You've heard about IVF - but could IVM be better?

A woman who ten years ago became the first to conceive thanks to a course of a pioneering fertility treatment called In Vitro Maturation (IVM), celebrated her twins' 10th birthday this week. 

Tina Milkovic was the first woman to receive what was then a brand new form of fertility treatment, and went on to be the first to conceive thanks to IVM. 

An alternative to IVF, the treatment allows women with polycystic ovaries to have a chance at a safe assisted conception, as the drugs involved in IVF can pose a serious health risk to sufferers of PCOS (polycystic ovarian syndrome). 

Diagnosed with PCOS (which can affect ovulation, making it more difficult to conceive naturally) in her 20s, Tina and her husband Joe had already been trying for a baby for a year before they sought help from a fertility clinic in Oxford. 

"At the time all I knew about was IVF. But the problem with IVF is that it has some quite severe side effects to women like myself who have PCOS," says Tina. "We were going to embark on IVF and had even bought the drugs, but we were quite fortunate - just before we were about to start the licence was granted for IVM and we decided to try the new technique because there was less risk involved for me."

Tina fell pregnant after just one round of IVM - which sees the eggs matured in the lab before being implanted into the womb lining, rather than in the ovaries - and went on to have a healthy pregnancy with her daughter, Isabella, and son, Ilia, who are now thriving ten-year-olds. 

But a decade later, the treatment is still used in a relatively small number of cases, with around 3000 babies born after IVM worldwide, compared to more than a million after IVF.

We look at what this little known treatment entails.

How does it differ from IVF?

IVM specialist Tim Child explains that while the implantation process is almost exactly the same, the eggs are matured in a lab rather than in the woman's ovaries as with IVF. "During an IVM cycle we don't stimulate the ovaries with drugs. We do a scan, we look at the resting follicles in the ovaries and then we use the same needle that we would use for an IVF egg collection to go through the top of the vagina and then with that needle we drain these tiny follicles, and we take the immature eggs out of the ovaries, and then mature the eggs in the laboratory for one to two days.

"So rather than let them mature in the body, they mature in the laboratory, giving them the drugs they need there.

"Once they've matured, it's then the same as an IVF cycle, we fertilise them in the lab and then put them back. "

What are the benefits of IVM?

The chief benefit for sufferers of PCOS is that you are not having to inject your body with high levels of hormones. Mr Child explains: "During IVF the woman has around two weeks of a daily injection of a drug to stimulate the ovaries.

"The downside of stimulating the ovaries is that the woman's hormones go high during an IVF cycle, so she can get bloating, breast tenderness and various other symptoms. And in about one per cent or more of IVF cycles, the degree of stimulation will be so severe that she'll develop a complication called OHSS which is basically over stimulation, and she'll end up in hospital.

"Some people say they won't even go through another IVF cycle because they felt so unwell with OHSS. 

"It has even, rarely, been a fatal condition."

Why don't more women opt to have IVM?

IVM is still used in only a small number of cases not because it's a high risk treatment, but because the success rate is half that of IVF. 

Mr Child explains that around 25 per cent of patients in his Oxford Clinic conceive using IVM, whereas the success rates with IVF are double that. "There are a couple of different possible reasons for that," he says. "The first is that the eggs probably prefer to be matured in the woman's body because it's more natural. The second is that the endometrium - the womb lining - hasn't had all the hormones around to help prepare it for an embryo emplanting, so when we put an embryo back, the womb lining is probably not receptive.

"Patients often understandably vote with their feet and will say I like the idea of IVM but if IVF works better I'll take that."

Advice | Types of fertility treatment

What is the future of IVM?

Though it is still not available on the NHS, IVM costs significantly less than IVF (one round costs about ￡3500 compared to ￡5500 for IVF). You can also do safely do more rounds of it and the whole process is a lot quicker. 

All this points to researchers finding a way to increase the success rate of IVM, to make it a viable option for more women. Mr Child says they are now looking at giving women hormone tablets which will "get the womb lining ready for implantation" and therefore hopefully increase the success rate.