DUO INTRAVAGINAL CULTURE (IVC) PROVIDES A POTENTIALLY ADVANTAGEOUS SECOND SOURCE OF EMBRYOS FOR SAME-SEX FEMALE COUPLES

Abstract

Intravaginal culture (IVC) with the INVOcell™ device (INVO Bioscience, FL, USA) is a recent addition to assisted reproductive technology (ART). While originally positioned to increase access to in vitro fertilization (IVF) by decreasing costs, IVC’s role in ART continues to evolve. One expanded use of IVC is to provide an opportunity for same-sex female couples to physically share in the culture and gestating process by allowing one partner to incubate embryos and the other to carry the pregnancy. Another possible advantage of IVC in this population is the opportunity to have each partner concomitantly carry an INVOcell device with sibling oocytes. To report a case of a same-sex female couple who concomitantly cultured sibling oocytes intravaginally but had markedly different outcomes. Partner A underwent controlled ovarian stimulation (COS). Partner B underwent medicated uterine preparation for an anticipated fresh embryo transfer of embryos derived from Partner A’s IVC. Prior to egg retrieval, the couple was counseled that the expected egg yield would be significantly greater than the amount of oocytes that is recommended by the manufacturer to be used in a single INVOcell™ device. Options for the disposition of supernumerary eggs were discussed including the use of a second IVC device in Partner B and standard benchtop laboratory culture. Partner A’s egg retrieval yielded a total of 33 oocytes and the couple elected to use both additional culture options. 13 oocytes were fertilized and cultured in a benchtop incubator (Geri, Genea Biomedx, Sydney, Australia). Two INVOcell™ devices were loaded with 10 eggs each, placed intravaginally into each partner and removed after 5 days of culture. Standard benchtop culture of 13 oocytes yielded a total of 9 high-quality blastocysts. IVC of 10 oocytes in Partner A yielded a solitary degenerating blastocyst. IVC of 10 sibling oocytes in Partner B yielded three transfer-grade blastocysts. After extensive counseling, Partner B underwent an embryo transfer of two blastocysts, one from standard benchtop culture and one from Partner B’s IVC. An intrauterine pregnancy resulted and is currently ongoing. Same-sex female couples utilizing IVC should consider each carrying an INVOcell™ device. This approach allows more eggs to be cultured per cycle, requires a minimal amount of extra pre- and post-IVC lab work and potentially safeguards against a poor outcome in the event that one culture system fails to yield any usable embryos.