The Place of In Vitro Maturation in Assisted Reproductive Technology

Abstract

In vitro maturation (IVM) is an assisted reproductive technology (ART) whereby immature cumulus-oocyte complexes are collected and matured in vitro, without need for controlled ovarian stimulation and ovulation triggering. Advantages of IVM over in vitro fertilization (IVF) include mild or no stimulation, lower medication costs and less patient burden. However, early clinical outcomes with IVM were suboptimal. More recently, clinical studies reported live birth rates after IVM of about 40%. New IVM culture systems are being used to improve the efficacy of IVM. These have been in widespread use for animals for many years and are now showing promise in the clinical setting. Patients more likely to benefit from IVM over IVF include those at risk of OHSS (e.g. women with polycystic ovary syndrome), when the time for ovarian stimulation is limited, or where sustained elevations of estradiol are contraindicated (e.g. oncofertility indications). The main barrier to use of IVM to date was its relative efficacy compared with IVF, and there have also been concerns over the health of infants born following IVM. However, no differences in congenital abnormalities between IVM and other ARTs have been identified. In addition, there is a lack of both experience and standardized protocols. Strategies to overcome barriers to the use of IVM include better training for clinicians, more and better funded research in the field, and improved recognition of IVM by fertility specialists. Overall, IVM offers a valuable alternative for ART in select patient populations. New approaches to IVM appear to have the potential to achieve pregnancy outcomes equivalent to those after IVF. Increasing the use of IVM in the future can be achieved with improved training and education for fertility specialists, and increased funding for IVM research, with the ultimate goal of improving fertility outcomes.

Granulosa secreted factors improve the developmental competence of cumulus oocyte complexes from small antral follicles in sheep

“…Motile sperms were separated using a swim-up preparation; 100 μl of fresh sperm (from a ram of proven fertility) was kept under Tyrode's albumin lactate pyruvate medium in 5% CO 2 , 38.5˚C, and humidified air for up to 45 minutes to allow motile sperm to swim up. Subsequently, insemination was carried out by adding 5×10 3…”

“…Since then, a great result has been achieved by capacitation prematuration-IVM (CAPA-IVM). Despite this recent progress in CAPA-IVM, this method has not replaced the conventional IVM procedure in humans and other species [1][2][3].…”

Coenzyme Q10 improves the in vitro maturation of oocytes exposed to the intrafollicular environment of patients on fertility treatment

“…In vitro maturation (IVM) of oocytes is an assisted reproductive technology long used in the animal field as a tool to produce embryos in vitro . It has not been widely used in human ART, since it is still considered to produce suboptimal results ( Vuong et al , 2019 ). In humans, IVM is indicated mainly for patients with polycystic ovaries (PCO) or polycystic ovary syndrome (PCOS) on account of its nature (minimal stimulation and no hCG trigger), and the almost inexistent risk of ovarian hyperstimulation syndrome (OHSS), a potentially life-threatening condition ( MacDougall et al, 1993 ; Brinsden et al, 1995 ).…”

Bioguided isolation of compounds with antioxidant activity to improve the in vitro maturation of mammalian oocytes

“…Generally, fertility preservation and infertility treatments have emerged at the forefront of reproductive-related research in recent years (Vuong, Ho, Gilchrist, & Smitz, 2019). This exponential growth was due to the increased application of assisted reproductive technologies, such as in vitro embryo production (IVEP).…”