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

Abstract

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.

Rescue IVM of Denuded GV- and MI-Stage Oocytes of Premenopausal Rats with Oncostatin M, Insulin-like Growth Factor I, and Growth Hormone

“…Most of the published data about rescue IVM were about retrieved immature oocytes after COH in normo-hyper-responder patients. Hatrnaz et al [ 15 ] revealed a 65% maturation rate and 30% live births in 13 PCOS patients. The 79% maturation rate and 27% blastocyst/oocyte yield were observed in PCOS patients by Madkour et al [ 16 ].…”

“…Therefore, rescue IVM has not been implemented in routine clinical practice. Nevertheless, several studies demonstrated reasonable clinical outcomes in hyper-responder patients [ 15 ], patients with polycystic ovarian syndrome (PCOS) [ 16 ], and patients with low functional ovarian reserve [ 13 ].…”

Can in vitro maturation overcome cycles with repeated oocyte maturation arrest? A classification system for maturation arrest and a cohort study

“…It is thought that OMA is a problem inherent to the oocyte itself rather than to the intra‐follicular environment. Problems related to the intra‐follicular environment or, possibly, related to apoptotic factors playing a role in oocyte maturation could potentially be managed by IVM 7 by removing the oocyte from this environment. The stimulation protocol used in the IVF cycles appears to have had minimal effect on maturation of the oocytes in cases of repeated OMA.…”