Abstract
ObjectiveTo evaluate the influence of ovarian follicular dominance on the outcome of oocyte in-vitro maturation.MethodsThis retrospective cohort study included 21 patients with polycystic ovaries or polycystic ovary syndrome (Rotterdam criteria, 2004) subjected to 24 in-vitro maturation (IVM) cycles between October 2015 and January 2017. Patients undergoing IVM received minimal gonadotropin stimulation starting on day 2 or 3 of the cycle; ovum pick-up typically occurred on days 6 to 8. No hCG-trigger shot was given. Following 30h of IVM, mature oocytes were inseminated by ICSI and the resulting embryos cultured up to the blastocyst stage.ResultsOvarian follicular dominance was observed in nine of the 24 IVM cycles. Oocyte IVM yielded an overall maturation rate of 69.3±23.8%, and no difference was observed when the groups with or without a dominant follicle were assessed independently. The rates of fertilization and usable blastocysts per fertilized oocyte, mature oocyte (Metaphase II) or cumulus-oocyte-complex were nearly three times higher (28.7±22.5%) in the group without ovarian follicular dominance. No differences were found in the clinical pregnancy rates attained by the individuals with or without a dominant follicle after 21 vitrified-warmed blastocyst transfer cycles.ConclusionOccurrence of ovarian follicular dominance during hormonal stimulation for in-vitro maturation negatively impacted embryological outcomes. Strategies devised to limit the appearance of ovarian follicular dominance must be further explored.
Highlights
Oocyte in-vitro maturation (IVM) is a poorly disseminated assisted reproductive technology, especially because it has been perceived as a procedure with suboptimal results in comparison to traditional ICSI
Our preliminary findings provide insight into the negative effects of ovarian follicular dominance in the preparations for IVM
Ovarian follicular dominance is a naturally occurring event during the menstrual cycle (Pache et al, 1990), during controlled ovarian stimulation, efforts are directed towards its avoidance, as it has been suggested to be a negative factor for the outcome of assisted reproductive technology (ART) procedures (Yoldemir et al, 2011)
Summary
Oocyte in-vitro maturation (IVM) is a poorly disseminated assisted reproductive technology, especially because it has been perceived as a procedure with suboptimal results in comparison to traditional ICSI. IVM offers multiple benefits (in particular, for the patient), many embryologists and clinicians are still reluctant to consider it as an alternative ART procedure. This limits the amount of clinically relevant data and impairs the development of evidence-based enhancements to the procedure. When undergoing ovarian stimulation with gonadotropins (in fertility treatment), patients suffering from either of the conditions are at risk of developing ovarian hyperstimulation syndrome (OHSS), a potentially dangerous condition (MacDougall et al, 1993; Brinsden et al, 1995). Due to its nature, IVM is a valuable tool for preserving fertility in cancer patients in which hormonal stimulation must be avoided or limited (De Vos, 2016; Wang et al, 2016)
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