In Vitro Maturation of Human Oocytes
There is a growing interest in natural cycle in vitro fertilization (IVF) and in vitro maturation (IVM) treatment. Recovery of immature oocytes followed by IVM is a potentially useful treatment for women with infertility. The method is particularly effect
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In Vitro Maturation of Human Oocytes Zhi-Yong Yang, Ling Wang, and Ri-Cheng Chian 17.1 Introduction – 172 17.2 Indications for IVM Treatment – 172 17.2.1 Infertility with PCO or PCOS – 172 17.2.2 High Responders to Gonadotropin Stimulation – 172 17.2.3 Poor Responders to Gonadotropin Stimulation – 173 17.2.4 Oocyte Donation – 173 17.2.5 Fertility Preservation – 173
17.3 Step-by-Step Protocol for IVM Treatment – 173 17.3.1 Monitoring and Management of an IVM Cycle – 173 17.3.2 Oocyte Collection Procedure – 174 17.3.3 Laboratory Procedure – 175 17.3.4 Embryo Transfer – 176 17.3.5 Luteal-Phase Support – 177
17.4 Clinical Outcome of IVM Treatment – 177 17.5 Pregnancy Loss – 178 17.6 Obstetric Outcome and Congenital Abnormalities – 178 17.7 Physical and Neuromotor Development – 178 17.8 Future Goals – 178 Review Questions – 179
References – 180
© Springer Nature Switzerland AG 2019 Z. P. Nagy et al. (eds.), In Vitro Fertilization, https://doi.org/10.1007/978-3-319-43011-9_17
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Learning Objectives 55 55 55 55 55 55
Describe the source of immature oocytes derived from. Prepare medium for IVM procedure. Collect and identify immature oocytes. Assess the maturity of immature oocytes. Inseminate IVM oocytes and culture fertilized zygotes. Determine the timing of embryo transfer for IVM.
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Introduction
Today, pregnancy rates achieved with in vitro fertilization (IVF) treatment have exceeded that achieved in natural cycles [1–3]. These figures are achieved with simultaneous transfer of multiple embryos in a given treatment cycle. Traditionally, production of multiple embryos has been only possible after development of controlled ovarian stimulation (COS) protocols. In a natural menstrual cycle, several antral follicles are present in the human ovary. The interactions between the growing follicles, the pituitary gland, and the hypothalamus prevent multifollicular growth and allow only one follicle complete maturation and reach ovulation in the majority of cycles. COS with exogenous gonadotropins and gonadotropin-releasing releasing hormone analogs enables overriding this natural selection process and collection of multiple mature oocytes, which are amenable to fertilization. COS has been an integral part of conventional IVF treatment for over 20 years. COS requires multiple daily injections and frequent monitoring scans creating direct and indirect costs, loss of working time, and inconvenience. Unfortunately, the cost of drugs used for COS poses a substantial financial burden and at times prevents a couple’s access to treatment. The most important medical problem associated with COS is the risk of ovarian hyperstimulation syndrome (OHSS). OHSS is a potentially lethal condition, most commonly occurring as an iatrogenic complication of COS [4]. It is characterized by ovarian enlargement and increased capillary permeability, causing fluid shift to the third space. This results in ascites formation, hypovolemia, hemoconcentration, and hypercoagulability. OHSS may be
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