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Hatirnaz E, Hatirnaz S, Kanat-Pektas M, Dokuzeylul Gungor N, Erol O, Kalyoncu S, Dahan MH. The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation. J Obstet Gynaecol Res 2021; 47:2684-2691. [PMID: 34028123 DOI: 10.1111/jog.14858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/24/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aims to determine the effects of early and late onset estrogen supplementation on the immature oocyte retrieval, fertilization and clinical pregnancy rates in follicle stimulating hormone (FSH) and human chorionic hormone (hCG) primed in vitro maturation (IVM) cycles of the patients with polycystic ovary syndrome (PCOS). METHODS This is a retrospective analysis of 161 patients with PCOS who underwent FSH and hCG primed IVM. Group 1 included 120 patients who received early onset estrogen supplementation while group 2 consisted of 41 patients who had late onset estrogen supplementation in primed IVM cycles. Immature oocyte (germinal vesicle and/or metaphase I) retrieval and fertilization rates were the primary outcomes, whereas clinical pregnancy and live rates were the secondary outcomes. RESULTS Group 1 patients had significantly higher body mass index and more previous IVF attempts (p = 0.001 and p = 0.008, respectively). All of the retrieved oocytes from the PCOS patients were either germinal vesicle or metaphase I oocytes and there were no metaphase II oocytes among the retrieved oocytes. Both groups had statistically similar numbers of metaphase I and fertilized oocytes (p > 0.05 for both). However, group 1 patients had significantly lower number of germinal vesicle oocytes but significantly higher number of metaphase II oocytes (p = 0.001 for both). Both groups had statistically similar fertilization (85.0% vs 78.0%), clinical pregnancy (49.2% vs 43.9%) and live birth (37.5% vs 39.0%) rates (p > 0.05 for all). CONCLUSION Early onset estrogen supplementation appears to improve the quality of retrieved immature oocytes and contribute to the maturation of oocytes in stimulated IVM cycles.
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Affiliation(s)
- Ebru Hatirnaz
- In Vitro Fertilization Center, Department of Obstetrics and Gynecology, Medicana International Hospital, Samsun, Turkey
| | - Safak Hatirnaz
- In Vitro Fertilization Center, Department of Obstetrics and Gynecology, Medicana International Hospital, Samsun, Turkey
| | - Mine Kanat-Pektas
- Department of Obstetrics and Gynecology, School of Medicine, Kocatepe University, Afyonkarahisar, Turkey
| | - Nur Dokuzeylul Gungor
- In Vitro Fertilization Center, Department of Obstetrics and Gynecology, BAU MedicalparkGöztepe Hospital, Istanbul, Turkey
| | - Onur Erol
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Senol Kalyoncu
- Department of Obstetrics and Gynecology, TOBB ETU Hospital, Ankara, Turkey
| | - Michael H Dahan
- McGill Fertility Center, Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
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Vuong LN, Le AH, Ho VNA, Pham TD, Sanchez F, Romero S, De Vos M, Ho TM, Gilchrist RB, Smitz J. Live births after oocyte in vitro maturation with a prematuration step in women with polycystic ovary syndrome. J Assist Reprod Genet 2020; 37:347-357. [PMID: 31902102 PMCID: PMC7056678 DOI: 10.1007/s10815-019-01677-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/22/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Standard oocyte in vitro maturation (IVM) usually results in lower pregnancy rates than in vitro fertilization (IVF). IVM preceded by a prematuration step improves the acquisition of oocyte developmental competence and can enhance embryo quality (EQ). This study evaluated the effectiveness of a biphasic culture system incorporating prematuration and IVM steps (CAPA-IVM) versus standard IVM in women with polycystic ovarian morphology (PCOM). Methods Eighty women (age < 38 years, ≥ 25 follicles of 2–9 mm in both ovaries, no major uterine abnormalities) were randomized to undergo CAPA-IVM (n = 40) or standard IVM (n = 40). CAPA-IVM uses two steps: a 24-h prematuration step with C-type natriuretic peptide-supplemented medium, then 30 h of culture in IVM media supplemented with follicle-stimulating hormone and amphiregulin. Standard IVM was performed using routine protocols. Results A significantly higher proportion of oocytes reached metaphase II at 30 h after CAPA-IVM versus standard IVM (63.6 vs 49.0; p < 0.001) and the number of good quality embryos per cumulus-oocyte complex tended to be higher (18.9 vs 12.7; p = 0.11). Clinical pregnancy rate per embryo transfer was 63.2% in the CAPA-IVM versus 38.5% in the standard IVM group (p = 0.04). Live birth rate per embryo transfer was not statistically different between the CAPA-IVM and standard IVM groups (50.0 vs 33.3% [p = 0.17]). No malformations were reported and birth weight was similar in the two treatment groups. Conclusions Use of the CAPA-IVM system significantly improved maturation and clinical pregnancy rates versus standard IVM in patients with PCOM. Furthermore, live births after CAPA-IVM are reported for the first time.
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Affiliation(s)
- Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam. .,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam. .,HOPE Research Center, Ho Chi Minh City, Vietnam.
| | - Anh H Le
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Vu N A Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Flor Sanchez
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium.,Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru
| | - Sergio Romero
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium.,Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru
| | - Michel De Vos
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium
| | - Tuong M Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Robert B Gilchrist
- Fertility and Research Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Johan Smitz
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium
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Ho VNA, Pham TD, Le AH, Ho TM, Vuong LN. Live birth rate after human chorionic gonadotropin priming in vitro maturation in women with polycystic ovary syndrome. J Ovarian Res 2018; 11:70. [PMID: 30149808 PMCID: PMC6112143 DOI: 10.1186/s13048-018-0445-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/16/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In vitro maturation (IVM) has some advantages over conventional in vitro fertilization (IVF), particularly in polycystic ovary syndrome (PCOS) where the risk of ovarian hyperstimulation is high. We studied the live birth rate in a large series of PCOS women undergoing human chorionic gonadotropin (hCG)-priming IVM. METHODS This retrospective study included women with PCOS aged 18-42 years undergoing IVM with hCG priming. We reported live birth rate after the first embryo transfer and cumulative live birth rate from embryos obtained in the IVM cycle. We also performed logistic regression to assess which factors predicted number of oocytes and live birth. RESULTS We included 921 women (age 28.9±3.5 years, body mass index 21.8±3.1 kg/m2, infertility duration 3.7±2.6 years, 81% primary infertility, 88% first IVF attempt, 94% ovulation induction failure). Live birth rate after the first embryo transfer was 31.7%, with a cumulative live birth rate from the cycle of 33.7%. High anti-Müllerian hormone levels predicted a high number of oocytes and a high oocyte maturation rate while the opposite was the case when luteinizing hormone levels were high. CONCLUSIONS In women with PCOS, hCG priming IVM was feasible and resulted in acceptable live birth rates.
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Affiliation(s)
- V. N. A. Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - T. D. Pham
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - A. H. Le
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - T. M. Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - L. N. Vuong
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Wang X, Tsai T, Qiao J, Zhang Z, Feng HL. Impact of gonadotropins on oocyte maturation, fertilisation and developmental competence in vitro. Reprod Fertil Dev 2015; 26:752-7. [PMID: 23726536 DOI: 10.1071/rd13024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 05/02/2013] [Indexed: 11/23/2022] Open
Abstract
The aim of the present study was to evaluate the dose-dependent effects of gonadotropins, either singly (Bravelle (B), Luveris (L), Menupur (M), Repronex (R), Gonal-F (G), Follism (F) and Norvarel (N)) or in combination (Menupur+Bravelle; Repronext+Bravelle; and Bravelle+Norvarel), on rates of oocyte maturation, fertilisation and early embryo development in vitro in an animal model. Bovine cumulus-oocyte complexes (COCs) were purchased commercially and cultured in TCM-199 with 10% fetal bovine serum supplemented with varying concentrations of gonadotropin (0, 5, 10, 20, 40IU or United States Pharmacopoeia (USP) mL-1) for 24 and 48h according to current IVF clinical stimulation protocols. All gonadotropins enhanced oocyte maturation in vitro in a dose-dependent manner. Individually, Gonal-F (Merck KGaA, Darmstadt, Germany), Follism (Merck Co, Whitehouse Station, NJ, USA) and Repronext (Ferring, Parsippany, NJ, USA) promoted oocyte maturation; in combination, they effectively enhanced COC expansion and increased the maturation competence of MII oocytes. However, high concentrations of gonadotropins may result in maturation arrest. Specific combinations of gonadotropins may change the rate of early embryonic development (8-16-cells) and morula-blastocyst formation. These data provide support for the responsiveness of bovine oocytes to gonadotropins in vitro and the need to consider variations in the relative concentrations and ratio of combinations (FSH/LH or human chorionic gonadotropin) for optimisation of oocyte developmental competence. The results of the present study could be applied to therapeutic clinical stimulation protocols and help improve IVF success rates.
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Affiliation(s)
- Xuemei Wang
- Department of Obstetrics and Gynecology, New York Hospital Queens, Weill Medical College of Cornell University, New York, NY 11355, USA
| | - Tony Tsai
- Department of Obstetrics and Gynecology, New York Hospital Queens, Weill Medical College of Cornell University, New York, NY 11355, USA
| | - Jie Qiao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100083, China
| | - Zhan Zhang
- Reproductive Medical Center, The Third Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou , 450052, China
| | - Huai L Feng
- Department of Obstetrics and Gynecology, New York Hospital Queens, Weill Medical College of Cornell University, New York, NY 11355, USA
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