Cultured Pearls
Cultured pearls are created by the same process as natural pearls. That is, they result from the introduction of an irritant inside the shell of certain types of mollusks (i.e., oysters, clams, etc.). The difference is that, in the case of cultured pearls, the irritant is inserted rather than being naturally occurring. Natural pearls are caused by a grain of sand or something of similar size. Cultured pearls generally start with a much larger irritant (relative to a grain of sand), but it still takes two to three years for the pearl to be created after the insertion of the irritant. Freshwater cultural pearls don't require an irritant; these are created by making a small slit on the inside lining of the mollusk.
Cultured pearls are authentic pearls. They are made exactly the same way a natural pearl is in that a pearl oyster secretes the same mineral and protein around an irritant.
Are cultured pearls as valuable as natural pearls? Natural pearls once commanded much higher prices than cultured pearls. Today, however, many cultured pearls can come with quite a hefty price tag. Often natural pearls are imperfect, but the culturing process can create pearls of superior size, color, and shape.
To sum up, cultured pearls are real pearls. They are harvested, not manufactured. Cultured pearls require the same type of care as natural pearls. Imitation pearls are artificial and are completely man-made while cultured pearls are made by mollusks, with a little help from mankind.