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.
Highlights
The story of in vitro fertilization (IVF) began with immature oocytes from unstimulated cycles and succeeded with the birth of Louise Brown in 1978(1); the roots of studies about immature oocytes and in vitro oocyte maturation (IVM) go back to the 1930s(2)
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
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
Summary
The story of in vitro fertilization (IVF) began with immature oocytes from unstimulated cycles and succeeded with the birth of Louise Brown in 1978(1); the roots of studies about immature oocytes and in vitro oocyte maturation (IVM) go back to the 1930s(2). The total number of babies born from IVM is around 5000, which cannot be compared to the huge number of babies born from conventional IVF (>7 million). This means that IVM carries some controversies and is not a first-choice treatment in ART[8]. IVM has been studied extensively in women PCOS, but indications other than PCOS such as normoresponder women, poor responder women, fertility preservation, rescue IVM for preventing OHSS in stimulated cycles[10], oocyte maturation problems, and patients with cancer who need urgent fertility preservation were introduced into IVM practice[11,12,13,14,15]. The clinical outcomes of this rescue IVM is acceptable and promising
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