In vitro maturation and fertilization of oocytes from unstimulated ovaries in infertile women with polycystic ovary syndrome

Ultrasonographic assessment of endometrial receptivity at embryo transfer in an in vitro maturation of oocyte program

Comparison of survival rate of cleavage stage embryos produced from in vitro maturation cycles after slow freezing and after vitrification

Gonadotropin-releasing hormone agonist to induce final oocyte maturation prevents the development of ovarian hyperstimulation syndrome in high-risk patients and leads to improved clinical outcomes compared with coasting

Clinical outcomes for various causes of infertility with natural-cycle in vitro fertilization combined with in vitro maturation of immature oocytes

New Belgian legislation regarding the limitation of transferable embryos in in vitro fertilization cycles does not significantly influence the pregnancy rate but reduces the multiple pregnancy rate in a threefold way in the Leuven University Fertility Center

Clinical-pregnancy outcome after vitrification of blastocysts produced from in vitro maturation cycles

In vitro maturation of oocytes: uncommon indications

Day 2 embryo transfer (ET) and day 3 ET afford similar reproductive outcomes in the poor responder

Obstetric outcome of patients with polycystic ovary syndrome treated by in vitro maturation and in vitro fertilization and embryo transfer

Letrozole appears to improve live birth rates and pregnancy rates in infertile women with anovulatory PCOS, compared to SERMs, when used for ovulation induction, followed by intercourse. There is high-certainty evidence that OHSS rates are similar with letrozole or SERMs. There was high-certainty evidence of no difference in miscarriage rate and multiple pregnancy rate. We are uncertain if letrozole increases live birth rates compared to LOD. In this update, we added good quality trials and removed trials with concerns over data validity, thereby upgrading the certainty of the evidence base.

Cetrorelix lowers premature luteinization rate in gonadotropin ovulation induction–intrauterine insemination cycles: a randomized-controlled clinical trial

What is the effect of pretreatment with oral contraceptive pills (OCPs) on oocyte and embryo quality and pregnancy rates in women with polycystic ovary syndrome (PCOS) scheduled for IVF/ICSI cycles? In women with PCOS who underwent a first or second IVF/ICSI cycle with a GnRH antagonist protocol and were randomized to start ovarian stimulation immediately, the quality of cleavage-stage embryos was non-inferior to pretreatment with OCP. PCOS in Asian populations is characterized by high levels of circulating LH in the early follicular phase. Previous studies indicated that inappropriately high LH levels might affect oocyte maturation and fertilization rates, and impaired embryo quality, consequently resulting in higher rates of impaired pregnancy and miscarriage in women with PCOS. OCPs are frequently used as pretreatment to lower LH levels in PCOS patients. We performed a randomized controlled trial. After informed consent, women diagnosed with PCOS scheduled for their first or second IVF/ICSI cycle with a GnRH antagonist protocol were randomized to receive OCPs (OCP group) or start ovarian stimulation immediately, regardless of the day of the menstrual cycle (non-OCP group). Using a non-inferiority hypothesis, the sample size was calculated at 242 women. The study lasted from 7 February 2018 to 31 August 2021. A total of 242 infertility patients with PCOS undergoing the first or second cycle of IVF or ICSI were enrolled and randomized into two groups. In the OCP group, recombinant FSH was started on Day 7 of the washout period after pretreatment with OCP. In the non-OCP group, recombinant FSH was started immediately regardless of the day of the menstrual cycle. All participants received standardized GnRH antagonist ovarian stimulation. The freeze-all strategy was applied to all participants. The primary outcome was the number of good-quality embryos on Day 3 after insemination. Secondary outcomes included the rates of blastocyst formation, implantation, clinical pregnancy, and live birth from the first frozen/warmed embryo transfer cycles and cumulative live birth rates. We randomized 242 women to receive OCP (n = 121) or start immediately with ovarian stimulation (n = 121). The number of good-quality embryos on Day 3 in the OCP group was non-inferior to the non-OCP group (OCP group versus non-OCP group, 6.58 ± 4.93 versus 7.18 ± 4.39, AD -0.61, 95% CI: -1.86 to 0.65, P = 0.34). The rates of blastocyst formation (55.4% versus 52.9%, relative risk (RR) 1.11, 95% CI: 0.96 to 1.28, P = 0.17), implantation (63.0% versus 65.5%, RR 0.90, 95% CI: 0.53 to 1.53, P = 0.79), clinical pregnancy (67.9% versus 68.8%, RR 0.96, 95% CI: 0.54 to 1.71, P = 1.0), and live birth rate (52.8% versus 55.1%, RR 0.92, 95% CI: 0.53 to 1.56, P = 0.79) of the first frozen/warmed embryo transfer cycles were all comparable between the OCP and non-OCP group, respectively. Cumulative live birth rates were also similar in the OCP and non-OCP groups (78.3% versus 83.5%, respectively RR 0.71, 95% CI: 0.36 to 1.42, P = 0.39). Only patients with PCOS in Southern China were recruited. Therefore, caution is necessary when generalizing our results to all such patients with PCOS. Also, since a freeze-only strategy was used, the results of this study are only applicable when infertile women with PCOS undergo the freeze-only method. The obvious treatment difference between the two groups meant that the study was designed as an open-label study for women and doctors. The study had a randomized controlled design that minimized bias. Pretreatment with OCPs to lower LH levels in patients with PCOS before ovarian stimulation in IVF or ICSI cycles may not improve the quality of cleavage-stage embryos. This study was funded by the National Key Research and Development Program of China (No. 2023YFC2705503). This study was supported in part by the Investigator-Initiated Studies Program (grant from MSD and Organon). BWM reports consultancy, travel support, and research funding from Merck. He reports consultancy from Organon and Norgine, and also reports holding stock from ObsEva. No conflicts of interest are declared for the other authors. Chinese Clinical Trial Registry (No. chiCTR1800014822). URL: https://www.chictr.org.cn/showproj.html?proj=25280. 7 February 2018. 22 February 2018.

BackgroundSeveral studies have demonstrated that pre-treatment with long-acting Gonadotropin-Releasing Hormone agonists (GnRHa) can significantly enhance the clinical pregnancy rate among recurrent implantation failure (RIF) patients. Investigations have also suggested that GnRHa pre-treatment could ameliorate the clinical pregnancy and live birth rates in polycystic ovary syndrome (PCOS) patients. But there is a dearth of research on whether long-acting GnRHa pre-treatment yields superior clinical outcomes for RIF patients with PCOS.MethodsThe retrospective study enrolled 1602 patients under the age of 40 meeting the criteria for RIF at the Reproductive Medicine Center of Nanjing Drum Tower Hospital, who underwent frozen-thawed embryo transfer (FET) between January 2017 and December 2021. All cycles were categorized into hormone replacement therapy (HRT) Group (n = 1283) and GnRHa-HRT Group (n = 319), contingent on the usage of long-acting GnRHa pretreatment. Primary outcomes investigated in this study was clinical pregnancy rate, while live birth rate and early miscarriage rate were deemed as secondary outcomes. Univariate analysis and a multivariate logistic regression model were employed to assess the impact of GnRHa pretreatment on the clinical pregnancy rate in RIF patients. The influence of long-acting GnRHa pretreatment on clinical pregnancy outcomes was re-examined in PCOS and non-PCOS subgroups. Additionally, an interaction analysis was performed to evaluate the effect of PCOS on the relationship between long-acting GnRHa pretreatment and the clinical pregnancy rate.ResultsMultiple regression analysis showed that long-acting GnRHa pretreatment had a positive impact on the clinical pregnancy rate (aOR = 1.51, 95%CI: 1.15–1.99, P = 0.003). We divided the RIF population into two subgroups, for PCOS patients, although the clinical pregnancy rate was higher in women who received GnRHa pretreatment compared to those who did not, it was not statistically significant (aOR = 1.51, 95%CI: 0.81–2.82, P = 0.195). Interaction analysis suggested that for PCOS patients, there was no significant difference in the clinical pregnancy rate between women who received GnRHa pretreatment and those who did not (P interaction = 0.818), indicating that the effect of GnRHa pretreatment on the clinical pregnancy rate was not influenced by PCOS.ConclusionsOur study demonstrates that long-acting GnRHa pretreatment can enhance clinical pregnancy outcomes in patients with RIF. Among RIF patients without PCOS, the clinical pregnancy rate exhibited a significant increase following GnRHa pretreatment compared to the control group. However, in RIF patients with concurrent PCOS, there was no significant elevation in the clinical pregnancy rate post-GnRHa pretreatment. Therefore, GnRHa pretreatment is effective in improving pregnancy outcomes for RIF patients. However, whether GnRHa pretreatment is suitable for RIF patients with PCOS requires more cautious clinical discussion.

BackgroudThe effect of hCG priming on oocyte maturation and subsequently outcome in IVM cycles has remained a debated issue. A randomized controlled study was performed to investigate whether or not hCG priming prior to oocyte aspiration can improve the developmental competence of immature oocytes from unstimulated ovaries in women with polycystic ovarian syndrome (PCOS).MethodsEighty two patients with PCOS underwent IVM cycles. Each patient was randomly assigned to the hCG-primed (10,000 IU) or non-primed groups 36–38 hours before oocyte retrieval depending on the computerized random table. After the oocytes had in vitro matured, fertilization, culture and embryo transfer were performed.ResultsThe average number of cumulus-oocyte complexes (COCs) recovered was 13.80 and 14.35 in the hCG-primed and non-primed groups, respectively (p > 0.05). The maturation rate of COCs was significantly improved in the hCG-primed group (55.43% vs. 42.29%; p < 0.05). The fertilization and cleavage rates were comparable between the groups. The hCG-primed and non-primed groups did not differ with respect to the clinical pregnancy (37.50% vs. 50.00%), live birth (22.50% vs. 30.95%), and implantation rates (32.86% vs. 32.56%). The pregnancy losses was 6 (40.00%) of 15 clinical pregnancies in the hCG-primed group, and 8 (38.10%) of 21 clinical pregnancies in the non-primed group.ConclusionsWhile a significant improvement in the nuclear maturation rate of immature oocytes was observed in hCG-primed IVM cycles with PCOS patients, the use of hCG prior to oocyte retrieval did not improve the subsequent embryo developmental competence. The high rate of pregnancy loss in IVM cycles should receive more attention.

Oocyte retrieval versus conversion to intrauterine insemination in patients with poor response to gonadotropin therapy