Abstract
BackgroundThe in vitro maturation (IVM) technique has physical and financial benefits, but a lower efficiency and outcome that is still unclear whether it is related to polycystic ovary syndrome (PCOS) itself or the IVM procedure. In this study, we analyzed the clinical and laboratory outcomes of an optimized IVM protocol in patients with and without PCOS. We also discussed the possible reasons for early embryo arrest in the IVM cycle.MethodsThis prospective study involved 58 PCOS patients and 56 non-PCOS patients who underwent mild stimulated IVF combined IVM (IVF/M) cycles. The clinical and laboratory outcomes were compared between the two groups. Also, metaphase II (MII) oocytes were obtained after IVM from the two groups, and in vivo MII oocytes randomly collected from IVF patients were examined for mitochondrial function using a laser scanning confocal microscope (LSCM). The aneuploidy rate for arrested cleavage embryos from IVM and IVF oocytes were screened using Next Generation Sequencing (NGS).ResultsMildly stimulated IVF/M resulted in cumulative clinical pregnancy and implantation rates (40.2, 28.7% in the PCOS group vs. 41.9, 36% in the non-PCOS group), respectively. The blastocyst formation rates were comparable (28% vs. 28.2%) in PCOS and non-PCOS groups, respectively. Using LSCM, there was a significant decrease in the mitochondrial membrane potential of IVM oocytes compared with the control IVF oocytes (P < 0.001), but no significant difference between the PCOS and non-PCOS groups. The NGS showed that the aneuploidy rates were comparable (75, 75, and 66.6%) in IVM-PCOS, IVM-non-PCOS, and control IVF arrested embryos, respectively.ConclusionsThe mildly stimulated IVF/M protocol produced acceptable clinical outcomes in PCOS and non-PCOS patients. IVM itself rather than the PCOS condition adversely affected the embryo development through its effect on mitochondrial function, which appeared to be a possible cause for the embryo arrest in the IVM cycles rather than chromosomal aneuploidy.
Highlights
In vitro maturation of human oocytes (IVM) is a promising laboratory technique in which germinal vesicle (GV) and metaphase I (MI) oocytes proceed to metaphase II (MII) oocytes
Mild stimulated IVF/M cycles can be an attractive choice for normal ovulatory and anovulatory polycystic ovary syndrome (PCOS) patients to avoid ovarian hyper stimulation syndrome (OHSS) and due to its simplified patient-friendly ART procedure that has lower cost and acceptable clinical pregnancy rates
The current study reported no significant differences in the laboratory and clinical outcomes of the in vitro maturation (IVM) procedure in PCOS and non-PCOS patients, which encourage clinicians to apply such technique for non-PCOS as well PCOS patients
Summary
In vitro maturation of human oocytes (IVM) is a promising laboratory technique in which germinal vesicle (GV) and metaphase I (MI) oocytes proceed to metaphase II (MII) oocytes. Both immature and mature oocytes can be retrieved in natural cycles or mildly stimulated cycles using hCG or GnRH agonist priming. Natural cycle IVF/M has achieved higher cumulative clinical pregnancy rates with in-vivo mature oocytes obtained from dominant follicles and immature oocytes retrieved from smaller follicles after IVM culture [2]. Natural cycle IVF/M has been an attractive choice for infertility treatment for various reasons It resulted in fewer numbers of retrieved oocytes due to small size in addition to the in vitro maturation culture defect. We discussed the possible reasons for early embryo arrest in the IVM cycle
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