IVM research at the Vrije Universiteit Brussel has been supported by grants from: the Institute for the Promotion of Innovation by Science and Technology in Flanders (Agentschap voor Innovatie door Wetenschap en Technologie-IWT, project 110680); the Fund for Research Flanders (Fonds Wetenschappelijk Onderzoek-Vlaanderen-FWO, project G.0343.13), the Belgian Foundation Against Cancer (HOPE project, Dossier C69). The authors have no conflicts of interest.
Purpose To investigate the effectiveness of a biphasic IVM culture strategy at improving IVM outcomes in oocytes from small follicles (< 6 mm) compared with routine Standard IVM in patients with polycystic ovaries. Methods This prospective pilot study was performed in 40 women with polycystic ovaries whose oocytes were randomized to two IVM culture methods. Patients received a total stimulation dose of 450 IU rFSH. Cumulus-oocyte complexes (COCs) from follicles < 6 mm and ≥ 6 mm were retrieved and cultured separately in either a prematuration medium with c-type natriuretic peptide followed by IVM (CAPA-IVM), or STD-IVM. Primary outcomes were maturation rate, embryo quality, and the number of vitrified day 3 embryos per patient. Results Use of the CAPA-IVM system led to a significant improvement in oocyte maturation (p < 0.05), to a doubling in percentage of good and top-quality day 3 embryos per COC, and to an increased number of vitrified day 3 embryos (p < 0.001), compared to STD IVM. Oocytes from follicles < 6 mm benefited most from CAPA-IVM, showing a significant increase in the amount of good and top-quality embryos compared to STD IVM. CAPA-IVM yielded significantly (p < 0.0001) less GV-arrested oocytes and larger oocyte diameters (p < 0.05) than STD IVM. Conclusions CAPA-IVM brings significant improvements in maturation and embryological outcomes, most notably to oocytes from small antral follicles (< 6 mm), which can be easily retrieved from patients with a minimal ovarian stimulation. The study demonstrates the robustness and transferability of the CAPA-IVM method across laboratories and populations.
PurposeOncofertility focuses on providing fertility and endocrine-sparing options to
patients who undergo life-preserving but gonadotoxic cancer treatment. The
resources needed to meet patient demand often are fragmented along
disciplinary lines. We quantify assets and gaps in oncofertility care on a
global scale.MethodsSurvey-based questionnaires were provided to 191 members of the Oncofertility
Consortium Global Partners Network, a National Institutes of
Health–funded organization. Responses were analyzed to measure trends
and regional subtleties about patient oncofertility experiences and to
analyze barriers to care at sites that provide oncofertility services.ResultsSixty-three responses were received (response rate, 25%), and 40 were
analyzed from oncofertility centers in 28 countries. Thirty of 40 survey
results (75%) showed that formal referral processes and psychological care
are provided to patients at the majority of sites. Fourteen of 23
respondents (61%) stated that some fertility preservation services are not
offered because of cultural and legal barriers. The growth of oncofertility
and its capacity to improve the lives of cancer survivors around the globe
relies on concentrated efforts to increase awareness, promote collaboration,
share best practices, and advocate for research funding.ConclusionThis survey reveals global and regional successes and challenges and provides
insight into what is needed to advance the field and make the discussion of
fertility preservation and endocrine health a standard component of the
cancer treatment plan. As the field of oncofertility continues to develop
around the globe, regular assessment of both international and regional
barriers to quality care must continue to guide process improvements.
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