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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.
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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
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Nargund G, Datta A, Campbell S, Patrizio P, Chian R, Ombelet W, Von Woolf M, Lindenberg S, Frydman R, Fauser BC. The case for mild stimulation for IVF: ISMAAR recommendations. Reprod Biomed Online 2022; 45:1133-1144. [DOI: 10.1016/j.rbmo.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 10/16/2022]
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Effect of dominant follicle status at the time of retrieval on the clinical outcomes in natural cycle IVF combined with immature oocyte treatment. Aging (Albany NY) 2022; 14:4728-4738. [PMID: 35674776 PMCID: PMC9217702 DOI: 10.18632/aging.204106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
Abstract
Objective: It is commonly believed that the oocytes from small follicles are unhealthy when a dominant follicle (DF) is recruited in the ovaries, especially when the DF is ovulated. This study aims to confirm whether the presence or ovulation of DF at the time of retrieval affects the clinical outcome of the natural cycle IVF with in vitro maturation (NC-IVF/M) treatment. Methods: Data were collected from 446 women with regular menstrual cycle and 536 retrieval cycles using NC-IVF/M treatment. The cycles were divided into three groups based on the results of the oocyte retrieval cycle. Group A covers the collection of oocytes from the DF and small follicles; Group B incorporates failed oocyte retrieval from DF and then the oocytes are retrieved only from small follicles; and Group C includes the retrieval of oocytes only from small follicles accompanied with an ovulated DF. Furthermore, Group B and C have subgroups to include whether in vivo matured oocytes were obtained from small follicles. Following aspiration of DF and small follicles, mature oocytes were inseminated on the date of retrieval by intracytoplasmic sperm injection (ICSI) and the immature oocytes were matured in vitro. If the immature oocytes were matured in vitro, they were inseminated using ICSI, and then the embryos obtained from in vivo and in vitro matured oocytes were transferred accordingly. Results: The oocytes from DF were successfully retrieved in 445 cycles (83.0%), failed to be retrieved in 54 cycles (10.1%) and ovulated in 37 cycles (6.9%). In Group A, an average of 2.0 ± 1.7 mature oocytes were retrieved, which was significantly higher than the average of Group B, with 1.3 ± 1.3 matured oocytes and Group C, with an average of 1.1 ± 1.5 matured oocytes (P < 0.01). However, the average number of immature oocytes retrieved from each group show no difference among the three groups. There was no significant difference in maturation rates of immature oocytes, fertilization rates among the three groups. The clinical pregnancy rate per transfer cycle is 34.5%, 34.6% and 25.7% in Group A, B and C, respectively. No significant differences were observed in embryonic development and implantation capacity in Group B and C in comparison to Group A. And there was no significant difference in clinical pregnancy, implantation, live birth and miscarriage rates among the three groups. No significant differences were observed in the developmental and implantation capacity according to with or without in vivo matured oocytes were retrieved in Group B and Group C. Conclusion: The presence or ovulation of the dominant follicle from the ovaries does not significantly influence the developmental and implantation capacity of immature oocytes retrieved from small follicles, suggesting that NC-IVF/M is a promising treatment option for women without ovarian stimulation.
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Elshewy N, Ji D, Zhang Z, Chen D, Chen B, Xue R, Wu H, Wang J, Zhou P, Cao Y. Association between mild stimulated IVF/M cycle and early embryo arrest in sub fertile women with/without PCOS. Reprod Biol Endocrinol 2020; 18:71. [PMID: 32669130 PMCID: PMC7362506 DOI: 10.1186/s12958-020-00622-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/18/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The in vitro maturation (IVM) technique has physical and financial benefits, but a lower efficiency and outcome that is still unclear whether it is related to polycystic ovary syndrome (PCOS) itself or the IVM procedure. In this study, we analyzed the clinical and laboratory outcomes of an optimized IVM protocol in patients with and without PCOS. We also discussed the possible reasons for early embryo arrest in the IVM cycle. METHODS This prospective study involved 58 PCOS patients and 56 non-PCOS patients who underwent mild stimulated IVF combined IVM (IVF/M) cycles. The clinical and laboratory outcomes were compared between the two groups. Also, metaphase II (MII) oocytes were obtained after IVM from the two groups, and in vivo MII oocytes randomly collected from IVF patients were examined for mitochondrial function using a laser scanning confocal microscope (LSCM). The aneuploidy rate for arrested cleavage embryos from IVM and IVF oocytes were screened using Next Generation Sequencing (NGS). RESULTS Mildly stimulated IVF/M resulted in cumulative clinical pregnancy and implantation rates (40.2, 28.7% in the PCOS group vs. 41.9, 36% in the non-PCOS group), respectively. The blastocyst formation rates were comparable (28% vs. 28.2%) in PCOS and non-PCOS groups, respectively. Using LSCM, there was a significant decrease in the mitochondrial membrane potential of IVM oocytes compared with the control IVF oocytes (P < 0.001), but no significant difference between the PCOS and non-PCOS groups. The NGS showed that the aneuploidy rates were comparable (75, 75, and 66.6%) in IVM-PCOS, IVM-non-PCOS, and control IVF arrested embryos, respectively. CONCLUSIONS The mildly stimulated IVF/M protocol produced acceptable clinical outcomes in PCOS and non-PCOS patients. IVM itself rather than the PCOS condition adversely affected the embryo development through its effect on mitochondrial function, which appeared to be a possible cause for the embryo arrest in the IVM cycles rather than chromosomal aneuploidy.
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Affiliation(s)
- Nagwa Elshewy
- grid.412679.f0000 0004 1771 3402Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dongmei Ji
- grid.412679.f0000 0004 1771 3402Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
| | - Zhiguo Zhang
- grid.412679.f0000 0004 1771 3402Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
- grid.186775.a0000 0000 9490 772XNHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
| | - Dawei Chen
- grid.412679.f0000 0004 1771 3402Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
- grid.186775.a0000 0000 9490 772XNHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
| | - Beili Chen
- grid.412679.f0000 0004 1771 3402Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
| | - Rufeng Xue
- grid.412679.f0000 0004 1771 3402Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
| | - Huan Wu
- grid.412679.f0000 0004 1771 3402Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
| | - Jianye Wang
- grid.412679.f0000 0004 1771 3402Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
| | - Ping Zhou
- grid.412679.f0000 0004 1771 3402Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
- grid.186775.a0000 0000 9490 772XNHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Engineering Technology Research center for Bio preservation and Artificial Organs, Hefei, China
| | - Yunxia Cao
- grid.412679.f0000 0004 1771 3402Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
- grid.186775.a0000 0000 9490 772XNHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Engineering Technology Research center for Bio preservation and Artificial Organs, Hefei, China
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Yang ZY, Chian RC. Development of in vitro maturation techniques for clinical applications. Fertil Steril 2017; 108:577-584. [PMID: 28965552 DOI: 10.1016/j.fertnstert.2017.08.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/01/2017] [Indexed: 12/13/2022]
Abstract
In vitro maturation (IVM) refers to maturation in culture of immature oocytes at different stages that may or may not have been exposed to short courses of gonadotropins. The source of immature oocytes is an important feature for subsequent embryonic development, pregnancy, and healthy live births. IVM is an effective treatment that has already achieved significant outcomes of acceptable pregnancy and implantation rates and has led to the births of several thousand healthy babies. As the development of IVM treatment continues, an attractive possibility for improving the already successful outcome is to combine a natural-cycle in vitro fertilization (IVF) treatment with immature-oocyte retrieval followed by IVM of those immature oocytes. If the treatment processes can be simplified for immature-oocyte retrieval, different types of infertile women may be able to take advantage of these treatments. Mild-stimulation IVF combined with IVM treatment may represent a viable alternative to the standard treatment. Although IVM treatment is still considered to be experimental, it is now time to reconsider the IVM technology and its development. Mild-stimulation IVF combined with IVM may prove to be not just alternatives to standard treatments, but potentially first-line treatment choices.
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Affiliation(s)
- Zhi-Yong Yang
- Center for Reproductive Medicine, Tenth People's Hospital of Tongji University, Shanghai, People's Republic of China
| | - Ri-Cheng Chian
- Center for Reproductive Medicine, Tenth People's Hospital of Tongji University, Shanghai, People's Republic of China; Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
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Combelles CM. In VitroMaturation of Human Oocytes: Current Practices and Future Promises. Hum Reprod 2016. [DOI: 10.1002/9781118849613.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Teramoto S, Osada H, Sato Y, Shozu M. Nondominant small follicles are a promising source of mature oocytes in modified natural cycle in vitro fertilization and embryo transfer. Fertil Steril 2016; 106:113-118. [PMID: 27041027 DOI: 10.1016/j.fertnstert.2016.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether oocyte retrieval from nondominant small follicles supplies mature oocytes and increases live births in natural cycle IVF and embryo transfer (IVF-ET). DESIGN Retrospective cohort study. SETTING Private assisted reproductive technology practice. PATIENT(S) Seven hundred seventy-one infertile women who underwent natural cycle IVF between 2011 and 2013. INTERVENTION(S) The LH surge was triggered via nasal buserelin when the dominant follicle reached 16-18 mm during nonstimulated cycles, and as many oocytes as possible were retrieved from nondominant small follicles (a diameter of 3-10 mm) after retrieval from the large (dominant) follicle. The embryos were cryopreserved once they had yielded good-quality blastocysts and then transferred (one per cycle) during subsequent cycles. MAIN OUTCOME MEASURE(S) Number of mature oocytes (metaphase II) and resulting live births yielded via oocyte retrieval from the initial cycle of treatment. RESULT(S) Among 771 women, nondominant small follicle puncture yielded 902 metaphase II oocytes and 78 live births, whereas large dominant follicle puncture yielded 466 metaphase II oocytes and 90 live births. Successes in oocyte retrieval and live births resulting from small follicle puncture were positively correlated with ovarian reserve but did not depend on the outcomes of the dominant follicle puncture. CONCLUSION(S) Nondominant small follicles are a promising supplementary source of mature oocytes for natural cycle IVF.
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Affiliation(s)
| | | | - Yasunori Sato
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Postgraduate School of Medicine, Chiba, Japan
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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.
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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,
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Lim KS, Chae SJ, Choo CW, Ku YH, Lee HJ, Hur CY, Lim JH, Lee WD. In vitro maturation: Clinical applications. Clin Exp Reprod Med 2013; 40:143-7. [PMID: 24505559 PMCID: PMC3913892 DOI: 10.5653/cerm.2013.40.4.143] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 11/27/2013] [Accepted: 11/28/2013] [Indexed: 12/02/2022] Open
Abstract
Oocyte in vitro maturation (IVM) is an assisted reproductive technology in which oocytes are retrieved from the antral follicles of unstimulated or minimally stimulated ovaries. IVM of human oocytes has emerged as a promising procedure. This new technology has advantages over controlled ovarian stimulation such as reduction of costs, simplicity, and elimination of ovarian hyperstimulation syndrome. By elimination or reduction of gonadotropin stimulation, IVM offers eligible infertile couples a safe and convenient form of treatment, and IVM outcomes are currently comparable in safety and efficacy to those of conventional in vitro fertilization. IVM has been applied mainly in patients with polycystic ovary syndrome or ultrasound-only polycystic ovaries, but with time, the indications for IVM have expanded to other uncommon situations such as fertility preservation, as well as to normal responders. In this review, the current clinical experiences with IVM will be described.
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Zhang S, Li J, Zhou G, Qin S, Xin N, Guo J, Xu Y. Infertility treatment for azoospermic patients with a history of infectious parotitis (mumps) using combined techniques. HUM FERTIL 2013; 16:266-8. [PMID: 24279634 DOI: 10.3109/14647273.2013.840392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to investigate the clinical efficacy of in vitro maturation-intracytoplasmic sperm injection (IVM-ICSI) technique on the treatment of azoospermic patients with a history of infectious parotitis (mumps). METHODS Spermatozoa were obtained from the testes of azoospermic patients with a history of mumps and fertilized by ICSI. Eggs were retrieved from the spouse of patients in the natural cycle. Fertilized embryos were transferred into the uterus of patients' respective spouses. RESULTS Live sperm were retrieved from 16 of out of 24 (67%) azoospermic patients with a history of mumps. Using IVM-ICSI, the normal fertilization rate was 71.2%. A total of 23 treatment cycles were completed in the spouses of 16 patients and of these, 9 patients' spouses became pregnant (a pregnancy rate of 39.1%). The success rate for infertility treatment of mumps patients was equally high at 56.3% (9/16). CONCLUSION The IVM-ICSI technique is a simple, effective and economic method for infertility treatment in azoospermic patients with a history of mumps.
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Affiliation(s)
- Shuiwen Zhang
- Reproductive Medical Center, Beijing Military General Hospital , Beijing 100700
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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]
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The possible role of natural cycle and modified natural cycle in IVF. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2012. [DOI: 10.1016/j.mefs.2012.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Yang SH, Patrizio P, Yoon SH, Lim JH, Chian RC. Comparison of pregnancy outcomes in natural cycle IVF/M treatment with or without mature oocytes retrieved at time of egg collection. Syst Biol Reprod Med 2012; 58:154-9. [DOI: 10.3109/19396368.2012.655403] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lamazou F, Fuchs F, Grynberg M, Gallot V, Herzog E, Fanchin R, Frydman N, Frydman R. [Cancellation of IVF-ET cycles: poor prognosis, poor responder, or variability of the response to controlled ovarian hyperstimulation? An analysis of 142 cancellations]. ACTA ACUST UNITED AC 2011; 41:41-7. [PMID: 21835556 DOI: 10.1016/j.jgyn.2011.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/31/2011] [Accepted: 06/03/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION This retrospective study aimed at analyzing IVF-ET management and outcome after cancellation of a first cycle for poor response. PATIENTS AND METHOD One hundred and forty-two infertile patients were included in this observational study. After an overall analysis on the outcome of the second IVF-ET attempt, a sub-analysis was performed according to the presence or the absence of poor prognostic criteria defined as mentioned: patient age superior to 38 years old, antral follicle count (3-9 mm in diameter) inferior to 10 on cycle day 3 and day 3 serum AMH and FSH levels less than 1 ng/mL and more than 10 IU/mL, respectively. Main outcome measures were the cancellation rates, pregnancy and live birth rates. RESULTS When a controlled ovarian stimulation was performed, patients with poor prognosis had higher cancellation rates (37.8% vs. 13.3%, P<0.004) and lower pregnancy and live birth rates (22.2% vs. 35.0%, P<0.05 and 11.1% vs. 26.1%, P<0.05, respectively) as compared to good prognosis women. CONCLUSION The relatively high cancellation rate in patients with poor prognosis raises the question of the use of IVF modified natural cycle in this group.
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Affiliation(s)
- F Lamazou
- Service de gynécologie-obstétrique et médecine de reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de Porte-de-Trivaux, 92141 Clamart, France.
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Lou HY, Huang XY. Modified natural cycle for in vitro fertilization and embryo transfer in normal ovarian responders. J Int Med Res 2011; 38:2070-6. [PMID: 21227012 DOI: 10.1177/147323001003800622] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Controlled ovarian hyperstimulation (COH) using a gonadotrophin-releasing hormone (GnRH) analogue plus gonadotrophins is used widely in in vitro fertilization (IVF), but there can be significant complications. Sixty women with a normal ovarian response participated in a comparison of COH (triptorelin [GnRH agonist] 0.1 mg/day SC from day 21 of the menstrual cycle [before the IVF cycle] and recombinant follicle-stimulating hormone (FSH) 150 - 300 IU/day from day 2 of the IVF cycle, when triptorelin was reduced to 0.05 mg/day) with a modified natural cycle (MNC) treatment (human menopausal gonado trophin [HMG] 150 IU/day IM if serum oestradiol was ≤ 50 pg/ml on day 2 or 3 of the menstrual cycle). The groups did not differ significantly in implantation rate (21.1% and 22.6%, respectively) and clinical pregnancy rate (30.0% and 30.0%, respectively). When comparing successful pregnancies, MNC patients had significantly lower values than COH patients for total amount of gonadotrophin (HMG and recombinant FSH) used, number of oocytes retrieved and medication cost. It is concluded that MNC seems to be a feasible treatment option, with low medication cost, relatively low risk of complications and, possibly, greater patient acceptability.
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Affiliation(s)
- H Y Lou
- Department of Obstetrics and Gynaecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, China
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Xu Y, Li J, Zhou G, Guo J. Clinical outcomes for various causes of infertility with natural-cycle in vitro fertilization combined with in vitro maturation of immature oocytes. Fertil Steril 2010; 94:777-80. [DOI: 10.1016/j.fertnstert.2009.09.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/20/2009] [Accepted: 09/30/2009] [Indexed: 10/20/2022]
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Ben-Haroush A, Sapir O, Fisch B. Aspiration of immature oocytes during cesarean section for fertility preservation and future surrogacy. Am J Obstet Gynecol 2010; 203:e12-4. [PMID: 20609698 DOI: 10.1016/j.ajog.2010.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/17/2010] [Accepted: 04/08/2010] [Indexed: 11/18/2022]
Abstract
A 38-year-old pregnant patient with a history of renal transplantation sought embryo freezing for fertility preservation and future surrogacy. A cesarean section was performed with direct aspiration of small ovarian follicles. Thirteen identified oocyte-cumulus complexes were cultured. Intracytoplasmatic sperm injection was performed on all mature oocytes and the resulting 4 zygotes were cryopreserved.
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Affiliation(s)
- Avi Ben-Haroush
- Infertility and In Vitro Fertilization Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Braga DPDAF, Figueira RDCS, Ferreira RC, Pasqualotto FF, Iaconelli A, Borges E. Contribution of in-vitro maturation in ovarian stimulation cycles of poor-responder patients. Reprod Biomed Online 2009; 20:335-40. [PMID: 20117048 DOI: 10.1016/j.rbmo.2009.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 06/18/2009] [Accepted: 11/26/2009] [Indexed: 11/17/2022]
Abstract
This cohort study evaluated whether rescue spontaneous maturation (RSM) could be a valid method to increase the number of embryos available for transfer and whether transfers with RSM-derived embryos would contribute to clinical outcomes of poor-responder patients in ovarian stimulation cycles. The study included 440 patients undergoing intracytoplasmic sperm injection cycles in which fewer than five metaphase II (MII) oocytes and at least one immature oocyte were retrieved after follicle aspiration. Patients were allocated into two groups based on the injected oocytes' nuclear maturation status: MII group (n=330), in which only embryos derived from MII oocytes were transferred, and RSM group (n=110), in which at least one embryo derived from an RSM oocyte was transferred. No differences between the MII and RSM groups were observed for pregnancy (16.7% versus 16.5%) or miscarriage (25.5% versus 29.4%) rates, respectively. The RSM group had a higher number of transferred embryos (1.87+/-1.24 versus 2.35+/-1.22; P<0.001), a lower embryo transfer cancellation rate (14.5% versus 6.36%; P=0.025) and lower implantation rate (15.4+/-31.5% versus 10.5+/-22.3%; not significant). These findings suggest that RSM did not contribute to the outcomes in poor-responder cycles.
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Lim JH, Yang SH, Xu Y, Yoon SH, Chian RC. Selection of patients for natural cycle in vitro fertilization combined with in vitro maturation of immature oocytes. Fertil Steril 2009; 91:1050-5. [DOI: 10.1016/j.fertnstert.2008.01.066] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 01/08/2008] [Accepted: 01/17/2008] [Indexed: 10/22/2022]
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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]
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Abstract
PURPOSE OF REVIEW In-vitro maturation of oocytes was primarily developed to make in-vitro fertilization safer and simpler for women with polycystic ovaries and high risk of ovarian hyperstimulation syndrome. In-vitro maturation has potentially many advantages over conventional in-vitro fertilization. A simple protocol with decreased or no hormonal stimulation before oocyte retrieval and thus lower cost of the treatment cycle are clear benefits. More importantly, the risk of ovarian hyperstimulation syndrome is entirely avoided. RECENT FINDINGS The clinical outcome has substantially improved in recent years with pregnancy rates between 20 and 54%. The birth of approximately 400 children has been reported in the literature, but about three times as many are known to have been born. The postnatal follow-up studies of the children have been reassuring. SUMMARY Although good results have been reported by some clinics, in-vitro maturation has not yet become a mainstream fertility treatment. The most important reason for this is the lower chance of a live birth per treatment compared with conventional in-vitro fertilization. Several aspects of the clinical in-vitro maturation need to be improved to give in-vitro maturation a place among assisted reproduction techniques it deserves.
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Matsuura T, Takehara Y, Kaijima H, Teramoto S, Kato O. Natural IVF cycles may be desirable for women with repeated failures by stimulated IVF cycles. J Assist Reprod Genet 2008; 25:163-7. [PMID: 18297389 DOI: 10.1007/s10815-008-9204-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2007] [Accepted: 01/24/2008] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Although many reports support stimulated in vitro fertilization, several patients do not respond to it well. Furthermore, stimulated treatment could be associated with reduced ovarian response. We describe three successful cases involving patients of advanced age from whom dominant follicles were retrieved during the natural cycle. MATERIALS AND METHODS All patients had failed to bear children through stimulated in vitro fertilization. In case 1, a follicle was retrieved after a gonadotropin-releasing hormone agonist was used to induce luteinizing hormone surge. In cases 2 and 3, pregnancy was achieved via completely natural cycles. RESULTS One embryo was transferred every 16 cycles. Ongoing pregnancy--defined as pregnancy progressing beyond gestation week 9--was established in three cycles. The patients successfully delivered and had uneventful neonatal courses. CONCLUSION Mature oocyte retrieval followed by natural rather than stimulated in vitro fertilization might be a potential treatment for patients of advanced age when stimulated in vitro fertilization has been repeatedly unsuccessful.
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Affiliation(s)
- Toshiki Matsuura
- Kato Ladies Clinic, 7-20-3, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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