choice of embryo selection for transfer. About 70% of the immature eggs retrieved will be successfully matured in the laboratory. But only 60% of the mature eggs, following fertilisation will develop into embryos.

The major disadvantage in IVM is its success rate which is only between 20 to 25%. This figure is very low compared to IVF which can be as high as 45%. However IVM is at the infant stage. When IVF started in the 1980s the success rate then was only 14%. Another major shortcoming with IVM is that the cultured mature eggs have hardened egg shells. As result of this, insemination can only be done by micro injection of sperm into the egg or ICSI. Finally the culture media use to nurture the eggs to maturity need to be improved. It is hope that by improving the culture media, the percentage of mature eggs per cycle of treatment would improve.

IVM is a potentially cheaper, shorter and a safer option of treatment for infertility. However, its usefulness is presently limited to only a few groups of patients. More research is needed to support its use. It’s now up to the scientists to explore this revolution in fertility treatment.

Summary:

1. IVF is more expensive than IVM. The cost of treatment ranges between RM15000 to RM18000 while IVM may cost only around RM5000 to RM8000 per treatment cycle.
2. All risks associated with IVF are less in IVM especially Ovarian Hyperstimulation Syndrome (OHSS).
3. IVM is a new technology and hence the success rate is low compared to IVF. More research is needed to support its use.
4. IVF will remain the mainstay of treatment for infertile couple while IVM may be suitable to certain groups.