Retrieving oocytes from small non-stimulated follicles in polycystic ovary syndrome (PCOS): in vitro maturation (IVM) is not indicated in the new GnRH antagonist era

Ziegler, Dominique de; Streuli, Isabelle; Gayet, Vanessa; Frydman, Nelly; Bajouh, Osama S.; Chapron, Charles

doi:10.1016/j.fertnstert.2012.06.043

Cited by 25 publications

(21 citation statements)

References 54 publications

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“…Further worries have been reported on low pregnancy and live birth rates, as compared to conventional assisted reproduction techniques [ 16 , 25 ]. There are reports to suggest that IVM should be kept aside and performed only in certain cases when no other option is available, such as in sub-fertile cancer patients, as there are other / newer options for controlled ovarian hyperstimulation in women at high risk for ovarian hyperstimulation syndrome [ 26 ]. In a recent update of a Cochrane review, the comparison of IVM to conventional IVF treatment was assessed [ 27 ]; nevertheless, the potential differential efficacy of IVM in PCOS versus non-PCOS subjects has not been yet addressed, in the context of a meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

In Vitro Maturation in Women with vs. without Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis

et al. 2015

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ObjectiveTo evaluate in vitro maturation (IVM) in sub-fertile women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilisation (IVF), by comparing outcomes with a control group of non-PCOS.Study designA search strategy was developed for PubMed and studies reporting rates of the following outcomes (live birth; clinical pregnancy; implantation; cycle cancellation; oocyte maturation; oocyte fertilization; miscarriage) between patients with PCOS, PCO and controls undergoing IVM were deemed eligible. The review was conducted in accordance to the PRISMA guidelines and included studies quality was assessed through the Newcastle-Ottawa Quality scale. ORs with their corresponding 95% CIs were calculated for the main analysis and subgroup analyses were performed for PCOS cases vs. controls and PCOS vs. PCO cases. Alternative analyses were performed for live birth and clinical pregnancy, based on cycles and on women. Subgroup analyses for FSH stimulation, hCG priming and type of procedure (IVF/ICSI) were undertaken for all meta-analyses encompassing at least four study arms. Random effects models were used to calculate pooled effect estimates.ResultsEleven studies were identified. A total of 268 PCOS patients (328 cycles), 100 PCO patients (110 cycles) and 440 controls (480 cycles) were included in the meta-analysis. A borderline trend towards higher birth rates among PCOS patients emerged (pooled OR = 1.74, 95%CI: 0.99–3.04) mainly reflected at the subgroup analysis vs. controls. Clinical pregnancy (pooled OR = 2.37, 95%CI: 1.53–3.68) and implantation rates (pooled OR = 1.73, 95%CI: 1.06–2.81) were higher, while cancellation rates lower (pooled OR = 0.18, 95%CI: 0.06-0.47) among PCOS vs. non-PCOS subjects; maturation and miscarriage rates did not differ between groups, while a borderline trend towards lower fertilization rates among PCOS patients was observed.ConclusionThe present meta-analysis provides preliminary evidence on the effectiveness of IVM as a treatment option when offered in sub-fertile PCOS women, as the latter present at least as high outcome rates as those in non-PCOS.

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Section: Introductionmentioning

confidence: 99%

In Vitro Maturation in Women with vs. without Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis

et al. 2015

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“…IVM has lost its value over time because the clinical outcomes, number of matured oocytes, and developmental competence of embryos are not as good as those obtained from stimulated cycles. Recent advances in ovarian stimulation procedures, safer protocols aimed at decreasing the risk of OHSS, have decreased the attention on IVM ( 16 , 17 ) . However, accumulating data from articles supporting IVM because it is safe, cost-effective, simple, repeatable, flexible, and patient friendly in nature, without the risk of OHSS, it serves as a good treatment option.…”

Section: Discussionmentioning

confidence: 99%

The use of in vitro maturation in stimulated antagonist in vitro fertilization cycles of normo-hyperresponder women due to arrested follicular development: A rescue procedure

Hatırnaz¹,

Akarsu

Hatırnaz³

et al. 2018

tjod

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Objective: To evaluate the impact of rescue in vitro maturation (IVM) on the clinical outcomes of women with arrested follicular development in stimulated in vitro fertilization (IVF) cycles.Materials and Methods:This is a retrospective review of 13 patients who were evaluated as normo-hyperresponders for ovarian stimulation. The main outcome measure was the clinical pregnancy and livebirth rates. The purpose of gonadotropin stimulation in patients undergoing IVF is to retrieve multiple oocytes by avoiding multifetal gestation and Ovarian Hyperstimulation syndrome (OHSS). The ovarian response to stimulation ranges from poor response to OHSS, which is related to the follicular number and the dose of the gonadotropins used. However, in some cycles of normo-hyperresponder women, follicular development decelerates or ceases. Close follow-up in a daily manner and increasing the dose of gonadotropins did not change the follicular arrest. This clinical situation has two edges; one is cycle cancellation, which has undesired psychological outcomes for women and the IVF team, and second one is the prolongation of the IVF cycle. For such circumstances, IVM may be a valuable option. Stimulated IVF cycles were converted to IVM as a rescue IVM procedure following detailed informed consent of the women who were close to cycle cancellation.Results:Thirteen 13 IVM cycles and their clinical outcomes are presented. Six women achieved pregnancies, but only 4 delivered 5 healthy live born. The other two women had biochemical loss during follow-up.Conclusion:Based on the data obtained, it can be concluded that gonadotropin-stimulated cycles with follicular arrest at the edge of cancellation can be shifted to rescue IVM procedures with reasonable clinical outcomes.

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“…Those recent reports are encouraging, as in Europe the pregnancy and delivery rates in this group of patients undergoing ICSI was 35.5% and 24.3%, respectively [37]. de Ziegler et al [38] opposed the need of IVM in the gonadotropin-releasing hormone (GnRH) antagonist era. However, his conclusion is based on outdated publication [28,39,40], with poor results in terms of pregnancy and delivery rates in IVM.…”

Section: Ivm In Women With Normal Ovulatory Cyclesmentioning

confidence: 99%

In Vitro Maturation and Fertilization of Oocytes: From Laboratory Bench to Clinical Practice

Ellenbogen¹,

Paz²,

Michaeli³

et al. 2020

Innovations in Assisted Reproduction Technology

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Retrieval of immature oocytes from non-stimulated ovaries, followed by in vitro maturation (IVM), was initially proposed in order to avoid side effects of gonadotropin administration. The goal is to eradicate or significantly decrease the risk of ovarian hyperstimulation syndrome (OHSS) in patients with polycystic ovary syndrome (PCOS) and to reduce drug cost and burden of patients. This technology was also proposed for treatment of normal ovulatory women, fertility preservation, or infrequent conditions as failure of oocyte to mature or repeated development of poor-quality embryos. There is no downregulation, and only a small amount of hormones are injected if at all. In vitro maturation of the oocyte procedure obtained up to 35% clinical pregnancy rate in young women, compared with in vitro fertilization (IVF) in many programs. The obstetric and perinatal outcomes of IVM cycles are comparable with IVF/ICSI cycles; therefore it may gradually substitute IVF in certain cases, as the technique continues to develop and pregnancy rates continue to increase. IVM holds great promises as an alternative to assisted reproductive technologies and may be the procedure of choice not only for infertile patients but also for obtaining oocytes for donation or fertility preservation.

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Retrieving oocytes from small non-stimulated follicles in polycystic ovary syndrome (PCOS): in vitro maturation (IVM) is not indicated in the new GnRH antagonist era

Cited by 25 publications

References 54 publications

In Vitro Maturation in Women with vs. without Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis

In Vitro Maturation in Women with vs. without Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis

The use of in vitro maturation in stimulated antagonist in vitro fertilization cycles of normo-hyperresponder women due to arrested follicular development: A rescue procedure

In Vitro Maturation and Fertilization of Oocytes: From Laboratory Bench to Clinical Practice

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