Treatment of women with PCOS with CAPA IVM – Drug-Free IVF protocol resulting in India’s first CAPA IVM baby

Shiva (35) and Shylaja (33) married for 5 years were diagnosed with primary infertility. They had undergone multiple failed OI TI cycles and was referred to Oasis Fertility with severe PCOD. Dr Jalagam Kavya Rao, Clinical Head & Fertility Specialist, Oasis Fertility, Warangal conducted a fertility evaluation for both the husband and wife. After the investigations, Shylaja was found to have an AMH of 11.7 and an irregular menstrual cycle. The husband had a normal sperm count with a slight decrease in sperm motility.

Dr Kavya made a thorough investigation of the couple and planned for an IUI cycle initially. As no dominant follicles were observed during the course of treatment, Dr Kavya advised the patient to take up IVF. But as the patient was worried about too many injections, medications, and the physical, emotional, and financial trauma associated with IVF, Dr Kavya suggested the patient CAPA IVM which is a Drug-Free IVF procedure an alternative to traditional IVF with the advantage of being economical and less intensive and which could give hope and confidence to the couple.

*The names of the couple have been changed to maintain confidentiality.

What is CAPA IVM?

IVM has been shown to offer promising results in helping a subset of the population to conceive. Though IVM has been available for many years, the pre-maturation step that has been added in recent times has shown better outcomes than seen previously.

CAPA IVM is a drug-free IVF treatment and also results in comparable outcomes to traditional IVF. Also called Biphasic In Vitro Maturation, it is the advanced version of the IVM protocol and Oasis Fertility is the only centre in India that has the expertise and experience in this treatment.

CAPA IVM comes to the rescue of those women who are concerned about medications, and hormonal injections being given and those who prefer to try an economical and less intensive treatment.

For whom CAPA IVM can be recommended?

• Women with PCOS
• Patients with malignancy & who need immediate treatment (IVF is a 2-week process and hence not suitable)
• Resistant Ovary Syndrome
• Patients with Thrombophilia &
• Oocyte maturation problems

Dr Kavya initially planned an IUI protocol for the couple that included Letrozole + HMG 75 IU followed by 2 doses of Gonadotropins for 2 days (Day 3 & Day 5) and along with Gonadotropin, Letrozole was administered from Day 3 to Day 7. A follicular scan was done on day 9,11,13,16. 4 HMG 150 injection was given on Day 18 but no dominant follicle was observed. Shylaja was on Dexamethasone (1 mg) throughout the cycle. On Day 21, the cycle was canceled as Shylaja was found to have resistant PCOD.

Dr Kavya decided to offer CAPA IVM, the advanced drug-free protocol that could enable Shylaja to conceive with very few injections and no side effects. On Day 1, 2 and 3 of her periods, Menopur 150 was given and after 3rd dose, immature oocytes were retrieved from Shylaja and 2 steps of maturation were carried out.

a. Oocytes were cultured in 24-hrs Prematuration Step (medium containing C-type natriuretic peptide)

b. These Oocytes were again incubated in 30 hrs Maturation Step (medium containing follicle stimulating hormone & Amphiregulin)

The prematuration step improves the maturation potential of oocytes following which ICSI can be done. 20 oocytes were retrieved and fertilization was done after which 8 Grade 1 embryos were got on Day 3. 4 Grade 1 embryos were frozen on Day 3 and the remaining were cultured till Day 5. Sequential embryo transfer was done with 2 Day 3 and 1 Day 5 blastocyst which led to the birth of the first CAPA IVM baby in India. The research pursuit, commitment, and perseverance of Dr Kavya and her team of embryologists have created history. The couple was happy as they got a positive outcome without many injections, complications, or high costs and after many years of failed treatment which was physically, emotionally, and financially demanding.