Occurrence of ovarian follicular dominance during stimulation for IVM impacts usable blastocyst yield

Abstract

ObjectiveTo evaluate the influence of ovarian follicular dominance on the outcome of oocyte in-vitro maturation.MethodsThis retrospective cohort study included 21 patients with polycystic ovaries or polycystic ovary syndrome (Rotterdam criteria, 2004) subjected to 24 in-vitro maturation (IVM) cycles between October 2015 and January 2017. Patients undergoing IVM received minimal gonadotropin stimulation starting on day 2 or 3 of the cycle; ovum pick-up typically occurred on days 6 to 8. No hCG-trigger shot was given. Following 30h of IVM, mature oocytes were inseminated by ICSI and the resulting embryos cultured up to the blastocyst stage.ResultsOvarian follicular dominance was observed in nine of the 24 IVM cycles. Oocyte IVM yielded an overall maturation rate of 69.3±23.8%, and no difference was observed when the groups with or without a dominant follicle were assessed independently. The rates of fertilization and usable blastocysts per fertilized oocyte, mature oocyte (Metaphase II) or cumulus-oocyte-complex were nearly three times higher (28.7±22.5%) in the group without ovarian follicular dominance. No differences were found in the clinical pregnancy rates attained by the individuals with or without a dominant follicle after 21 vitrified-warmed blastocyst transfer cycles.ConclusionOccurrence of ovarian follicular dominance during hormonal stimulation for in-vitro maturation negatively impacted embryological outcomes. Strategies devised to limit the appearance of ovarian follicular dominance must be further explored.

Association between mild stimulated IVF/M cycle and early embryo arrest in sub fertile women with/without PCOS

“…Our findings showed a lower outcome efficiency compared with the non-hCG primed IVM cycles reported in the Walls et al study, which compared the outcome of 98 IVF cycles with 80 cycles of non-hCG primed IVM treatment in PCOS patients. They found that the cumulative clinical pregnancy and implantation rates were nearly 51% and live birth rate was 41.3% [14], which was consistent with other studies that used similar approaches [9,37]. These high rates of cumulative clinical pregnancy and implantation may be due to the transfer of blastocyst embryos in fresh and frozen ET cycles.…”

Factors Influencing the In Vitro Maturation (IVM) of Human Oocyte

“…Other sibling follicles undergo atresia. Whereas, for IVM cycles, most centers prefer to schedule oocyte retrieval when the diameter of DF reaches 10–12 mm or when the endometrial thickness reaches at least 5–6 mm for the PCOS patients without leading follicles [ 21 , 118 , 119 , 120 ]. DF size exceeding the upper limit can cause detrimental effects on the sibling immature oocytes, resulting in a decreased quality of the retrieved oocytes [ 21 ].…”