Live birth rate after human chorionic gonadotropin priming in vitro maturation in women with polycystic ovary syndrome

Abstract

BackgroundIn 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.MethodsThis 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.ResultsWe 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.ConclusionsIn women with PCOS, hCG priming IVM was feasible and resulted in acceptable live birth rates.

Live births after oocyte in vitro maturation with a prematuration step in women with polycystic ovary syndrome

“…Clinical pregnancy rates in non-hCG priming frozen embryo transfers after standard IVM were either lower (31.8%) [28] or higher (51.3%) [8] than the 37.5% found in our study. Reported IVM live birth rates range from 24 to 41% [7,8,27,28,30,31], similar rates to those found in the present study with standard IVM (37.5%). Nevertheless, live birth rates in studies most similar to ours (no hCG priming and frozen embryo transfer) vary widely, from below (24%) [31] to above (41%) [8].…”

“…In the present study, we report a clinical pregnancy rate of 60% using CAPA-IVM compared with 37.5% using standard IVM, and the latter is comparable to rates reported in previous IVM studies [7,8,[27][28][29][30], although an array of different IVM protocols was used in these studies, including some with hCG priming, which was not used in the current study. Clinical pregnancy rates in non-hCG priming frozen embryo transfers after standard IVM were either lower (31.8%) [28] or higher (51.3%) [8] than the 37.5% found in our study.…”

“…The live birth rate was not significantly different between the groups. Rates of ectopic pregnancy and miscarriage were low, and although the rate of miscarriage before 12 weeks tended to be higher in the CAPA-IVM, early miscarriage rates were similar to those found in other studies [27,28]. Although additional research is needed to more reliably determine the miscarriage rate with CAPA-IVM versus standard IVM, the results of the current study support the hypothesis that prematuration IVM systems improve oocyte developmental competence and that this could lead to improved outcomes in human IVM, at least in patients with PCOM like those included in this study.…”

The Place of In Vitro Maturation in Assisted Reproductive Technology

“…Despite these advantages compared with standard IVF, the technology did not become widely adopted by the profession, because clinical outcomes after IVM were initially suboptimal, with live birth rates per cycle of less than 20% (Child et al, 2001;Child et al, 2002;Söderström-Anttila et al, 2005). However, more recent studies in experienced centers have reported improved live birth rates of approximately 40% (Shalom-Paz et al, 2012;Walls et al, 2015;Ho et al, 2018;Junk and Yeap, 2012). Nevertheless, the chances of a live birth with IVM are currently still slightly lower with IVM than with IVF (Walls et al, 2015).…”

In vitro fertilisation/intracytoplasmic sperm injection beyond 2020

“…The main limitation of IVM to date has been its efficiency compared with conventional IVF. With improved IVM protocols and optimisation of IVM culture systems, success rates have improved, with reported meiotic maturation rates per cumulus‐oocyte complex (COC) of up to 70% and clinical pregnancy rates per embryo transfer of 35–43% . As is often the case with newly emerging IVF technologies, safety data are limited, but early reports on both the obstetric outcomes of pregnancies following IVM and the resulting health of the children are promising …”