Enhancing the scope of in vitro maturation for fertility preservation: transvaginal retrieval of immature oocytes during endoscopic gynaecological procedures

Abstract

STUDY QUESTION Could in vitro maturation (IVM) following transvaginal oocyte retrieval during gynaecological surgery (IVM-surgery) be an effective and safe strategy for fertility preservation? SUMMARY ANSWER IVM-surgery on unstimulated ovaries is a novel option that can be considered for fertility preservation for women requiring gynaecological surgery, but more research is needed to identify appropriate patients who may benefit and to determine the cost-effectiveness of such an approach. WHAT IS KNOWN ALREADY IVM followed by oocyte/embryo cryopreservation has been useful as a safe reproductive strategy for some infertile women. STUDY DESIGN, SIZE, DURATION This prospective cohort study comprised 158 consecutive women with polycystic ovary syndrome (PCOS) who underwent laparoscopy or hysteroscopy for other reasons and had concomitant transvaginal oocyte retrieval followed by IVM between 2014 and 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 158 women with anovulatory PCOS who underwent IVM-surgery in our infertility centre were recruited for this study. Matured IVM oocytes obtained from these women were either freshly fertilized and subsequently frozen at the blastocyst stage (fresh oocyte group, n = 46) or the oocytes were frozen (frozen oocyte group, n = 112) for fertility preservation followed by later thawing for insemination and cleavage embryo transfer (ET) (n = 33). The following outcomes were then evaluated: embryological data, clinical pregnancy rate, live birth rate (LBR), neonatal outcomes, post-operative complications and post-operative ovarian function. MAIN RESULTS AND THE ROLE OF CHANCE Among all the women who underwent IVM-surgery, the clinical pregnancy rate and LBR per initiated IVM cycle were 9.5% (15/158) and 6.9% (11/158), respectively. Women (40.6%, 20/33) who underwent the procedure with frozen-thawed oocytes (oocyte survival rate, 83.0%) obtained a high quality of cleaved embryos. In the fresh oocyte group, the clinical pregnancy rate and LBR per ET cycle were 69.2 and 53.8%, respectively. In the frozen oocyte group, the clinical pregnancy rate and LBR per ET cycle were 28.6 and 19.1%, respectively. No adverse neonatal outcomes were recorded. IVM-surgery was not associated with post-operative complications, a longer hospital stay, or impaired ovarian function. LIMITATIONS, REASONS FOR CAUTION Because of the small sample size and the low utilization rate and cost-effectiveness per retrieval, the present findings should be interpreted with caution, and further studies are needed for the long-term follow-up of live births. WIDER IMPLICATIONS OF THE FINDINGS This strategy can also help patients with normal ovulation to obtain available oocytes and embryos for cryopreservation and subsequent use. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by the Joint Research Fund for Overseas Natural Science of China (No. 31429004), the National Key Research and Development Program of China (No. 2017YFC1002000, 2017YFC1001504, 2016YFC1000302), the Ministry of Science and Technology of China Grants (No. 2014CB943203), the Chinese Society of Reproductive Medicine Fund (No. 16020400656) and the National Natural Science Foundation of China (No. 81300456). All the authors have nothing to disclose in terms of conflicts of interest. TRIAL REGISTRATION NUMBER chictr-ONC-17011861

Lipid Metabolism Was Associated With Oocyte in vitro Maturation in Women With Polycystic Ovarian Syndrome Undergoing Unstimulated Natural Cycle

“…Clinical pregnancy was defined as the ultrasound visualization of at least one gestational sac on 30 days after ET. Live birth was defined as the delivery of at least one newborn, irrespective of the gestation (Song et al, 2020). Clinical outcomes of embryo transfer cycles were measured by clinical pregnancy rate per cycle (CPR, the number of cycles achieving clinical pregnancy/the number of embryo transfer cycles), cumulative clinical pregnancy rate (CCPR, the number of patients achieving clinical pregnancy/the number of patients undergoing at least one embryo transfer cycle), live birth rate per cycle (LBR, the number of cycles achieving live birth/the number of embryo transfer cycles), cumulative live birth rate (CLBR, the number of patients achieving live birth/the number of patients undergoing at least one embryo transfer cycle).…”

Clinical Outcomes of In Vitro Maturation After Oocyte Retrieval With Gynecological Surgery for Refractory Polycystic Ovary Syndrome: A Retrospective Cohort Study

“…For patients with anti-mullerian hormone (AMH) < 5 ng/ml, laparoscopic ovarian drilling is not considered. As this study was conducted based on a finished prospective cohort study, detailed information can be found in XL Song's study (8).…”

“…After 7 days of progesterone treatment, one blastocyst was transferred into the uterine. Detailed information can be found in XL Song's study (8).…”

“…On one hand, IVM-surgery for patients who will undergo subsequent IVF could avoid the additional procedures of ovarian stimulation and oocyte retrieval, which will reduce surgery associated complications, cost and extra time requirements. On the other hand, for patients who wish to have spontaneous pregnancy, IVM-surgery could restore normal pelvic anatomy, create conditions for spontaneous pregnancy and furthermore allow for fertility preservation (8).…”

Impact of Maturation and Vitrification Time of Human GV Oocytes on the Metaphase Plate Configuration

“…Immature oocytes collection and in vitro maturation are techniques with multiple potential indications: Patients at risk of ovarian hyperstimulation (OHSS) or with Polycystic Ovary Syndrome (PCOS); women that underwent invasive surgery; patients at risk of exposure to estrogens; oocyte donation program; optimization of stimulated cycles; classic in vitro fertilization (IVF) or assisted by intracytoplasmic sperm microinjection (ICSI), and fertility preservation for social reasons or cancer patients [26][27][28]. In this last group, patients for oocyte vitrification and ovarian cortex preservation are included.…”