Follicular aspiration during the selection phase prevents severe ovarian hyperstimulation in patients with polycystic ovary syndrome who are undergoing in vitro fertilization

Live birth following vitrification of in vitro matured oocytes derived from sibling smaller follicles at follicle selection phase in the context of in vitro fertilization

In ovarian stimulation, a 31-year-old woman with polycystic ovary syndrome was at the risk of developing ovarian hyperstimulation syndrome, follicle aspiration was performed, and eight immature oocytes were collected from follicle fluids. After 28 h in vitro culture, six of them reached MII and were vitrified. The patient failed to conceive in her fresh in vitro fertilization cycle and next two replacement cycles. In the third replacement cycle, a successful pregnancy was obtained by vitrified-thawed oocytes. This case demonstrates that follicular aspiration during follicle selection phase has protective effects against developing ovarian hyperstimulation syndrome, and rescued immature oocytes are viable and could produce promising embryos for live birth.

Review of the evidence base of strategies to prevent ovarian hyperstimulation syndrome

The English-language literature was reviewed to examine the evidence base for strategies that have been used to prevent ovarian hyperstimulation syndrome (OHSS). Prediction of OHSS by pretreatment patient characteristics and ovarian response parameters is unreliable, with a significant number of OHSS cases occurring in patients not thought to be high risk, while the majority of 'high-risk' cycles do not result in OHSS. Alternatives to ovarian stimulation should always be considered, depending on the clinical situation. Monofollicular ovulation induction with a cautious step-up regime carries a lower risk of overstimulation than step-down regimes. In in vitro fertilization (IVF) cycles, a low starting dose of follicle-stimulating hormone (FSH) and the use of 5000 iu human chorionic gonadotrophin (hCG) for final follicular maturation may benefit patients at high risk of OHSS. The role of GnRH antagonists is unclear. In women with polycystic ovaries, who are undergoing ovarian stimulation for IVF, metformin co-treatment may reduce the risk of OHSS. Coasting of cycles with over-response is associated with a reduced risk of OHSS, although precise criteria for initiating and ending coasting are not definable at present. Elective cryopreservation of all embryos prevents late OHSS, but its value has been poorly researched. The literature does not support a role for intravenous albumin, administered around the time of oocyte retrieval, in preventing OHSS. Evidence is insufficient regarding a possible role for hexa-ethyl starch. hCG should not be used for luteal support, as it is associated with a higher risk of OHSS, and equivalent pregnancy rates are obtained with the use of progesterone.

Injection of day 2 embryo culture supernatant into the uterine cavity did not improve the pregnancy rate of day 3 embryo transfer in patients who underwent in vitro fertilization-embryo transfer: a randomized clinical trial

OBJECTIVE

To evaluate the effectiveness of uterine cavity injection of day 2 embryo culture supernatant before day 3 embryo transfer in patients who are undergoing in vitro fertilization-embryo transfer.

DESIGN

Randomized controlled trial.

SETTING

A reproductive medical centre.

PATIENT(S)

A total of 90 infertile women, 45 of them in the study group and 45 in the control group.

INTERVENTION(S)

Uterine cavity infection of day 2 embryo culture supernatant before day 3 embryo transfer.

MAIN OUTCOME MEASURE(S)

Embryo implantation rate and pregnancy rate.

RESULT(S)

The pregnancy versus implantation rates in the study group and control group were 48.9% versus 44.4% and 27.3% versus 22.1%, respectively. Although both pregnancy and implantation rates in the study group were higher than those in the control group, no statistically significant differences were found in these two parameters.

CONCLUSION(S)

Injection of day 2 embryo culture supernatant into the uterine cavity cannot improve the implantation and pregnancy rates of day 3 embryo transfer.