Pregnancy and delivery after in vitro maturation of naked ICSI GV oocytes with GH and transfer of a frozen thawed blastocyst: case report

Abstract

Purpose:To determine if GV oocytes, collected at the time of ICSI, can be matured in vitro and rescued for therapeutic treatment. A patient for whom all the collected oocytes at the GV stage after a classical COH protocol were matured in vitro with GH. Method: All the naked oocytes were matured in a culture medium (ISM2) containing 15% patient serum +1.6 units of GH (Saizen) per millilitre. Oocytes were incubated overnight at 37 • C. The MII oocytes obtained were micro-injected. A fresh transfer was performed and a supernumerary blastocyst was frozen. Results: The patient was pregnant and delivered a healthy girl after transfer of the frozen/thawed blastocyst. The baby girl is now 2 years old. Conclusion: In vitro maturation with GH allows rescuing naked GV oocytes collected at the time of ICSI. GH action does not pass through the cumulus cells. According to the possible lack of synchrony between the embryo and the uterus, we recommend to freeze the embryos obtained and to replace them in a controlled cycle.

The value of growth hormone supplements in ART for poor ovarian responders

“…In several animal models of in vitro maturation exogenous administration of GH increased follicular IGF-1 and IGF-2 in as well as oocyte competence (28,29). Growth hormone could possibly increase the DNA repair capacity in oocytes as shown in liver cells (30).…”

Extrapituitary growth hormone

“…In bovine COCs [99,102], but not in equine COCs [103], GH modulates connexin-43 expression and the gap junctions between cumulus cells, through which COC factors regulate oocyte maturation. It is also possible that GH acts directly on the oocyte to induce its maturation, since GHR mRNA is readily detectable in the oocytes of humans [104,105], cattle [89,106], horses and pigs [103], and in laying hens [88] and tilapia [107]. At the cellular level, the GHR has been localized in the monkey within the oocyte plasma membrane and in the ooplasm [108].…”

Commercially available enhanced in vitro maturation medium does not improve maturation of germinal vesicle and metaphase I oocytes in standard in vitro fertilization cases

“…Another study observed significantly higher maturation to MII in addition to significantly higher numbers of day 2 and day 3 embryos using media supplemented with EGF family members than without (11). The addition of GH to culture media has been shown to stimulate cytoplasmic maturation and genetic competence in both denuded oocytes and those with intact cumulus complexes (9). Importantly, GV and MII oocytes and preimplantation embryos exhibit growth hormone receptor gene expression, suggesting that GH is an important component during folliculogenesis and subsequent embryo development (12).…”

“…The primary goal in the application of IVM for these patients would be to maximize the number of mature oocytes available for potential fertilization and development. As with IVM in nonstimulated cycles, IVM oocytes from stimulated cycles also have been demonstrated to result in healthy live births (4)(5)(6)(7)(8)(9). Despite these reports of successful treatment cycles, IVM efficiency, as measured by evidence of normal epigenetic reprogramming during meiosis, fertilization, pre-and postimplantation development, and live birth rates, remains uncertain.…”