1
|
Gilchrist RB, Ho TM, De Vos M, Sanchez F, Romero S, Ledger WL, Anckaert E, Vuong LN, Smitz J. A fresh start for IVM: capacitating the oocyte for development using pre-IVM. Hum Reprod Update 2024; 30:3-25. [PMID: 37639630 DOI: 10.1093/humupd/dmad023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/08/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND While oocyte IVM is practiced sporadically it has not achieved widespread clinical practice globally. However, recently there have been some seminal advances in our understanding of basic aspects of oocyte biology and ovulation from animal studies that have led to novel approaches to IVM. A significant recent advance in IVM technology is the use of biphasic IVM approaches. These involve the collection of immature oocytes from small antral follicles from minimally stimulated patients/animals (without hCG-priming) and an ∼24 h pre-culture of oocytes in an advanced culture system ('pre-IVM') prior to IVM, followed by routine IVF procedures. If safe and efficacious, this novel procedure may stand to make a significant impact on human ART practices. OBJECTIVE AND RATIONALE The objectives of this review are to examine the major scientific advances in ovarian biology with a unique focus on the development of pre-IVM methodologies, to provide an insight into biphasic IVM procedures, and to report on outcomes from animal and clinical human data, including safety data. The potential future impact of biphasic IVM on ART practice is discussed. SEARCH METHODS Peer review original and review articles were selected from PubMed and Web of Science searches for this narrative review. Searches were performed using the following keywords: oocyte IVM, pre-IVM, biphasic IVM, CAPA-IVM, hCG-triggered/primed IVM, natural cycle IVF/M, ex-vivo IVM, OTO-IVM, oocyte maturation, meiotic competence, oocyte developmental competence, oocyte capacitation, follicle size, cumulus cell (CC), granulosa cell, COC, gap-junction communication, trans-zonal process, cAMP and IVM, cGMP and IVM, CNP and IVM, EGF-like peptide and IVM, minimal stimulation ART, PCOS. OUTCOMES Minimizing gonadotrophin use means IVM oocytes will be collected from small antral (pre-dominant) follicles containing oocytes that are still developing. Standard IVM yields suboptimal clinical outcomes using such oocytes, whereas pre-IVM aims to continue the oocyte's development ex vivo, prior to IVM. Pre-IVM achieves this by eliciting profound cellular changes in the oocyte's CCs, which continue to meet the oocyte's developmental needs during the pre-IVM phase. The literature contains 25 years of animal research on various pre-IVM and biphasic IVM procedures, which serves as a large knowledge base for new approaches to human IVM. A pre-IVM procedure based on c-type natriuretic peptide (named 'capacitation-IVM' (CAPA-IVM)) has undergone pre-clinical human safety and efficacy trials and its adoption into clinical practice resulted in healthy live birth rates not different from conventional IVF. WIDER IMPLICATIONS Over many decades, improvements in clinical IVM have been gradual and incremental but there has likely been a turning of the tide in the past few years, with landmark discoveries in animal oocyte biology finally making their way into clinical practice leading to improved outcomes for patients. Demonstration of favorable clinical results with CAPA-IVM, as the first clinically tested biphasic IVM system, has led to renewed interest in IVM as an alternative, low-intervention, low-cost, safe, patient-friendly ART approach, and especially for patients with PCOS. The same new approach is being used as part of fertility preservation in patients with cancer and holds promise for social oocyte freezing.
Collapse
Affiliation(s)
- Robert B Gilchrist
- Fertility & Research Centre, Discipline of Women's Health, School of Clinical Medicine, University of New South Wales Sydney, NSW, Australia
| | - Tuong M Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Michel De Vos
- Brussels IVF, UZ Brussel, Brussels, Belgium
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Flor Sanchez
- Centro de Estudios e Investigaciones en Biología y Medicina Reproductiva, Lima, Peru
| | - Sergio Romero
- Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru
- Centro de Fertilidad y Reproducción Asistida, Lima, Peru
| | - William L Ledger
- Fertility & Research Centre, Discipline of Women's Health, School of Clinical Medicine, University of New South Wales Sydney, NSW, Australia
- City Fertility, Global CHA IVF Partners, Sydney, NSW, Australia
| | - Ellen Anckaert
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lan N Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Johan Smitz
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
2
|
Chelenga M, Yanagawa Y, Katagiri S, Nagano M. Pre-maturational culture promotes the developmental competence of bovine oocytes derived from an 8-day in vitro growth culture system. J Reprod Dev 2023; 69:214-217. [PMID: 37197977 PMCID: PMC10435529 DOI: 10.1262/jrd.2023-022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023] Open
Abstract
In this study, we evaluated the effects of pre-maturational culture (pre-IVM) on the developmental competence of bovine oocytes derived from an 8-day in vitro growth (IVG) culture system. IVG oocytes were subjected to 5 h pre-IVM before in vitro maturation, followed by in vitro fertilization (IVF). The proportion of oocytes that progressed to the germinal vesicle breakdown stage was similar between groups with and without pre-IVM. Although metaphase II oocytes and cleavage rates after IVF were similar regardless of pre-IVM culture, the blastocyst rate was significantly higher in the group with pre-IVM (22.5%) than without pre-IVM (11.0%, P < 0.05). In conclusion, pre-IVM culture improved the developmental competence of bovine oocytes derived from an 8-day IVG system.
Collapse
Affiliation(s)
- Madalitso Chelenga
- Laboratory of Theriogenology, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan
- Department of Clinical Studies, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Malawi
| | - Yojiro Yanagawa
- Laboratory of Theriogenology, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan
| | - Seiji Katagiri
- Laboratory of Theriogenology, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan
| | - Masashi Nagano
- Laboratory of Animal Reproduction, Department of Animal Science, School of Veterinary Medicine, Kitasato University, Towada 034-8628, Japan
| |
Collapse
|
3
|
Peserico A, Di Berardino C, Capacchietti G, Camerano Spelta Rapini C, Liverani L, Boccaccini AR, Russo V, Mauro A, Barboni B. IVM Advances for Early Antral Follicle-Enclosed Oocytes Coupling Reproductive Tissue Engineering to Inductive Influences of Human Chorionic Gonadotropin and Ovarian Surface Epithelium Coculture. Int J Mol Sci 2023; 24:ijms24076626. [PMID: 37047595 PMCID: PMC10095509 DOI: 10.3390/ijms24076626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
In vitro maturation (IVM) is not a routine assisted reproductive technology (ART) for oocytes collected from early antral (EA) follicles, a large source of potentially available gametes. Despite substantial improvements in IVM in the past decade, the outcomes remain low for EA-derived oocytes due to their reduced developmental competences. To optimize IVM for ovine EA-derived oocytes, a three-dimensional (3D) scaffold-mediated follicle-enclosed oocytes (FEO) system was compared with a validated cumulus-oocyte complex (COC) protocol. Gonadotropin stimulation (eCG and/or hCG) and/or somatic cell coculture (ovarian vs. extraovarian-cell source) were supplied to both systems. The maturation rate and parthenogenetic activation were significantly improved by combining hCG stimulation with ovarian surface epithelium (OSE) cells coculture exclusively on the FEO system. Based on the data, the paracrine factors released specifically from OSE enhanced the hCG-triggering of oocyte maturation mechanisms by acting through the mural compartment (positive effect on FEO and not on COC) by stimulating the EGFR signaling. Overall, the FEO system performed on a developed reproductive scaffold proved feasible and reliable in promoting a synergic cytoplasmatic and nuclear maturation, offering a novel cultural strategy to widen the availability of mature gametes for ART.
Collapse
Affiliation(s)
- Alessia Peserico
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, Italy
| | - Chiara Di Berardino
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, Italy
| | - Giulia Capacchietti
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, Italy
| | - Chiara Camerano Spelta Rapini
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, Italy
| | - Liliana Liverani
- Institute of Biomaterials, Department of Materials Science and Engineering, Friedrich-Alexander University of Erlangen-Nuremberg, 91054 Erlangen, Germany
- DGS S.p.A., 00142 Rome, Italy
| | - Aldo Roberto Boccaccini
- Institute of Biomaterials, Department of Materials Science and Engineering, Friedrich-Alexander University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Valentina Russo
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, Italy
| | - Annunziata Mauro
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, Italy
| | - Barbara Barboni
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, Italy
| |
Collapse
|
4
|
Yang W, Chen X, Liu Z, Zhao Y, Chen Y, Geng Z. Integrated transcriptome and proteome revealed that the declined expression of cell cycle-related genes associated with follicular atresia in geese. BMC Genomics 2023; 24:24. [PMID: 36647001 PMCID: PMC9843891 DOI: 10.1186/s12864-022-09088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/16/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Geese exhibit relatively low reproductive performance, and follicular atresia is an important factor that restricts the egg production of geese. Systematic analysis of the regulation of follicle atresia in geese through transcriptome and proteome levels could provide meaningful information on clarifying the mechanism of follicle atresia in poultry. RESULT The granulosa cell layer was loose, disintegrated and showed apoptosis in atretic follicles and remained intact in normal follicles. The hormone levels of FSH and LH were significantly decreased in the atresia follicles compared to the normal follicles (P < 0.05). A total of 954 differentially expressed genes (DEGs, 315 increased and 639 decreased) and 161 differentially expressed proteins (DEPs, 61 increased and 100 decreased) were obtained in atresia follicles compared to normal follicles, of which, 15 genes were differentially expressed in both transcriptome and proteome. The DEGs were mainly enriched in sodium transmembrane transport, plasma membrane, and transmembrane transporter activity based on the GO enrichment analysis and in the cell cycle pathway based on the KEGG enrichment analysis. The DEPs were mainly enriched in localization, lysosome, and phospholipid-binding based on the GO enrichment analysis. Candidate genes Smad2/3, Smad4, Annexin A1 (ANXA1), Stromelysin-1 (MMP3), Serine/threonine-protein kinase (CHK1), DNA replication licensing factor (MCM3), Cyclin-A2 (CCNA2), mitotic spindle assembly checkpoint protein (MAD2), Cyclin-dependent kinase 1 (CDK1), fibroblast growth factor 12 (FGF12), and G1/S-specific cyclin-D1 (CCND1) were possibly responsible for the regulation of atresia. CONCLUSION The cell cycle is an important pathway for the regulation of follicular atresia. Sodium outflow and high expression of MMP3 and MMP9 could be responsible for structural destruction and apoptosis of follicular cells.
Collapse
Affiliation(s)
- Wanli Yang
- grid.411389.60000 0004 1760 4804College of Animal Science and Technology, Anhui Agricultural University, No. 130 Changjiang West Road, Hefei, 230036 China
| | - Xingyong Chen
- grid.411389.60000 0004 1760 4804College of Animal Science and Technology, Anhui Agricultural University, No. 130 Changjiang West Road, Hefei, 230036 China ,grid.411389.60000 0004 1760 4804Anhui Province Key Laboratory of Local Livestock and Poultry Genetic Resource Conservation and Bio-breeding, Anhui Agricultural University, NO. 130 Changjiang West Rd, Hefei, 230036 China
| | - Zhengquan Liu
- grid.411389.60000 0004 1760 4804College of Animal Science and Technology, Anhui Agricultural University, No. 130 Changjiang West Road, Hefei, 230036 China
| | - Yutong Zhao
- grid.411389.60000 0004 1760 4804College of Animal Science and Technology, Anhui Agricultural University, No. 130 Changjiang West Road, Hefei, 230036 China
| | - Yufei Chen
- grid.411389.60000 0004 1760 4804College of Animal Science and Technology, Anhui Agricultural University, No. 130 Changjiang West Road, Hefei, 230036 China
| | - Zhaoyu Geng
- grid.411389.60000 0004 1760 4804College of Animal Science and Technology, Anhui Agricultural University, No. 130 Changjiang West Road, Hefei, 230036 China ,grid.411389.60000 0004 1760 4804Anhui Province Key Laboratory of Local Livestock and Poultry Genetic Resource Conservation and Bio-breeding, Anhui Agricultural University, NO. 130 Changjiang West Rd, Hefei, 230036 China
| |
Collapse
|
5
|
Chian R, Li J, Lim J, Yoshida H. IVM of human immature oocytes for infertility treatment and fertility preservation. Reprod Med Biol 2023; 22:e12524. [PMID: 37441160 PMCID: PMC10335168 DOI: 10.1002/rmb2.12524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/18/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Background Thousands of healthy babies are born from in vitro maturation (IVM) procedures, but the rate of efficiency differs with the source of immature oocytes obtained. Recently, there are different IVM protocols proposed for infertility treatment and fertility preservation. Methods Based on the literature, the clinical application for IVM of immature oocytes was summarized. Main findings Results Immature oocytes may be retrieved from women after priming with or without the use of follicular stimulation hormone (FSH), human chorionic gonadotrophin (hCG) or a combination of both FSH and hCG. Successful pregnancy rates with IVM technology seem to be correlated with the number of immature oocytes obtained. With the source and culture course of immature oocytes, there are various IVM protocols. IVM of immature oocytes is profoundly affected by the culture conditions, but no breakthrough has been made by improving the IVM medium itself. Thus, the clinical application of IVM technology continues to evolve. Conclusion IVM technology is a useful technique for infertile women and fertility preservation. Mild stimulation IVF combined with IVM of immature oocytes is a viable alternative to the conventional stimulation IVF cycle treatment as it may prove to be an optimal first-line treatment approach.
Collapse
Affiliation(s)
- Ri‐Cheng Chian
- Center for Reproductive MedicineShanghai 10th People's Hospital of Tongji UniversityShanghaiChina
| | - Jian‐Hua Li
- Reproductive Medical Center, Senior Department of Obstetrics and GynecologyThe Seventh Medical Center of PLA General HospitalBeijingChina
| | | | | |
Collapse
|
6
|
Krisher RL. Present state and future outlook for the application of in vitro oocyte maturation (IVM) in human infertility treatment. Biol Reprod 2022; 106:235-242. [DOI: 10.1093/biolre/ioac010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
In vitro oocyte maturation (IVM) is an assisted reproductive technology in which a meiotically immature oocyte (prophase I or germinal vesicle stage) is recovered from an antral follicle and matured in vitro prior to fertilization. This technology, although in widespread use in domestic livestock, is not typically implemented during human IVF cycles. This review examines how IVM is currently used in the clinical setting, including the various ways IVM is defined in practice. The role of IVM in patient care, and the major challenges for implementation are described. Efficiency and safety are critically explored. The role of IVM in oncofertility will also be discussed. Finally, the outlook for the future of clinical IVM is considered.
Collapse
|
7
|
Lu BJ, Lin CJ, Lin BZ, Huang L, Chien LT, Chen CH. ART outcomes following ovarian stimulation in the luteal phase:a systematic review and meta-analysis. J Assist Reprod Genet 2021; 38:1927-1938. [PMID: 34036454 PMCID: PMC8417163 DOI: 10.1007/s10815-021-02237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study aimed to evaluate the impact of luteal phase ovarian stimulation (LPS) on the outcomes of assisted reproductive technology (ART) for infertile couples and patients desiring non-urgent egg cryopreservation. METHODS We included all studies reported patients who received LPS and that used follicular phase ovarian stimulation (FPS) as a comparison group until January 2021. Prior meta-analysis regarding the outcomes of LPS in double stimulation and fertility preservation have already been published, so these studies were excluded. Risk of Bias in Non-randomized Studies of Interventions was used to assess the study quality. The study was registered in the International Prospective Register of Systematic Reviews database (CRD42020183946). RESULTS Twelve studies with a total of 4433 patients were included. The regimen employed can be categorized into two groups, but there is currently no evidence to support one over the other. After we excluded the largest study, the clinical pregnancy rate and live birth rate were similar after FPS and LPS. There were significantly more stimulation days and total gonadotropins used in the LPS group. After subgroup analysis, we found that poor responders received significantly more cumulus oocyte complexes (+0.64) in the LPS group. CONCLUSION Current evidence indicates that patients in the LPS group could achieve pregnancy outcomes non-inferior to those in the FPS group. Because of current debate over freeze-all policy and the limited data about live birth rate, the universal use of LPS is considered controversial. In the future, more well-designed studies are necessary to investigate the indications for LPS and its cost-effectiveness.
Collapse
Affiliation(s)
- Buo-Jia Lu
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, No.252, Wu Hsing Street, Taipei, 110 Taiwan
| | - Chien-Ju Lin
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu, 30071 Taiwan
| | - Bou-Zenn Lin
- Department of Gastroenterology, Ren-Ai Branch, Taipei City Hospital, No. 10, Sec. 4, Ren-Ai Rd., Da’an Dist, Taipei, 106 Taiwan
| | - Li Huang
- Department of Family Medicine, Taipei Medical University Hospital, No.252, Wu Hsing Street, Taipei, 110 Taiwan
| | - Li-Ting Chien
- Taipei Medical University Library, No.250, Wu Hsing Street, Taipei, 110 Taiwan
| | - Chi-Huang Chen
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, No.252, Wu Hsing Street, Taipei, 110 Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wu Hsing Street, Taipei, Taiwan
| |
Collapse
|
8
|
Strowitzki T, Bruckner T, Roesner S. Maternal and neonatal outcome and children's development after medically assisted reproduction with in-vitro matured oocytes-a systematic review and meta-analysis. Hum Reprod Update 2020; 27:460-473. [PMID: 33377477 DOI: 10.1093/humupd/dmaa056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND IVM was implemented in medically assisted reproduction 25 years ago. IVM does not involve controlled ovarian stimulation (COS) and is mainly indicated in patients with a high risk of ovarian hyperstimulation syndrome, in particular in patients with polycystic ovary syndrome (PCOS); it is also an acknowledged option in fertility protection. However, the in-vitro culture of immature oocytes raises concerns over their developmental potential and the putative impact on children's health. Although an increasing number of studies on obstetric and neonatal outcomes of IVM children and their development have been published in recent years, study designs are difficult to compare, since IVM is used in women with various indications and IVM protocols do not follow the same standards. OBJECTIVE AND RATIONALE The aim of this systematic review was to evaluate the current evidence from IVM children of an impact of in-vitro culture of immature oocytes. Primary outcome parameters were birthweight and children's development up to the age of 2 years. We also compared pregnancy pathologies and the outcome of IVM children and COS children in relation to maternal indications, in particular PCOS, and to the type of IVM protocols with or without ovulation trigger as the secondary outcome parameters. IVM is an accepted clinical option for many centres; however, a comprehensive analysis of the available data is needed to establish whether the use of human oocytes that are fully matured in vitro is safe for both children and their mothers. SEARCH METHODS Google Scholar and PubMed were used for identifying peer-reviewed original articles and reviews through January 2020. A total of 191 studies were screened and 16 studies were included in the qualitative synthesis. Studies were stratified according to indications, the use of an ovulation trigger and multiplicity. OUTCOMES Birthweights of IVM singletons and multiples were comparable to their respective COS controls: birthweights were also similar if the analysis was restricted to mothers with PCOS. IVM children had a comparable birthweight to COS children, irrespective of whether an ovulation trigger was used in IVM cycles or not. The frequency of gestational diabetes (GD) in singleton pregnancies was comparable between IVM and COS, regardless of infertility background. There was also no difference in GD frequency between IVM and COS, if an hCG ovulation trigger in IVM cycles was used or not. Hypertensive disorders in singleton pregnancies of women with PCOS were significantly more frequent after IVM compared to COS, in particular if IVM cycles were performed only with in-vitro matured oocytes. There was no difference in the preterm birth rate of singleton pregnancies between IVM and COS. Preterm birth rates were still similar if only women diagnosed with PCOS were compared and whether an ovulation trigger in IVM was used or not. The malformation rate in IVM children did not differ in COS children versus children after natural conception. At the age of 2 years, IVM singletons showed similar anthropometric and mental development compared to COS children or children from natural conception. WIDER IMPLICATIONS The higher incidence of hypertensive disorders in IVM pregnancies needs monitoring during pregnancy. Current data on the development of IVM children are encouraging, although the quality of many studies is limited and long-term data beyond 2 years are scarce. Further studies should be based on generally accepted IVM protocols. Studies on long-term outcomes beyond 2 years are needed to search for potential long-time sequelae of IVM.
Collapse
Affiliation(s)
- Thomas Strowitzki
- Department of Gynecological Endocrinology and Reproductive Medicine, Heidelberg University, 69121 Heidelberg, Germany
| | - Thomas Bruckner
- Institute for Medical Biometry and Informatics, Heidelberg University, 69121 Heidelberg, Germany
| | - Sabine Roesner
- Department of Gynecological Endocrinology and Reproductive Medicine, Heidelberg University, 69121 Heidelberg, Germany
| |
Collapse
|
9
|
Acupuncture for premature ovarian insufficiency: a systematic review and meta-analysis. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2020. [DOI: 10.1007/s11726-020-1153-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Ortega-Hrepich C, Drakopoulos P, Bourgain C, Van Vaerenbergh I, Guzman L, Tournaye H, Smitz J, De Vos M. Aberrant endometrial steroid receptor expression in in-vitro maturation cycles despite hormonal luteal support: A pilot study. Reprod Biol 2019; 19:210-217. [PMID: 31262644 DOI: 10.1016/j.repbio.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 01/12/2023]
Abstract
Clinical outcomes of fresh embryo transfer in non-hCG triggered in vitro maturation (IVM) cycles are inferior compared to vitrified-warmed embryo transfer. This is a prospective observational pilot study in a consecutive cohort of 31 polycystic ovary syndrome (PCOS) patients and 37 normo-ovulatory egg donors who underwent IVM without fresh embryo transfer between July 2009 and June 2014. All subjects received 150 IU of highly purified menotropin (HP-hMG) daily for three days. On cycle day 6, all patients started transdermal oestradiol (E2) at a daily dose of 9 mg. There was no human chorionic gonadotropin (hCG) trigger before oocyte retrieval (OR). Vaginal micronized progesterone was commenced on the evening after OR, at a daily dose of 600 mg. Additional luteal phase support (LPS) was administered as follows: Group A: no additional LPS; Group B: 1500 IU of hCG administered 4 h after OR and Group C: 5000 IU of hCG administered 4 h after OR + an additional injection of 5000 IU of hCG 1 day before endometrial biopsy. Endometrial biopsy for histology and immunohistochemistry (IHC) was performed on day 5 or 6 after OR. Instead of being downregulated, both PR-B and ERα in endometrial glands and stroma were moderately to strongly expressed in all three protocols, suggesting that the mid-luteal histological signature of endometrial receptivity is deficient in a non-hCG-triggered IVM cycle. Poor clinical outcomes after fresh embryo transfer following IVM are probably related to inappropriate endometrial development which may be linked to the short follicular phase of IVM cycles.
Collapse
Affiliation(s)
- Carolina Ortega-Hrepich
- Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; Clinica Monteblanco, Santiago, Chile
| | | | - Claire Bourgain
- Research Group Reproductive Immunology and Implantation, Vrije Universiteit Brussel, Laarbeeklaan 103,1090 Brussels, Belgium; AZ Imelda, Bonheiden, Belgium
| | - Inge Van Vaerenbergh
- Laboratory of Follicular Biology (FOBI), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | | | - Herman Tournaye
- Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Johan Smitz
- Laboratory of Follicular Biology (FOBI), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Michel De Vos
- Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
| |
Collapse
|
11
|
Abbara A, Clarke SA, Dhillo WS. Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment. Endocr Rev 2018; 39:593-628. [PMID: 29982525 PMCID: PMC6173475 DOI: 10.1210/er.2017-00236] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 06/27/2018] [Indexed: 01/20/2023]
Abstract
Infertility affects one in six of the population and increasingly couples require treatment with assisted reproductive techniques. In vitro fertilization (IVF) treatment is most commonly conducted using exogenous FSH to induce follicular growth and human chorionic gonadotropin (hCG) to induce final oocyte maturation. However, hCG may cause the potentially life-threatening iatrogenic complication "ovarian hyperstimulation syndrome" (OHSS), which can cause considerable morbidity and, rarely, even mortality in otherwise healthy women. The use of GnRH agonists (GnRHas) has been pioneered during the last two decades to provide a safer option to induce final oocyte maturation. More recently, the neuropeptide kisspeptin, a hypothalamic regulator of GnRH release, has been investigated as a novel inductor of oocyte maturation. The hormonal stimulus used to induce oocyte maturation has a major impact on the success (retrieval of oocytes and chance of implantation) and safety (risk of OHSS) of IVF treatment. This review aims to appraise experimental and clinical data of hormonal approaches used to induce final oocyte maturation by hCG, GnRHa, both GnRHa and hCG administered in combination, recombinant LH, or kisspeptin. We also examine evidence for the timing of administration of the inductor of final oocyte maturation in relationship to parameters of follicular growth and the subsequent interval to oocyte retrieval. In summary, we review data on the efficacy and safety of the major hormonal approaches used to induce final oocyte maturation in clinical practice, as well as some novel approaches that may offer fresh alternatives in future.
Collapse
Affiliation(s)
- Ali Abbara
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Sophie A Clarke
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Waljit S Dhillo
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| |
Collapse
|
12
|
Hatırnaz Ş, Ata B, Hatırnaz ES, Dahan MH, Tannus S, Tan J, Tan SL. Oocyte in vitro maturation: A sytematic review. Turk J Obstet Gynecol 2018; 15:112-125. [PMID: 29971189 PMCID: PMC6022428 DOI: 10.4274/tjod.23911] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023] Open
Abstract
In vitro maturation (IVM) is one of the most controversial aspects of assisted reproductive technology. Although it has been studied extensively, it is still not a conventional treatment option and is accepted as an alternative treatment. However, studies have shown that IVM can be used in almost all areas where in vitro fertilization (IVF) is used and it has a strong place in fertility protection and Ovarian Hyperstimulation syndrome management. The aim of this systematic review was to address all aspects of the current knowledge of IVM treatment together with the evolution of IVM and IVF.
Collapse
Affiliation(s)
- Şafak Hatırnaz
- Medicana International Hospital, In Vitro Fertilization Center, Samsun, Turkey
| | - Barış Ata
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, In Vitro Fertilization Center, İstanbul, Turkey
| | | | - Michael Haim Dahan
- Mc Gill University Faculty of Medicine, Department of Obstetrics and Gynecology, Quebec, Canada
| | - Samer Tannus
- Mc Gill University Faculty of Medicine, Department of Obstetrics and Gynecology, Quebec, Canada
| | - Justin Tan
- Mc Gill University Faculty of Medicine, Department of Obstetrics and Gynecology, Quebec, Canada
| | - Seang Lin Tan
- Originelle Women and Reproductive Medicine Center, Clinic of Obstetrics and Gynecology, Montreal, Quebec, Canada
| |
Collapse
|
13
|
Walls ML, Hart R, Keelan JA, Ryan JP. Structural and morphologic differences in human oocytes after in vitro maturation compared with standard in vitro fertilization. Fertil Steril 2016; 106:1392-1398.e5. [PMID: 27565256 DOI: 10.1016/j.fertnstert.2016.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/04/2016] [Accepted: 08/04/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To study whether the size and texture of oocytes/zygotes differ between in vitro maturation (IVM) and traditional IVF and to determine whether these affect the rate of fertilization and blastocyst development. DESIGN Prospective case-control study. SETTING Fertility clinic. PATIENT(S) The study involved 83 participants/cycles of IVF with intracytoplasmic sperm injection (ICSI) or IVM treatment. INTERVENTION(S) Participants were allocated to the following groups: patients with and without polycystic ovary syndrome (PCOS) undergoing ICSI (PCOS-ICSI and Control-ICSI), and patients with PCOS undergoing IVM (PCOS-IVM). All oocytes were cultured in an Embryoscope incubator. MAIN OUTCOME MEASURE(S) Oocyte/zygote sizes were recorded and texture parameters of the ooplasm were analyzed using ImageJ and maZda software. Measurements were recorded at five developmental stages: sperm injection, second polar body extrusion, the first pronuclei appearance, pronuclei disappearance, and immediately before cytokinesis. RESULT(S) Normally fertilized PCOS-IVM oocytes were significantly larger at the sperm injection and second polar body extrusion stages, compared with both the PCOS-ICSI and Control-ICSI groups. The PCOS-IVM oocytes were significantly larger at the pronuclei disappearance stage compared with the Control-ICSI group. Oocyte texture parameters were significantly different from both other treatment groups in the early developmental stages, although these were predominantly seen when compared with the Control-ICSI group. There were no significant differences in size or texture by the final stage of immediately before cytokinesis between any of the treatment groups. CONCLUSION(S) This study suggests that oocyte size and texture differ in the early stages of the first cell cycle.
Collapse
Affiliation(s)
- Melanie L Walls
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia; School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia.
| | - Roger Hart
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia; School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jeffrey A Keelan
- School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - John P Ryan
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia; School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| |
Collapse
|
14
|
Boots CE, Meister M, Cooper AR, Hardi A, Jungheim ES. Ovarian stimulation in the luteal phase: systematic review and meta-analysis. J Assist Reprod Genet 2016; 33:971-80. [PMID: 27146151 PMCID: PMC4974222 DOI: 10.1007/s10815-016-0721-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate whether outcomes are different if controlled ovarian stimulation (COS) is started in the luteal phase rather than the follicular phase. METHODS A systematic review and meta-analysis was performed. Sixteen studies were included in the qualitative analysis, and eight studies with a total of 338 women were included in the quantitative analysis. RESULTS Cycles initiated in the luteal phase were slightly longer (WMD 1.1 days, 95 % CI 0.39-1.9) and utilized more total gonadotropins (WMD 817 IU, 95 % CI 489-1144). However, no differences were noted in peak estradiol levels (WMD -411 pg/ml, 95 % CI -906-84.7) or in the total number of oocytes retrieved (WMD 0.52 oocytes, 95 % CI -0.74-1.7). There were slightly more mature oocytes retrieved in the luteal phase (WMD 0.77 oocytes, 95 % CI 0.21-1.3), and fertilization rates were significantly higher (WMD 10 %, 95 % CI 0.03-0.18). While only three studies reported pregnancy outcomes, no difference was noted in the FET pregnancy rates after COS in the luteal versus follicular phase (RR 0.95, 95 % CI 0.56-1.7). A post hoc power analysis revealed that a sample of this size was sufficient to detect a clinically meaningful difference of 2 oocytes retrieved with 93 % power. CONCLUSION Although initiating COS in the luteal phase requires a longer stimulation and a higher dose of total gonadotropin, these differences are not clinically significant. Furthermore, COS initiated in the luteal phase does not compromise the quantity or quality of oocytes retrieved compared to outcomes of traditional stimulation in the follicular phase.
Collapse
Affiliation(s)
- C E Boots
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA.
| | - M Meister
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA
| | - A R Cooper
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA
| | - A Hardi
- Washington University, 660 Euclid Avenue, St. Louis, MO, 63110, USA
| | - E S Jungheim
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA
| |
Collapse
|
15
|
|
16
|
Choavaratana R, Thanaboonyawat I, Laokirkkiat P, Prechapanich J, Suksompong S, Mekemaharn O, Petyim S. Outcomes of Follicle-Stimulating Hormone Priming and Nonpriming in in vitro Maturation of Oocytes in Infertile Women with Polycystic Ovarian Syndrome: A Single-Blinded Randomized Study. Gynecol Obstet Invest 2014; 79:153-9. [DOI: 10.1159/000367660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/14/2014] [Indexed: 11/19/2022]
|
17
|
Chang EM, Song HS, Lee DR, Lee WS, Yoon TK. In vitro maturation of human oocytes: Its role in infertility treatment and new possibilities. Clin Exp Reprod Med 2014; 41:41-6. [PMID: 25045627 PMCID: PMC4102689 DOI: 10.5653/cerm.2014.41.2.41] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/22/2014] [Accepted: 03/24/2014] [Indexed: 01/25/2023] Open
Abstract
IVM refers to the maturation of immature oocytes in culture after their recovery from small antral follicles at the stage prior to selection and dominance. IVM requires little or no FSH in vivo and has been proposed as an alternative to conventional IVF, since it reduces the primary adverse effects caused by controlled ovarian stimulation, including the ovarian hyperstimulation syndrome. Moreover, IVM is a promising option for cases for which no standard protocol is suitable, such as FSH resistance, contraindications for ovarian stimulatory drugs, and the need for urgent fertility preservation. Recently, IVM has been used in women with regular cycles and normal ovaries. However, the pregnancy rate following IVM is suboptimal compared with that of conventional IVF, indicating that further studies to optimize the protocol and the culture conditions are warranted.
Collapse
Affiliation(s)
- Eun Mi Chang
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Hang Seok Song
- Department of Biomedical Science, College of Life Science, CHA University, Seoul, Korea
| | - Dong Ryul Lee
- Department of Biomedical Science, College of Life Science, CHA University, Seoul, Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Tae Ki Yoon
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
| |
Collapse
|
18
|
Son WY, Tan SL. Comparison between slow freezing and vitrification for human embryos. Expert Rev Med Devices 2014; 6:1-7. [DOI: 10.1586/17434440.6.1.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
19
|
Abstract
Meiotic progression in the oocyte is defined as oocyte maturation from reinitiation of the first meiotic division from the germinal vesicle (GV) stage to the metaphase-II (M-II) stage (Fig. 1), (Cha and Chian, Hum Reprod Update 4:103-120, 1998). Priming with FSH or HCG prior to immature oocyte retrieval improves oocyte maturation and pregnancy rates. The size of follicles may be an important feature for IVM treatment. The combination of natural-cycle IVF with immature oocyte retrieval followed by IVM is an attractive treatment for young women with all types of infertility without recourse to ovarian stimulation with an acceptable pregnancy rate.
Collapse
Affiliation(s)
- Ri-Cheng Chian
- Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital, Women's Pavilion F3, 687 Pine Avenue West, Montreal, Quebec, Canada, H3A 1A1,
| | | |
Collapse
|
20
|
Labrecque R, Sirard MA. The study of mammalian oocyte competence by transcriptome analysis: progress and challenges. Mol Hum Reprod 2013; 20:103-16. [DOI: 10.1093/molehr/gat082] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
21
|
Chian RC, Uzelac PS, Nargund G. In vitro maturation of human immature oocytes for fertility preservation. Fertil Steril 2013; 99:1173-81. [DOI: 10.1016/j.fertnstert.2013.01.141] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/25/2013] [Accepted: 01/25/2013] [Indexed: 11/15/2022]
|
22
|
Fadini R, Mignini Renzini M, Dal Canto M, Epis A, Crippa M, Caliari I, Brigante C, Coticchio G. Oocyte in vitro maturation in normo-ovulatory women. Fertil Steril 2013; 99:1162-9. [DOI: 10.1016/j.fertnstert.2013.01.138] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/18/2013] [Accepted: 01/21/2013] [Indexed: 11/15/2022]
|
23
|
Xu B, Li Y. Flexible ovarian stimulation in a poor responder: a case report and literature review. Reprod Biomed Online 2013; 26:378-83. [DOI: 10.1016/j.rbmo.2012.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 09/29/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
|
24
|
Yalçınkaya E, Calışkan E, Budak O. In vitro maturation may prevent the cancellation of in vitro fertilization cycles in poor responder patients: A case report. J Turk Ger Gynecol Assoc 2013; 14:235-7. [PMID: 24592113 DOI: 10.5152/jtgga.2013.68335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/10/2013] [Indexed: 11/22/2022] Open
Abstract
In vitro maturation (IVM) is a promising technique that is used for the maturation of immature oocytes in laboratory conditions and preferred for use in patients with a diagnosis of polycystic ovary syndrome (PCOS) as an alternative to conventional in vitro fertilization (IVF) treatment. In this report, we present a case who surprisingly showed insufficient response to gonadotrophin stimulation during IVF treatment and whose cycle was retrieved from cancellation by using the in vitro maturation technique. As a result, we conclude that IVM may be a good option not only for PCOS patients, but also for poor responders.
Collapse
Affiliation(s)
- Ender Yalçınkaya
- Assisted Reproduction Unit, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Eray Calışkan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ozcan Budak
- Assisted Reproduction Unit, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| |
Collapse
|
25
|
De Vos M, Ortega-Hrepich C, Albuz FK, Guzman L, Polyzos NP, Smitz J, Devroey P. Clinical outcome of non–hCG-primed oocyte in vitro maturation treatment in patients with polycystic ovaries and polycystic ovary syndrome. Fertil Steril 2011; 96:860-4. [DOI: 10.1016/j.fertnstert.2011.07.1108] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 07/08/2011] [Accepted: 07/19/2011] [Indexed: 12/25/2022]
|
26
|
Priming in vitro maturation cycles with gonadotropins: salvage treatment for nonresponding patients. Fertil Steril 2011; 96:340-3. [DOI: 10.1016/j.fertnstert.2011.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 05/30/2011] [Accepted: 06/01/2011] [Indexed: 11/22/2022]
|
27
|
Reinblatt SL, Son WY, Shalom-Paz E, Holzer H. Controversies in IVM. J Assist Reprod Genet 2011; 28:525-30. [PMID: 21556889 DOI: 10.1007/s10815-011-9575-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 04/20/2011] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To explore four areas of controversy: the benefits of gonadotropin priming, benefits and timing of hCG trigger as well as the ideal protocols for endometrial preparation and luteal support. METHODS A literature review was performed to explore the current evidence RESULTS Current evidence suggests that Gonadotropin priming in combination with hCG prior to collection benefits patients with normal ovaries. In PCOS patients 10,000 IU hCG 38 h before retrieval increases the total number and rate of oocyte maturation. Gonadotropin priming may also benefit PCOS patients. The ideal timing of hCG trigger appears to be when the leading follicle is 10-12 mm. Sparse data exists regarding luteal support protocols. CONCLUSIONS There is still a need for well-designed studies to establish ideal methods for oocyte priming, timing of retrieval, endometrial preparation and luteal support. Further studies must incorporate both clinical and basic science principles of ovarian, follicular and endometrial physiology.
Collapse
Affiliation(s)
- Shauna Leigh Reinblatt
- MUHC Reproductive Center, Department of Obstetrics and Gynecology, Royal Victoria Hospital, Montreal, Quebec, Canada, H3A 1A1.
| | | | | | | |
Collapse
|
28
|
Abstract
Ovarian stimulation regimes may be hazardous to a small proportion of women or may result in side effects. For such women IVM is recommended. IVM technology can be divided into two main approaches, namely (i) FSH and (ii) hCG priming. These two approaches improve oocyte maturation and pregnancy rates when the immature oocytes are retrieved from women with PCOS. Although the size of follicles appears to be important for subsequent embryonic development however the developmental competence of oocytes derived from the small antral follicles seems not to be adversely affected by the presence of a dominant follicle. In general, the clinical pregnancy and implantation rates per ET are now in the order of 35–40% and 10–15% respectively in women with PCOS following IVM. The combination of natural cycle IVF with immature oocyte retrieval followed by IVM is an attractive treatment alternative for women with various forms of infertility without recourse to ovarian stimulation. Natural cycle IVF/M together with IVM alone can be used to treat more than half of the population of infertile patients with acceptable pregnancy rate. Approximately 2,000 healthy infants have been born following immature oocyte retrieval and IVM.
Collapse
Affiliation(s)
| | - Ri-Cheng Chian
- Department of Obstetrics and Gynecology, McGill University Montreal, Canada
| |
Collapse
|
29
|
Son WY, Tan SL. Laboratory and embryological aspects of hCG-primed in vitro maturation cycles for patients with polycystic ovaries. Hum Reprod Update 2010; 16:675-89. [DOI: 10.1093/humupd/dmq014] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Son WY, Chung JT, Gidoni Y, Holzer H, Levin D, Chian RC, Tan SL. Comparison of survival rate of cleavage stage embryos produced from in vitro maturation cycles after slow freezing and after vitrification. Fertil Steril 2009; 92:956-958. [DOI: 10.1016/j.fertnstert.2009.01.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 12/29/2008] [Accepted: 01/07/2009] [Indexed: 10/21/2022]
|
31
|
Predictive factors in in-vitro maturation in unstimulated women with normal ovaries. Reprod Biomed Online 2009; 18:251-61. [DOI: 10.1016/s1472-6483(10)60263-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
32
|
Effect of different gonadotrophin priming on IVM of oocytes from women with normal ovaries: a prospective randomized study. Reprod Biomed Online 2009; 19:343-51. [DOI: 10.1016/s1472-6483(10)60168-x] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
33
|
Hashimoto S, Fukuda A, Murata Y, Kikkawa M, Oku H, Kanaya H, Sonoda M, Sugihara K, Murata T, Nagata F, Nakaoaka Y, Morimoto Y. Effect of aspiration vacuum on the developmental competence of immature human oocytes retrieved using a 20-gauge needle. Reprod Biomed Online 2007; 14:444-9. [PMID: 17425825 DOI: 10.1016/s1472-6483(10)60891-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In-vitro maturation (IVM) of immature oocytes has been proposed as a potential alternative to conventional IVF treatment following ovarian stimulation. However, the effects of the oocyte retrieval conditions on subsequent development have not been well understood. This study assessed the effects of different aspiration vacuums during oocyte retrieval on the developmental competence of immature oocytes following IVM, IVF and embryo transfer, retrospectively. Immature oocytes were aspirated with 20-gauge needles with a vacuum of 180 or 300 mmHg. Immature oocytes were cultured in IVM medium for 26 h. All mature oocytes were inseminated by intracytoplasmic sperm injection (ICSI). Embryo transfer was carried out 2 or 3 days after ICSI. The percentage of cumulus-cell enclosed oocytes and of transferable embryos per retrieved oocytes in 180 mmHg (69.7% and 23.8%, respectively) were significantly higher (P < 0.01) than those in 300 mmHg (46.2% and 12.8%, respectively). The ongoing pregnancy rate per retrieval cycle in 180 mmHg (30%) was higher (P < 0.01) than that in 300 mmHg (4.3%). The data indicate that lower pressure of vacuum aspiration with a 20-gauge needle improves the developmental competence of immature oocytes following IVM, IVF and embryo transfer.
Collapse
Affiliation(s)
- Shu Hashimoto
- IVF Namba Clinic, 1-17-28 Minamihorie, Nishi-ku, Osaka, 550-0015 Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Lee SY, Son WY, Yoon SH, Lim JH. Clinical-pregnancy outcome after vitrification of blastocysts produced from in vitro maturation cycles. Fertil Steril 2007; 88:1449-51. [PMID: 17418831 DOI: 10.1016/j.fertnstert.2007.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 01/03/2007] [Accepted: 01/03/2007] [Indexed: 11/12/2022]
Abstract
This study was conducted to report the clinical-pregnancy outcome after vitrification of the blastocysts produced from in vitro maturation cycles. The survival rate after thawing was 92.0% (92/100). The clinical-pregnancy and implantation rates were 43.8% and 23.6%, respectively. These results suggest that the blastocyst-stage embryos produced from in vitro maturation cycles can be safely cryopreserved through vitrification.
Collapse
|
35
|
Suikkari AM, Söderström-Anttila V. In-vitro maturation of eggs: is it really useful? Best Pract Res Clin Obstet Gynaecol 2007; 21:145-55. [PMID: 17291833 DOI: 10.1016/j.bpobgyn.2006.09.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In in-vitro maturation (IVM), immature oocytes are collected from small antral follicles and allowed to mature in the laboratory before routine in-vitro fertilization or micro-injection. The authors' experience in IVM is based on the treatment of two main groups of patients: women with polycystic ovaries and women with normal ovaries. Patients with polycystic ovarian syndrome have irregular, mostly anovulatory cycles and are at increased risk for ovarian hyperstimulation syndrome because of their higher sensitivity to gonadotropins. Women with normal ovarian function may wish to avoid the side-effects of hormone injections, and therefore IVM has also been offered to couples with tubal, male factor and unexplained infertility. In all these groups of patients, immature oocytes have successfully been matured, fertilized and embryos transferred. Pregnancy rates have been reported to be between 4% and 54%. More than 300 children have been born and follow-up studies have reported no major concerns about the pregnancies, deliveries or health of the babies. There are still many questions concerning IVM. As the factors regulating follicle selection are poorly understood, no specific markers for the optimal time of immature oocyte collection have been defined. Furthermore, basic knowledge on the complex intracellular processes involved in the cytoplasmic maturation of human oocyte is lacking, making the design of optimal culture conditions for maturation difficult. The possible long-term effects of IVM on the health and development of children needs future study.
Collapse
Affiliation(s)
- Anne-Maria Suikkari
- Infertility Clinic of the Family Federation of Finland, P.O. Box 849, 00101 Helsinki, Finland.
| | | |
Collapse
|
36
|
Sato C, Shimada M, Mori T, Kumasako Y, Otsu E, Watanabe H, Utsunomiya T. Assessment of human oocyte developmental competence by cumulus cell morphology and circulating hormone profile. Reprod Biomed Online 2007; 14:49-56. [PMID: 17207331 DOI: 10.1016/s1472-6483(10)60763-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The predictive value of the morphology of the cumulus--oocyte complex (COC) has not yet been explored as a possible factor contributing to the success of human in-vitro maturation (IVM). In the present study, development-supporting competency of oocytes encircled in a large ( > or = 5) (grade A), moderate (3 approximately 4) (grade B) or small ( < or = 2) (grade C) number of cumulus cell layers was assessed, together with changes in hormonal profile following a truncated course of 150 IU pure FSH administration for 3 days prior to aspiration on laparoscopy indicated for endometriosis. FSH priming increased the number of COC aspirated without changing the proportion of the three morphological types of COC, which were then subjected to IVM in the presence of 200 mIU/ml FSH plus 1000 mIU/ml human chorionic gonadotrophin, followed by intracytoplasmic sperm injection. The highest development-supporting competence was observed not with oocytes in grade A COC harvested from natural cycles, but with oocytes in grade B COC from FSH-primed cycles. Hormonal profiles in patients bearing grade B COC were characterized by moderate response in oestradiol and progesterone production following FSH, with LH/FSH ratio being below 1.0. It is concluded that an optimal window of hormonal profile(s) may exist for follicle aspiration to obtain grade B COC in FSH-stimulated human IVM cycles.
Collapse
Affiliation(s)
- Chikako Sato
- St Luke Clinic, 5 Tsumori-Tomioka, Oita 870-047, Japan
| | | | | | | | | | | | | |
Collapse
|
37
|
Preis KA, Seidel GE, Gardner DK. Reduced oxygen concentration improves the developmental competence of mouse oocytes following in vitro maturation. Mol Reprod Dev 2007; 74:893-903. [PMID: 17192892 DOI: 10.1002/mrd.20655] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Reduced atmospheric oxygen concentration is beneficial to embryo development; however, optimal oxygen concentration for oocyte maturation remains undetermined. Likewise, there is no consensus of appropriate medium supplementation during maturation. The objective of this study was to determine whether oxygen tension (20% or 5% O2) and epidermal growth factor (EGF) affect oocyte metabolism and subsequent embryo development. Cumulus-oocyte complexes (COCs) were collected from 28-day-old equine chorionic gonadotropin (eCG) primed or unprimed F1 (C57BL/6xCBA) mice. COCs were matured in defined medium in one of four groups: 20% O2, 20% O2 + EGF, 5% O2, 5% O2 + EGF. In vivo matured COCs were also collected for analysis. COCs from unprimed mice, matured in 5% O2 +/- EGF or 20% O2 + EGF had higher metabolic rates than COCs matured in 20% O2 (P < 0.05). COCs from primed mice had higher metabolic rates when matured in the presence of EGF, regardless of oxygen tension (P < 0.01). Oxygen uptake and mitochondrial membrane potential were higher for in vivo matured oocytes and oocytes matured under 5% O2 compared to oocytes matured under 20% O2 (P < 0.05). Blastocyst formation was not different between maturation groups (primed or unprimed); however, embryo cell numbers were 20-45% significantly higher when COCs were matured at 5% O2 (P < 0.05). Results suggest that oocytes matured in physiological concentrations of oxygen have improved development and metabolic activity, more closely resembling in vivo maturation. These findings have implications for oocyte maturation in both clinical and research laboratories.
Collapse
Affiliation(s)
- Kimberly A Preis
- Colorado Center for Reproductive Medicine, Englewood, Colorado 80113, USA
| | | | | |
Collapse
|
38
|
Loutradis D, Kiapekou E, Zapanti E, Antsaklis A. Oocyte Maturation in Assisted Reproductive Techniques. Ann N Y Acad Sci 2006; 1092:235-46. [PMID: 17308148 DOI: 10.1196/annals.1365.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Human oocyte maturation is a long process during which nuclear maturation occurs resulting in germinal vesicle breakdown (transition from prophase I to metaphase II) and extrusion of the first polar body. During oocyte maturation, in parallel with nuclear maturation, a number of events take place in the oocyte cytoplasm that assist fertilization and early embryonic development. So far several attempts have been made to mature human oocytes in vitro. The main patient group to which in vitro maturation (IVM) has been applied is polycystic ovarian syndrome. In a concise review we present the techniques used for the IVM of oocytes and the role of hormones and growth factors in IVM and subsequent fertilization and early embryonic development.
Collapse
Affiliation(s)
- Dimitris Loutradis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, University of Athens, Athens, Greece
| | | | | | | |
Collapse
|
39
|
Montag M, Isachenko V, Isachenko E, von Wolff M, von Otte S, Schultze-Mosgau A, Al-Hasani S. Generierung und Konservierung von Keimzellen. GYNAKOLOGISCHE ENDOKRINOLOGIE 2006. [DOI: 10.1007/s10304-006-0162-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
Jurema MW, Nogueira D. In vitro maturation of human oocytes for assisted reproduction. Fertil Steril 2006; 86:1277-91. [PMID: 16996508 DOI: 10.1016/j.fertnstert.2006.02.126] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 02/21/2006] [Accepted: 02/21/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe and evaluate the current practice of in vitro maturation of oocytes for assisted reproduction. DESIGN Review of the available and relevant literature regarding in vitro maturation of oocytes. CONCLUSION(S) In vitro maturation of human oocytes retrieved from antral ovarian follicles is an emerging procedure quickly being incorporated into the realm of assisted reproductive technologies. This new technology has several potential advantages over traditional controlled ovarian hyperstimulation for IVF, such as reduction of costs by minimizing gonadotropin and GnRH analogue use, elimination of ovarian hyperstimulation syndrome, and simplicity of protocol. In vitro maturation of oocytes for assisted reproduction in human beings still is undergoing refinement but currently is providing efficacy and safety outcome comparable to that of traditional IVF in recent selected studies. Implementing in vitro maturation into an established IVF practice is feasible and requires only a few simple adjustments. Crucial to the advancement and optimization of the technology is a better understanding of how to maximize immature oocyte developmental competence and endometrial receptivity.
Collapse
Affiliation(s)
- Marcus W Jurema
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine and Infertility, Women and Infants' Hospital, Brown University Medical School, Providence, Rhode Island 02905, USA.
| | | |
Collapse
|
41
|
Dal Canto MB, Mignini Renzini M, Brambillasca F, Cepparo H, Comi R, Villa A, Rangoni G, Mastrolilli M, Crippa M, de Ponti E, Nielsen HI, Fadini R. IVM – the first choice for IVF in Italy. Reprod Biomed Online 2006; 13:159-65. [PMID: 16895627 DOI: 10.1016/s1472-6483(10)60610-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In March 2004, a new law was introduced in Italy to regulate assisted reproduction; at present it is impossible to use more than a maximum of three oocytes per IVF cycle, nor can embryos or prezygotes (2PN cells) be selected or cryopreserved. The prohibitions introduced by the new law have, on the one hand, reduced the expectations of success of current techniques and, on the other hand, stimulated clinicians and embryologists to work on new therapeutic strategies so as to offer the highest chances of success with the lowest risks. In-vitro maturation (IVM) of oocytes fits very well with these new requirements: ovarian stimulation is avoided and the handling of spare oocytes is facilitated. The IVM protocol is an intriguing alternative to conventional IVF techniques, since it removes the side-effects of drug stimulation, especially ovarian hyperstimulation syndrome, and it also reduces the costs of the entire procedure, both in terms of 'time consumption' and 'patient/society costs for drugs'. In the authors' IVF centre the IVM technique has been used for more than a year, with significant success in terms of maturation and fertilization rates, percentage of embryo transfers, number of pregnancies and, finally, healthy babies born.
Collapse
Affiliation(s)
- M B Dal Canto
- BIOGENESI Reproductive Medicine Centre, Istituti Clinici Zucchi, V. Zucchi, 24-Monza, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
|
43
|
Söderström-Anttila V, Mäkinen S, Tuuri T, Suikkari AM. Favourable pregnancy results with insemination of in vitro matured oocytes from unstimulated patients. Hum Reprod 2005; 20:1534-40. [PMID: 15695312 DOI: 10.1093/humrep/deh768] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose has been to develop an in vitro oocyte maturation (IVM) method for a wide range of patients. METHODS A total of 239 cycles with immature oocyte retrieval (IOC) were carried out without hormonal priming. Patients with regular cycles and normal or polycystic ovaries (PCO) and anovulatory cycles with PCOS were included. Insemination or intracytoplasmic sperm injection (ICSI) according to sperm quality was alternatively used in fertilization of the matured oocytes. RESULTS A total of 971 immature oocytes (mean 8.0 +/- 5.2) were collected in 122 IVM-IVF cycles and 851 oocytes (mean 7.3 +/- 4.4) in 117 IVM-ICSI cycles. The oocyte maturation and fertilization rate was 62.6% and 37.7% after insemination, and 53.9% and 69.3% after ICSI, respectively. The mean number of embryos transferred was 1.6. Clinical pregnancy rate per IOC was 23.8% in IVM-IVF and 17.1% in IVM-ICSI (ns). Implantation rate was higher in IVM-IVF (24.2%) than in IVM-ICSI (14.8%) (P < 0.05). CONCLUSIONS Insemination of IVM oocytes functions well, resulting in comparable pregnancy rates per IOC between IVM-IVF and IVM-ICSI. Good pregnancy results can be achieved both in patients with regular cycles and with PCO(S) by transferring only one or two embryos at a time.
Collapse
|
44
|
von Otte S, Schöpper B, Diedrich K, Al-Hasani S. Lessons learned from introducing an in-vitro maturation programme into clinical practice. Reprod Biomed Online 2005; 10 Suppl 3:75-82. [DOI: 10.1016/s1472-6483(11)60394-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
45
|
Abstract
The basis of in-vitro maturation (IVM) is the maturing in vitro of oocytes from the germinal vesicle (GV) stage of development to the metaphase II stage. Experience in handling immature oocytes has been obtained from two main groups. The first group is women suffering from polycystic ovarian syndrome, who are extremely sensitive to stimulation with exogenous gonadotrophins in assisted reproduction, and have a significant risk of developing ovarian hyperstimulation syndrome (OHSS). The second group is regular cycling women with normal ovaries referred for IVF due to severe male infertility. In both groups, aspiration of immature oocytes has been performed in unstimulated cycles and after priming with human chorionic gonadotrophin or FSH respectively. Clinical pregnancy rates of 24% per aspiration have been obtained. Children born after IVM appear to be healthy. These data, taken together, suggest that in future, immature oocyte retrieval combined with IVM could replace conventional IVF in selected patients.
Collapse
Affiliation(s)
- Anne Lis Mikkelsen
- The Fertility Clinic, Herlev University Hospital, DK-2730 Herlev, Denmark.
| |
Collapse
|
46
|
Abstract
Human ovarian tissue can be successfully cryopreserved, with good survival and function after thawing. Experimental animal studies regarding ovarian tissue cryopreservation resulting in live-born offspring preceded the present freezing systems in humans. On the basis of current knowledge, the standard method for human ovarian cryopreservation is slow programmed freezing, using human serum albumin-containing medium, and propanediol, dimethylsulphoxide (DMSO) or ethylene glycol as a cryoprotectant, combined with sucrose. Vitrification is still at the experimental stage. Whole organ cryopreservation is an interesting experimental option. Transplantation of the frozen-thawed tissue is a feasible method to utilize the tissue in infertility treatment. Ovarian function has been restored in humans. Because one healthy child has already been born from cryopreserved tissue, tissue cryopreservation should perhaps be offered to all young girls and women who can be predicted to undergo premature ovarian failure due to cancer treatment or genetic causes. Maturation of follicles in vitro from frozen-thawed tissue is another option that is still under development.
Collapse
Affiliation(s)
- Outi Hovatta
- Karolinska Institutet, Department of Clinical Science, Karolinska University Hospital Huddinge, SE 141 86 Stockholm, Sweden.
| |
Collapse
|
47
|
Papanikolaou EG, Platteau P, Albano C, Nogueira D, Cortvrindt R, Devroey P, Smitz J. Immature oocyte in-vitro maturation: clinical aspects. Reprod Biomed Online 2005; 10:587-92. [PMID: 15949215 DOI: 10.1016/s1472-6483(10)61665-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The development of immature oocyte collection techniques for in-vitro maturation (IVM), combined with novel culture techniques, opens new possibilities for assisted reproductive technology. Optimization of clinical management of IVM cycles will enhance pregnancy outcome, so that IVM might become an effective alternative assisted reproduction treatment for infertile patients irrespective of the cause of infertility. Parameters such as age and baseline antral follicular count are predictive of outcome and should be used as selection criteria for IVM treatment. Women with polycystic ovary disease and normo-ovulatory patients at risk of developing ovarian hyperstimulation syndrome might benefit from earlier retrieval of oocytes followed by IVM and embryo transfer. HCG priming before oocyte retrieval seems beneficial in terms of oocyte yield and maturational competence, and may increase the harvest of mature oocytes and lead to better endometrial synchronization with the developing embryo. The timing of aspiration may be crucial in IVM and selection criteria for follicle size at aspiration need defining prospectively for infertility type. Finer calibre aspiration needles and low aspiration pressure yield more oocytes. A combination of natural cycle IVF with IVM is a promising, mild and inexpensive assisted reproduction treatment, widely accessible the infertile population.
Collapse
Affiliation(s)
- E G Papanikolaou
- Centre for Reproductive Medicine, AZ-VUB, University Hospital, Dutch-Speaking Free University of Brussels, Laarbeeklaaan 101, 1090 Jette, Brussels, Belgium.
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
PURPOSE OF REVIEW The recovery of immature oocytes followed by in-vitro maturation (IVM) and in-vitro fertilization is an attractive alternative to conventional in-vitro fertilization treatment in which controlled ovarian stimulation with gonadotropins is used to increase the number of available oocytes and embryos. Significant progress has been made to improve pregnancy and implantation rates from in-vitro matured oocytes. This review summarizes current knowledge and achievements in human oocyte in-vitro maturation for clinical application, and will highlight recent advances reported in in-vitro maturation treatment. RECENT FINDINGS It has been demonstrated that priming of ovarian immature oocytes with follicle-stimulating hormone or human chorionic gonadotropin prior to immature oocyte retrieval improves oocyte maturation rates and embryo quality as well as pregnancy rates in infertile women with polycystic ovaries or polycystic ovary syndrome. The size of follicles may be important for the subsequent embryonic development, but the developmental competence of oocytes derived from the small antral follicles is not adversely affected by the presence of a dominant follicle. However oocyte maturation in vitro is profoundly affected by culture conditions. Currently more than 300 healthy infants have been born following immature oocyte retrieval and in-vitro maturation. In general, the clinical pregnancy and implantation rates have reached 30-35% and 10-15% respectively in infertile women with polycystic ovaries or polycystic ovary syndrome. SUMMARY In-vitro maturation treatment can now be offered as a successful option to infertile women with polycystic ovaries or polycystic ovary syndrome. It is possible to combine natural cycle in-vitro fertilization with immature oocyte retrieval followed by in-vitro maturation, and thus offer women with various causes of infertility reasonable pregnancy and implantation rates without recourse to ovarian stimulation. Further research remains to be done to address the mechanism of oocyte maturation in order to refine culture conditions and improve the implantation rate of oocytes matured in vitro.
Collapse
Affiliation(s)
- Ri-Cheng Chian
- McGill Reproductive Centre, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
| | | | | |
Collapse
|
49
|
Hovatta O. Cryopreservation and culture of human ovarian cortical tissue containing early follicles. Eur J Obstet Gynecol Reprod Biol 2004; 113 Suppl 1:S50-4. [PMID: 15041132 DOI: 10.1016/j.ejogrb.2003.11.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Maturation of oocytes from primordial follicles after cryopreservation of ovarian tissue with subsequent in vitro fertilisation would be an important method of infertility treatment for young women who are to undergo premature ovarian failure due to chemotherapy or genetic causes. Cryopreservation of human ovarian tissue is already feasible. Human primordial follicles can be cultured regularly to secondary and occasionally to early antral stages, yet cultures have to be further optimised before meiotically competent oocytes can be achieved for final maturation in vitro. Maturation in vitro (IVM) of oocytes obtained by aspiration from small antral follicles is already a feasible technique resulting in pregnancies, with many healthy infants born.
Collapse
Affiliation(s)
- Outi Hovatta
- Department of Obstetrics and Gynaecology, Karolinska Institutet, Huddinge University Hospital, S-14186 Stockholm, Sweden.
| |
Collapse
|
50
|
|