Luteal phase oocyte retrieval and in vitro maturation is an optional procedure for urgent fertility preservation

Purpose To highlight recent progress in understanding the pattern of follicular wave emergence of human menstrual cycle, providing a brief overview of the new options for human ovarian stimulation and oocyte retrieval by making full use of follicular physiological waves of the patients either with normal or abnormal ovarian reserve. Methods Literature review and editorial commentary. Results There has been increasing evidence to suggest that multiple (two or three) antral follicular waves are recruited during human menstrual cycle. The treatment regimens designed based on the theory of follicular waves, to promote increased success with assisted reproduction technology (ART) and fertility preservation have been reported. These new options for human ovarian stimulation and oocyte retrieval by making full use of follicular waves of the patients either with normal or abnormal ovarian reserve lead to new thinking about the standard protocols in ART and challenge the traditional theory that a single wave of antral follicles grows only during the follicular phase of the menstrual cycle. Conclusions The understanding of human ovarian folliculogenesis may have profound implications in ART and fertility preservation. Further studies are needed to evaluate the optimal regimens in ART based on the theory of follicular waves and to identify non-invasive markers for predicting the outcome and the potential utilities of follicles obtained from anovulatory follicular waves in ART.

Section: The Follicular Recruitment In Human Luteal Phasesupporting

confidence: 61%

Progress in understanding human ovarian folliculogenesis and its implications in assisted reproduction

Yang

Liu

et al. 2013

“…Currently, the IVM technique remains controversial in humans because of its suboptimal pregnancy rates when compared with regular IVF treatments and as such its use is restricted to specific indications. These include women at risk of hyperstimulation syndrome [1-4, 16, 18, 24], those women with cancer requiring immediate fertility preservation and those patients who cannot receive hormonal stimulation [6,17]. In view of the low pregnancy rate with IVM, a reliable and available tool needs to be discovered which is capable of predicting a subgroup of patients most likely to benefit from this novel treatment.…”

Section: Introductionmentioning

confidence: 99%

What is the optimal threshold of serum Anti-Müllerian hormone (AMH) necessary for IVM treatments?

Kedem

Yerushalmi

Maman

et al. 2013

Self Cite

Purpose To assesse circulating levels of Anti-Müllerian hormone (AMH) as a predictor of oocyte number and their potential to mature in vitro in both normo-ovulatory (NO) women and in women with Polycystic Ovary Syndrome (PCOS) undergoing in vitro maturation (IVM) treatments. Methods We prospectively studied NO women and women diagnosed with PCOS, (age range 21-39 years) underwent IVM treatments at our center. Serum AMH levels were quantified before each cycle and correlated to oocytes number, maturation and fertilization during in vitro maturation. Results 104 NO and 30 PCOS IVM cycles were followed with retrieval of a total of 672 and 491 oocytes, respectively. In NO women, the serum AMH level positively correlated with the number of oocytes retrieved, (R=0.6; P <0.0001) the number of M2 oocytes at 24 and 48 h (R=0.4; P <0.01; R=0.26 p<0.007, respectively) and with the total number of M2 oocytes (R=0.47; P<0.0001). In the PCOS group, the serum AMH level positively correlated only with the number of oocytes retrieved (R=0.43; P <0.03). Receiver operating characteristic (ROC) analyses showed that a cutoff AMH level of 1.56 (ng/ml) could identify patients with 5 or more oocytes at OPU with a sensitivity of 83 % and a specificity of 75 %. An AMH level of 1.63 (ng/ml) was the threshold for 5 or more matured oocytes (sensitivity=81 %, specificity=53 %). Conclusions Serum AMH may be used as a marker to identify candidates for IVM treatment in both NO and PCOS women.

“…Ovarian tissue cryopreservation (OTC) is an alternative protocol that has attracted interest due to the fact that the only precondition for its application is the presence of ovaries, while variables such as age [9], menstrual cycle phase [12,25] and subjacent disease do not have a bearing on whether or not it can be performed. In addition, the tissue reimplantation that follows depends purely on the absence of malignant cells [2,13,20,21,24].…”

Section: Introductionmentioning

confidence: 99%

“…In oncologic patients, oocytes can be retrieved by means of standard oocyte aspiration [12,15] or in association with OTC [9,10,12,19]. Collection of immature oocytes in association with OTC was first proposed by Revel et al [19], who described a procedure in which nine pre-chemotherapy female patients underwent oophorectomy by unilateral laparoscopy.…”

Section: Introductionmentioning

confidence: 99%

“…In another study, Huang et al [9] reported four cases of female oncologic patients in whom an oophorectomy (one) and wedge resections (three) were performed prior to cryopreservation of their ovarian tissue, after which immature oocytes were retrieved as described by Revel et al [19]. More recently, Maman et al [12] reported collection of compacted cumulusoocyte complexes by transvaginal ovarian punction of hCGprimed ovaries. In all these reports, recovered immature oocytes were matured in vitro in FSH supplemented media and subsequently cryopreserved or fertilized by ICSI.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous in vitro maturation of oocytes prior to ovarian tissue cryopreservation in natural cycles of oncologic patients

Escribá

Grau

Escrich

et al. 2012

Purpose To evaluate the recovery rate and spontaneous in vitro maturation (IVM) of immature oocytes enclosed within or released from follicles during the processing of ovarian tissue prior to its cryopreservation. Methods Thirty-three oncologic patients who had not previously undergone chemo or radiotherapy underwent ovarian tissue cryopreservation (OTC) during natural menstrual cycles. Immature oocytes, enclosed within follicles or released during ovarian cortex processing, were collected and matured spontaneously in vitro for 48 h. Nuclear maturation was assessed every 24 h and the ability of the IVM oocytes to display a normal activation response following parthenogenetic activation was evaluated. The following outcome measures were also evaluated: disease, age, FSH, LH, E2, P4 and AMH serum levels, menstrual cycle day, recovery and spontaneous IVM and parthenogenetic activation rates. Results Oocytes recovered per patient were 3.3±0.7 (1.8-4.7 oocytes, 95CI), regardless of the menstrual phase. The mean number of IVM oocytes per patient was 1.3±0.2 oocytes (95CI: 0.8-1.8), regardless of menstrual phase (p0 0.86) and oocyte origin (p00.61). Forty-one percent of oocytes extruded the second polar body and formed one pronucleus after parthenogenetic activation. Conclusion Twenty-one of the 33 women (63.6 %) requesting OTC produced at least one mature oocyte.