Benefit of FSH priming of women with PCOS to the in vitro maturation procedure and the outcome: a randomized prospective study

Abstract

The aim of this study was to determine whether the rates of in vitro oocyte maturation, fertilization and cleavage, as well as implantation rate and pregnancy rate, could be improved by low-dose priming with FSH in vivo before retrieval of immature oocytes in patients with polycystic ovary syndrome (PCOS). From March 1998 to June 2000, a total of 28 women underwent 36 completed treatment cycles, randomized sequentially in one of two groups. Women in group 1 (n = 12 cycles) received no stimulation and women in group 2 (n = 24 cycles) received 150 iu recombinant FSH day(-1) for 3 days, initiated on day 3 after menstruation. Aspiration was performed transvaginally between day 9 and day 17 in the unstimulated group and on day 8 or day 9 in the FSH-primed group after FSH deprivation for 2 or 3 days. All cumulus-enclosed oocytes of healthy appearance were matured in culture medium (TCM-199) in vitro for 28-36 h before intracytoplasmic sperm injection (ICSI). After oocyte retrieval the women were given oestradiol (6 mg day(-1)) and progesterone administration (300 mg day(-1)) was initiated 2 days later. Suitable embryos (maximum two embryos) were transferred on day 3 after ICSI. The percentage of oocytes reaching metaphase II was significantly higher (P < 0.05) in the FSH-primed group (59%, 92/156) compared with the non-primed group (44%, 36/81). There were no significant differences in the rates of oocyte fertilization and cleavage between these groups. No pregnancies were obtained in group 1 (0%, 0/12), whereas seven clinical pregnancies were obtained in group 2 (29%, 7/24) (P < 0.05). In group 2, 37 embryo transfers resulted in eight implantations (21.6%). Three healthy singleton children have been born at term; the remaining pregnancies ended with spontaneous abortions in the first trimester. These results indicate that priming with recombinant FSH before harvesting of immature oocytes from patients with PCOS may improve the maturational potential of the oocytes and the implantation rate of the cleaved embryos.

Anti-mullerian hormone as a predictive marker for the selection of women for oocyte in vitro maturation treatment

“…We suggested that only those cases which meet specific requirements should be eventually selected for an IVM procedure, although such recommendations sometimes fail to identify women with poor functional ovaries. That study showed that FSH and 17-β estradiol levels are negatively correlated to the number of oocytes retrieved, in agreement with the results of other authors [31,40,43].…”

“…It has been reported by various authors [31,32,40,43,44] that in IVM cycles the number of the available oocytes is well correlated with the outcome of the procedure. For that reason, women with polycystic ovaries, who have several antral follicles by definition, are the best candidates for an IVM treatment [31][32][33][34][35][36][37][38].…”

“…For that reason, women with polycystic ovaries, who have several antral follicles by definition, are the best candidates for an IVM treatment [31][32][33][34][35][36][37][38].…”

“…Alternative reproductive strategies have been proposed to reduce risks and costs of in-vitro technology or merely simplify the clinical procedure. In-vitro maturation (IVM) of oocytes has been adopted in some centres to avoid ovarian stimulation in women at high risk of ovarian hyperstimulation syndrome (OHSS), such as polycystic ovary (PCO) or polycystic ovary syndrome (PCOS) patients [31][32][33][34][35][36][37][38]. In other cases, IVM has been also suggested to represent an alternative for the treatment of women with normal ovarian physiology, but suffering from tubal pathologies or with an infertile partner [39][40][41].…”

Recent Advances in In Vitro Fertilization: Proteomics, Secretomics, Metabolomics and In Vitro Maturation

“…Many researchers have shown increased number of oocytes collected and the maturation potential of these oocytes with FSH treatment in patients without PCOS (35) , and in patients with PCOS (36) . However, other studies of FSH treatment revealed no increase in maturation, fertilization or pregnancy rates in these two groups (37,38) .…”