Aspiration of oocytes for in-vitro fertilization

The importance of follicular flushing in optimizing oocyte retrieval

PURPOSE OF REVIEW

To critically evaluate the use of follicular flushing during oocyte retrieval.

RECENT FINDINGS

The latest meta-analysis evaluating follicular flushing does not favour its use over single aspiration. The randomized controlled trials (RCTs) included, however, are characterized by significant heterogeneity regarding the population analysed, the needle type and lumen used, the aspiration pressure applied and the number of flushing attempts performed. More importantly, information regarding the flow rate used for aspiration is scarce. The only RCT employing a constant flow rate between single aspiration and follicular flushing in women with monofollicular development, suggests that a higher number of oocytes is retrieved after follicular flushing.

SUMMARY

In order to eliminate clinical heterogeneity that might obscure the detection of the true effect of follicular flushing, randomization to single aspiration and follicular flushing should occur within the same patient. This can be achieved by randomly allocating each patient's ovary to either single aspiration or follicular flushing, maintaining similar flow rates between the groups compared.Given the importance of maximizing the number of oocytes retrieved from a given number of follicles developed, the conduction of properly designed RCTs evaluating follicular flushing is certainly required.

Transvaginal ultrasound-guided oocyte retrieval in cattle: State-of-the-art and its impact on the in vitro fertilization embryo production outcome

Transvaginal ultrasound-guided oocyte retrieval (commonly called OPU) and in vitro embryo production (IVP) in cattle has shown significant progress in recent years, in part, as a result of a better understanding of the full potential of these tools by end users. The combination of OPU and IVP (OPU-IVP) has been successfully and widely commercially used worldwide. The main advantages are a greater number of embryos and pregnancies per unit of time, faster genetic progress due to donor quick turn around and more elite sires mating combinations, larger spectrum of female age (calves, prepuberal, heifer, cow) and condition (open, pregnant) from which to retrieve oocytes, a reduced number of sperm (even sexed) required to fertilize the oocytes, among other benefits. OPU-IVP requires significant less donor preparation in comparison to conventional embryo transfer (<50% of usual FSH injections needed) to the extent of no stimulating hormones (FSH) are necessary. Donor synchronization, stimulation, OPU technique, oocyte competence, embryo performance, and its impact on cryopreservation and pregnancy are discussed.

Association between oocyte retrieval technique and number of oocytes retrieved

PURPOSE

To assess if there is an optimal oocyte retrieval (OR) technique to retrieve a maximum number of oocytes and mature oocytes (MII).

METHODS

Retrospective cohort study in which nine physicians completed a survey on OR techniques. Number of oocytes/follicle cohort, MIIs/follicle cohort, and MIIs/oocytes retrieved (%MII) were assessed for each technique for patients undergoing OR from 3/2013 to 7/2019. Data were stratified by number of follicles on ultrasound on day of trigger (< 6, 6-10, > 10).

RESULTS

Patient demographics were equivalent between techniques. For < 6 follicles, three techniques resulted in significantly fewer oocyte/follicle (0.97 ± 0.48, 0.95 ± 0.66, and 0.90 ± 0.41) compared to the top-performing technique (TPT) (1.11 ± 0.55). For 6-10 follicles, two techniques resulted in significantly fewer oocyte/follicle (0.95 ± 0.39 and 0.93 ± 0.35) compared to the TPT (1.06 ± 0.42). A different technique had higher %MII (0.77 ± 0.19) compared to two techniques (0.74 ± 0.21 and 0.72 ± 0.22). For > 10 follicles, two techniques resulted in significantly fewer oocyte/follicle (1.01 ± 0.42 and 1.07 ± 0.40) compared to the TPT (1.15 ± 0.41). These two techniques also resulted in fewer MII/follicle (0.75 ± 0.33 and 0.81 ± 0.34 vs. 0.87 ± 0.34). There was no consistent TPT across follicle number groups or for all outcome variables.

CONCLUSIONS

There does not appear to be a clear TPT, even for patients with few follicles. Providers who perform OR in a similar fashion to physicians at our institution should feel confident that those techniques obtain equivalent oocyte yields.

Empty Zona Pellucida Only Case: A Critical Review of the Literature

The presence of empty zona pellucida (EZP) in oocytes following oocyte retrieval (OR) during an in vitro fertilization (IVF) cycle presents a major clinical and laboratory challenge in assisted reproduction. It has been attributed to several factors such as the ovarian stimulation protocol employed, the damaging of the follicles during oocyte retrieval (OR) mainly through the high aspiration pressure, during the denudation technique, and the degeneration of oolemma within the zona pellucida (ZP) through apoptosis. The role of ZP is pivotal from the early stages of follicular development up to the preimplantation embryo development and embryo hatching. Polymorphisms or alterations on the genes that encode ZP proteins may contribute to EZP. We present a critical review of the published literature hitherto on EZP and available options when encountered with the phenomenon of EZP. Concerning the former, we found that there is rare data on this phenomenon that merits documentation. The latter includes technical, genetic, and pathophysiological perspectives, along with specific treatment options. In conclusion, we identify the lack of a definitive management proposal for couples presenting with this phenomenon, we underline the need for an algorithm, and indicate the questions raised that point towards our goal for a strategy when addressing a previous finding of EZP.

Degenerative Oocytes in the Aspirated Cohort Are Not Due to the Aspirating Needle: a Prospective Randomized Pilot Study with Sibling Oocytes

The aim of this study is to compare two different needles (17G vs. 20-17G variable diameter) used for OPU and to assess whether the different stress forces along the needle affect the presence of degenerative oocytes, oocyte quality, and embryo morphokinetics. Prospective, randomized study enrolled women undergoing in vitro fertilization (IVF) intracytoplasmic sperm injection (ICSI) from August 2016 through August 2018 in an IVF unit at a tertiary care medical center. Ovaries were randomly aspirated using either a 20-17G needle or a 17G needle. The embryologist was blinded to the aspirating needle and sibling oocytes were separated according to needle used for fertilization and further evaluation. Oocytes were scored negatively if one of the following parameters was abnormal immediately after OPU: polar body shape, zona pellucida, cytoplasm, perivitelline space, or vacuoles. The presence of degenerative oocytes was noted at OPU. A total of 580 oocytes from 43 women were evaluated, 293 in the 17G needle group and 287 in the 20-17G group. Oocyte scoring was comparable between the two different needles (- 1.99 ± 1.9 vs. - 1.88 ± 1.69; P = 0.13), as were embryo quality and pregnancy rate. Cohorts with degenerative oocytes had lower oocyte scores (- 2.11 ± 1.81 vs. - 1.60 ± 1.50; P = 0.001) and poorer performance and fertilization rates (62.5% vs. 78.5%; P < 0.001) than did cohorts with no degenerative oocytes. Cycles with degenerative oocytes in the cohort at OPU demonstrated poorer oocyte quality and decreased fertilization, regardless of the needle used. 1.5.2016 NIH number NCT02749773.

Degenerated oocyte in the cohort adversely affects IVF outcome

The presence of Degenerated Oocyte (DEG) was mostly described after intracytoplasmic sperm injection (ICSI), with fewer reports on DEG at the time of ovum pick-up (OPU). This study aims to assess morphokinetics of embryos cultured in a time-lapse incubator and compare cohorts with and without DEG at OPU. In a retrospective cohort study from January 1, 2016 until September 31, 2017 a total of 399 IVF/ICSI cycles and 2980 embryos were evaluated. In 81 of 399 cycles at least one DEG oocyte was observed at the time of OPU. The remaining 318 cycles with no DEG oocyte were compared as a control group. In the DEG group, significantly more oocytes were collected per patient (12.9 ± 7.2 vs. 10.1 ± 6.1. P < 0.001). Fertilization rate, pregnancy and clinical pregnancy rates were comparable between the two groups, however, the morphokinetics and developmental scores of the embryos were significantly worse in the DEG group, (KID 3.4 ± 1.6 vs. 3.2 ± 1.6 P = 0.002 and ESHRE 1.5 ± 1.1 vs. 1.4 ± 1.0 P = 0.046). Significantly more patients achieved top-quality embryos in the NON DEG group (58.8% vs. 53.0%, P = 0.03), however, comparable delivery rate was achieved in both groups. In the DEG group, the frequency of DEG oocyte per cycle was negatively correlated with pregnancy rate. GnRH agonist protocol and the 17-20G needle used for OPU were significant predictors for the presence of DEG oocyte at OPU. In conclusions DEG oocyte may negatively affect IVF outcome, however, younger patients, and significantly more oocytes collected in the DEG group compensate for the IVF results.

Recommendations for good practice in ultrasound: oocyte pick up†

STUDY QUESTION

What is good practice in ultrasound (US), and more specifically during the different stages of transvaginal oocyte retrieval, based on evidence in the literature and expert opinion on US practice in ART?

SUMMARY ANSWER

This document provides good practice recommendations covering technical aspects of US-guided transvaginal oocyte retrieval (oocyte pick up: OPU) formulated by a group of experts after considering the published data, and including the preparatory stage of OPU, the actual procedure and post-procedure care.

WHAT IS KNOWN ALREADY

US-guided transvaginal OPU is a widely performed procedure, but standards for best practice are not available.

STUDY DESIGN SIZE DURATION

A working group (WG) collaborated on writing recommendations on the practical aspects of transvaginal OPU. A literature search for evidence of the key aspects of the procedure was carried out. Selected papers (n = 190) relevant to the topic were analyzed by the WG.

PARTICIPANTS/MATERIALS SETTING METHODS

The WG members considered the following key points in the papers: whether US practice standards were explained; to what extent the OPU technique was described and whether complications or incidents and how to prevent such events were reported. In the end, only 108 papers could be used to support the recommendations in this document, which focused on transvaginal OPU. Laparoscopic OPU, transabdominal OPU and OPU for IVM were outside the scope of the study.

MAIN RESULTS AND THE ROLE OF CHANCE

There was a scarcity of studies on the actual procedural OPU technique. The document presents general recommendations for transvaginal OPU, and specific recommendations for its different stages, including prior to, during and after the procedure. Most evidence focussed on comparing different equipment (needles) and on complications and risks, including the risk of infection. For these topics, the recommendations were largely based on the results of the studies. Recommendations are provided on equipment and materials, possible risks and complications, audit and training. One of the major research gaps was training and competence. This paper has also outlined a list of research priorities (including clarification on the value or full blood count, antibiotic prophylaxis and flushing, and the need for training and proficiency).

LIMITATIONS REASONS FOR CAUTION

The recommendations of this paper were mostly based on clinical expertise, as at present, only a few clinical trials have focused on the oocyte retrieval techniques, and almost all available data are observational. In addition, studies focusing on OPU were heterogeneous with significant difference in techniques used, which made drafting conclusions and recommendations based on these studies even more challenging.

WIDER IMPLICATIONS OF THE FINDINGS

These recommendations complement previous guidelines on the management of good laboratory practice in ART. Some useful troubleshooting/checklist recommendations are given for easy implementation in clinical practice. These recommendations aim to contribute to the standardization of a rather common procedure that is still performed with great heterogeneity.

STUDY FUNDING/COMPETING INTERESTS

The meetings of the WG were funded by ESHRE. The other authors declare that they have no conflict of interest.

TRIAL REGISTRATION NUMBER

NA.ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.

Oocyte retrieval at 140-mmHg negative aspiration pressure: A promising alternative to flushing and aspiration in assisted reproduction in women with low ovarian reserve

BACKGROUND:

Oocyte retrieval in women with low ovarian reserve is challenging and often results in poor pregnancy outcomes.

AIM:

The aim was to compare outcomes of oocyte retrieval using three aspiration methods in women with normal and low antral follicle counts (AFCs).

STUDY DESIGN:

Retrospective cohort study.

SETTING:

Tertiary care hospital.

MATERIALS AND METHODS:

Data from 172 women who underwent in-vitro fertilization/intracytoplasmic sperm injection over 3 years was studied after dividing into three groups: Group A (96) - normal AFC (≥10), direct oocyte retrieval at 120 mmHg, Group B (41) - low AFC (<10), direct retrieval at 140-mmHg, Group C (35) - low AFC, follicular flushing, and aspiration at 120-mmHg. In each group, oocyte yield, embryo quality, and pregnancy out comes were assessed.

RESULTS:

The oocyte and embryo yield in Groups A and B were comparable (P > 0.05) but were significantly less in Group C (P < 0.05). The pregnancy rates in Groups A and B were similar (35.4%, 39%) but were significantly less (17.1%) in Group C (P < 0.05). The live birth rate was 76% in Group A, 69% in Group B, and 50% in Group C. The miscarriage rates in the three groups were 21%, 31%, and 50%, respectively.

CONCLUSION:

Direct oocyte retrieval with 140-mmHg showed significantly better oocyte yield and pregnancy outcomes compared to flushing and aspiration in women with low AFC.

Approaches to oocyte retrieval for advanced reproductive technology cycles planning to utilize in vitro maturation: a review of the many choices to be made

PURPOSE

To evaluate the minutiae associated with oocyte retrieval for use in human in vitro maturation IVF cycles. Many of the relevant features of oocyte retrieval were identified by the Trounson group in the first publication on successful in vitro maturation using transvaginal oocyte harvesting and these were a major focus of this review.

METHODS

Published human and animal studies, together with topics from mathematics and mechanics, were used to try to understand the importance of different choices that could be made in structuring a transvaginal oocyte retrieval procedure in humans.

RESULTS

The published literature suggests that the highest oocyte recovery rate occurs using higher pressures and thicker needles, but this comes at the cost of damaging the cumulus oocyte complex. It is likely that this damage is caused by the sheer stress forces exerted on the cumulus oocyte complex due to parabolic forces associated with laminar flow within the needle and is likely worsened by irregular forces during intervals of turbulent flow occurring with entry into the needle. Larger needles also cause more pain and may be associated with more blood loss. Higher velocity entry into the follicle, needle rotation to prevent premature blockage of the lumen, and carefully timed applications of aspiration pressure theoretically optimize oocyte retrieval technique.

CONCLUSIONS

Oocyte retrieval for in vitro maturation is effected by the interaction of the many choices that need to be made in planning for the procedure. The most difficult decision involves aspiration pressure or fluid flow rate and needle size.

Longitudinal study of reproductive performance of female cattle produced by somatic cell nuclear transfer

The objective of this study was to determine whether or not reproductive performance in cattle produced by somatic cell nuclear transfer (SCNT) is significantly different from that of their genetic donors. To address this question, we directed two longitudinal studies using different embryo production procedures: (1) superovulation followed by artificial insemination (AI) and embryo collection and (2) ultrasound-guided ovum pick-up followed by in vitro fertilization (OPU-IVF). Collectively, these two studies represent the largest data set available for any species on the reproductive performance of female clones and their genetic donors as measured by their embryo production outcomes in commercial embryo production program. The large-scale study described herein was conducted over a six-year period of time and provides a unique comparison of 96 clones to the 40 corresponding genetic donors. To our knowledge, this is the first longitudinal study on the reproductive performance of cattle clones using OPU-IVF. With nearly 2,000 reproductive procedures performed and more than 9,200 transferable embryos produced, our observations show that the reproductive performance of cattle produced by SCNT is not different compared to their genetic donors for the production of transferable embryos after either AI followed by embryo collection (P = 0.77) or OPU-IVF (P = 0.97). These data are in agreement with previous reports showing that the reproductive capabilities of cloned cattle are equal to that of conventionally produced cattle. In conclusion, results of this longitudinal study once again demonstrate that cloning technology, in combination with superovulation, AI and embryo collection or OPU-IVF, provides a valuable tool for faster dissemination of superior maternal genetics.

In vivo collection of follicular fluid and granulosa cells from individual follicles of different diameters in cattle by an adapted ovum pick-up system

BACKGROUND

Most studies on granulosa cell (GC) function in cattle have been performed using GC and follicular fluid (FF) samples collected from slaughterhouse ovaries. Using this approach, the follicular developmental stage and functional status are unknown and indirectly inferred, limiting data interpretation. Ultrasound-guided follicle aspiration has previously been used to recover GC or FF samples, but this was mostly carried out in large follicles or pools of small follicles, without recording the efficiency of recovery. The present study was aimed at adapting and evaluating an ovum pick-up (OPU) system for the in vivo recovery of FF and GC from individual follicles of different diameters.

METHODS

In the first trial, the losses of fluid inside the tubing system were calculated using a conventional or an adapted-OPU system. Blood plasma volumes equivalent to the amount of FF in follicles of different diameters were aspirated using a conventional OPU Teflon circuit. The OPU system was then adapted by connecting 0.25 mL straws to the circuit. A second trial evaluated the efficiency of FF recovery in vivo. Follicles ranging from 4.0 to 16.8 mm in diameter were aspirated individually using the conventional or adapted-OPU systems. A third trial assessed the in vivo recovery of GC and the subsequent amount of RNA obtained from the follicles of different diameters from Holstein and Gir cattle.

RESULTS

In Trial I, the plasma recovery efficiency was similar (P > 0.05) for the volumes expected for 12 and 10 mm follicles, but decreased (P < 0.05) for smaller follicles (45.7+/-4.0%, 12.4+/-4.3% and 0.0+/-0.0% for 8, 6, and 4 mm follicles, respectively). Using the adaptation, the losses intrinsic to the aspiration system were similar for all follicle diameters. In Trial II, the expected and recovered volumes of FF were correlated (r = 0.89) and the efficiency of recovery was similar among follicles <12 mm, while larger follicles had a progressive increase in FF losses that was not related to the tubing system. In Trial III, the number of GC and amount of RNA obtained were not affected (P > 0.05) by follicle size, but differed according to breed (615,054+/-58,122 vs 458,095+/-36,407 for Holstein and Gir, respectively; P < 0.05).

CONCLUSIONS

The adapted-OPU system can be successfully used for the in vivo collection of FF and GC from follicles of different diameters. This will enable further endocrine, cellular, and gene expression analyses.

Follicular flushing during oocyte retrieval in assisted reproductive techniques

BACKGROUND

Ultrasound guided transvaginal aspiration of oocytes has replaced other methods of oocyte retrieval for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). However, there is controversy over whether flushing yields a larger number of oocytes and a higher potential for pregnancy than aspiration only.

OBJECTIVES

To determine whether follicular aspiration and flushing increases live birth or ongoing pregnancy rates and the number of oocytes over aspiration alone in women undergoing IVF and ICSI.

SEARCH STRATEGY

We searched the Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO and the citation lists of relevant publications (to April 2010).

SELECTION CRITERIA

Randomised controlled trials that compared follicular aspiration and flushing with aspiration alone were included. Trials were excluded if the flushing method comparison was confounded by comparisons of other methods.

DATA COLLECTION AND ANALYSIS

Eligible studies were assessed for methodological quality. For dichotomous data, odds ratios (OR) and 95% confidence intervals (CI) were calculated. For continuous data, mean differences were reported. The heterogeneity of the studies was examined by using statistical tests of homogeneity and the I(2) statistic.

MAIN RESULTS

No studies reported on the primary outcome of live birth. There was no evidence (3 studies, 164 patients) to suggest an association between follicular aspiration and flushing and ongoing or clinical pregnancy per woman randomised (OR 1.17, 95% CI 0.57 to 2.38). There was no evidence of a difference in adverse events reported between follicular aspiration and flushing and aspiration only. There was no evidence of significant differences in increased oocyte yield per woman randomised (1 study, 44 patients). Without flushing the operative time was significantly shorter, by 3 to 15 minutes (3 studies, P < 0.001) and the dose of pethidine required was significantly less (50 mg versus 100 mg, P < 0.00001).

AUTHORS' CONCLUSIONS

There is no evidence that follicular aspiration and flushing is associated with improved clinical or ongoing pregnancy rates, nor an increase in oocyte yield. The operative time is significantly longer and more opiate analgesia is required for pain relief during oocyte retrieval. There is a lack of evidence regarding the effect of follicular aspiration and flushing on live birth rates in the identified data.

Retrieval of rhesus monkey (Macaca mulatta) oocytes by ultrasound-guided needle aspiration: problems and solutions

Oocytes of nonhuman primates such as rhesus monkeys are excellent models for diverse studies on developmental biology, epigenetics, human reproduction, and assisted reproductive technologies, as well as on transgenics. Such studies require numerous oocytes that can be retrieved after controlled ovarian stimulation. Currently, most primate centers use laparoscopic aspiration or laparotomy followed by aspiration to collect rhesus oocytes, although the ultrasound-guided needle aspiration is more advantageous due to reduced infection risk, less injury, and a shorter recovery period. Yet, some initial difficulties associated with the ultrasound-guided needle aspiration limit its broader application. The objective of the present study was to address these obstacles. By presenting practical solutions to the initial difficulties, results from our study show that it is possible to collect a mean number of 38 +/- 10 rhesus oocytes per hormonally stimulated female. These results compare favorably to the average number of rhesus oocytes collected using the laparoscopic approach and suggest that when initial obstacles are overcome, the ultrasound-guided oocyte retrieval represents a good alternative to more invasive approaches.

Protocolos de produção in vitro de embriões na raça Gir

Avaliaram-se os efeitos de dois protocolos de punção folicular na quantidade/qualidade dos oócitos e na produção in vitro de embriões, em vacas da raça Gir, não-lactantes. O ciclo estral foi sincronizado com cloprostenol e ao longo do experimento os animais receberam implantes auriculares de norgestomet, renovados a cada 14 dias. Os animais foram submetidos aos protocolos I (sem estimulação hormonal, com punção folicular duas vezes/semana) e II (pré-tratamento com 250 UI de FSH em doses decrescentes, três dias antes da punção folicular). Os oócitos recuperados foram levados ao laboratório em meio TALP-Hepes e submetidos à maturação. Na fecundação in vitro utilizou-se sêmen de touro Gir, previamente capacitado. Após 22 horas de fecundação, os prováveis zigotos foram co-cultivados com células da granulosa em CR2aa acrescido de 10% de soro fetal bovino. A taxa de clivagem foi avaliada 72 horas pós-fecundação e a de blastocisto 192 horas pós-fecundação. O número total de folículos foi maior (P<0,05) no protocolo II, assim como o número de folículos grandes e médios (P<0,05) e o diâmetro do maior folículo (P<0,05), sendo o número de folículos pequenos (P<0,05) menor. O total de oócitos recuperados por sessão não foi diferente entre os protocolos I e II (P>0,05). O número de oócitos de grau I e a taxa de clivagem foram maiores (P<0,05) e o número de degenerados menor protocolo II. A pré-estimulação ovariana com FSH pode melhorar a qualidade e a taxa de clivagem dos oócitos recuperados por punção folicular em animais Gir.

The effects of IVF aspiration on the temperature, dissolved oxygen levels, and pH of follicular fluid

PURPOSE

To investigate the effects of IVF aspiration on the temperature, pH, and dissolved oxygen of bovine follicular fluid.

METHODS

The temperature was monitored at various positions in an aspiration kit. Dissolved oxygen and pH were measured before and after aspiration.

RESULTS

The temperature of follicular fluid dropped by 7.7 +/- 1.3 degrees C upon aspiration. Dissolved oxygen levels rose by 5 +/- 2 vol.%. The pH increased by 0.04 +/- 0.01.

CONCLUSIONS

The temperature change was attributed mainly to evaporation of fluid in the collection tube. Changes in dissolved oxygen levels and pH were due to contact with air. Standard vacuum-based aspiration may induce changes in follicular fluid, which could be detrimental to oocyte health and affect attempts to correlate chemical characteristics with oocyte quality.

Efeito da pré-estimulação ovariana sobre características de oócitos após punção folicular em bovinos

Avaliaram-se os efeitos da pré-estimulação ovariana com FSH e da imunização ativa contra inibina suína sobre o número e classificação morfológica de oócitos recuperados por punção folicular. Catorze vacas da raça Gir, pluríparas e não-lactantes, foram distribuídas em: TI - submetidas a pré-estimulação com 250 UI de FSH (n=4), TII - submetidas a imunização ativa contra inibina suína (n=4) e TIII - não tratadas (n=6; controle). Todos os animais tiveram seus folículos com diâmetro superior a três milímetros aspirados uma vez por semana, durante 10 semanas consecutivas. O TI apresentou aumento na população folicular total (P<0,05) e no número de folículos puncionados (P<0,001), porém a taxa de recuperação foi inferior à dos tratamentos II e III (68,8% vs. 78,4% e 76,3%, respectivamente; P<0,01). O TII não afetou as principais características ovarianas, exceto pelo aumento no número de folículos de tamanho médio (P<0,01). O TI produziu maior percentual de oócitos viáveis (77,2% vs. 69,8%; P<0,05) e de oócitos de Grau I (19,8% vs. 11,6%; P<0,001) do que o TIII. Os tratamentos I e II reduziram o percentual de oócitos degenerados (16,4% e 16,8% vs. 22,3%; P<0,05). A pré-estimulação ovariana com FSH demonstrou ser a alternativa mais consistente para aumentar a qualidade dos oócitos recuperados de vacas zebuínas.

Improved collection and developmental competence of immature macaque oocytes

Methods previously described to aspirate immature oocytes from ovaries of macaques result in approximately half the oocytes being stripped of cumulus cells. Here, we describe modifications of the needle aspiration assembly that yield much higher percentages of cumulus-intact oocytes when used with an ultrasound-guided method for oocyte recovery in monkeys. Sealing of the needle assembly appears to stabilize vacuum pressure at the needle tip and prevents air from entering the tubing. Reduction of the vacuum pressure from -100 to -20 kPa resulted in a significant decrease of denuded oocytes from over 50% to fewer than 10%. This was accompanied by a significant increase in the percentage of oocytes that developed into blastocysts after in vitro fertilization. Reduction of the aspiration pressure below -20 kPa significantly reduced the total number of oocytes recovered. We concluded that these modifications represent the best compromise to collect the largest number of cumulus-intact oocyte complexes from macaques.

Oocyte maturation in vitro

In contrast to conventional assisted reproduction techniques in which metaphase II oocytes are retrieved for fertilization in vitro, during the in-vitro maturation of oocytes, immature germinal vesicle stage oocytes are retrieved and matured in the laboratory before fertilization and embryo transfer. Whereas in-vitro maturation is technically more demanding than in-vitro fertilization it carries many potential advantages in terms of lower treatment costs and greater safety, as a result of reducing both the number of clinical consultations and the amount of pharmacological intervention. Although the technology is still experimental, in-vitro maturation has been successfully used for the treatment of patients with polycystic ovarian syndrome, and a number of pregnancies and live births have been reported. Despite these successes and much continuing research effort, the overall efficiency of in-vitro maturation remains low, and neither clinical nor laboratory procedures can be considered to be as robust and routinely feasible as conventional in-vitro fertilization techniques. The immediate goals for in-vitro maturation programmes are therefore to increase germinal vesicle oocyte recovery rates, optimize culture conditions, improve oocyte maturation potential, and after fertilization to produce pregnancy rates that are at least equivalent to those obtained using conventional in-vitro fertilization. This review focuses on the physiology and application of human oocyte maturation in vitro, and will detail the recent advances reported in this rapidly advancing field.