Thursday, 14 February 2019


 In-Vitro Maturation, commonly known as IVM, is an Assisted Reproductive Technology (ART) that involves collecting eggs from a woman before they are matured using hormonal injections. The eggs which are not yet mature are collected via a minor surgical procedure. Then, the premature eggs are matured in a culture using hormones. Eventually, the matured eggs are manually fertilized using a process called Intracytoplasmic Sperm Injection (ICSI). Once the embryos have time to begin development, they are transferred into the woman’s womb and the wait begins to see if pregnancy occurs.

How IVM is beneficial                     
IVM requires less medication than conventional IVF and lowers the immediate cost of treatment; however, the pregnancy rates are also lower, so it is unclear whether IVM is more cost-effective. An IVM cycle also takes less time.

Anti-Müllerian hormone, also known as Müllerian-inhibiting hormone, is a glycoprotein hormone structurally related to inhibin and activin from the transforming growth factor beta superfamily, whose key roles are in growth differentiation and folliculogenesis. Anti-mullerian hormone or AMH is produced by granulosa cells (cells lining the egg sacs or follicles) within the ovary. AMH can also help reproductive endocrinologists predict a woman’s response to ovarian stimulation and to determine the best strategy for IVF treatment.

Understanding AMH and its role in fertility
Inside the ovaries are follicles — pouch-like cavities that contain developing oocytes (eggs). A woman is born with all of the eggs she will ever have, and during the average 28-day menstrual cycle, the follicles release one mature egg into one of two fallopian tubes for fertilization to occur.

Learning the capacity of a woman’s follicle pool helps a fertility specialist determine fertility potential. Since very immature, primordial ovarian follicles produce AMH, specialists can use the results of blood work to assess egg supply.

What does AMH testing reveal?
AMH testing is performed as part of a complete fertility evaluation, along with FSH and estradiol blood testing and a transvaginal ultrasound assessment of the number of visible antral follicles.

Unlike other hormones, AMH levels do not fluctuate during the menstrual cycle, so the blood sample can be taken at any time of the month. A lower AMH value is found in women with a diminished ovarian reserve and those who are close to menopause. Women with lower AMH values will tend to have a poor response to ovarian stimulation for IVF, and may have fewer eggs retrieved.

What testing doesn’t reveal
While AMH gives fertility specialists a clue as to the quantity of remaining eggs, it cannot reveal the quality of those eggs; nor can the results definitively rule out conception.

Who can benefit from AMH testing?
• Women over 36 not able to conceive after 6 months of trying
• Women under 36 who have been trying to get pregnant for about 12 months
• Patients considering IVF or egg freezing, as low levels of AMH can indicate a potentially poor response to ovarian stimulation
• Women who have had chemotherapy or radiation to the pelvic region who want to know if it has affected their future fertility
Low AMH: What can be done?
A low AMH value doesn’t automatically mean you will have difficulty getting pregnant. A woman younger than 35 with a decreased egg reserve differs from an older woman with a diminished reserve. Because of her age, a younger woman’s egg quality may still be high.

When AMH and other tests point to a diminished ovarian reserve, fertility professionals can tailor treatment plans to yield promising results. Such protocols include freezing eggs or embryos for future use, and adjusting the doses of ovarian stimulation drugs to maximize the number of eggs harvested.
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