Braam Sanne C, Consten Dimitri, Smeenk Jesper M J, Cohlen Ben J, Curfs Max H J M, Hamilton Carl J C M, Repping Sjoerd, Mol Ben W J, de Bruin Jan Peter
Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands. Electronic Address:
Department of Obstetrics and Gynaecology, St. Elisabeth Hospital, Tilburg, The Netherlands.
Int J Fertil Steril. 2019 Apr;13(1):38-44. doi: 10.22074/ijfs.2019.5452. Epub 2019 Jan 6.
In vitro maturation (IVM) is an artificial reproductive technology in which immature oocytes are harvested from the ovaries and subsequently will be matured in vitro. IVM does not require ovarian hyperstimulation (OH) and thus the risk of ovarian hyperstimulation syndrome (OHSS) is avoided. In this study, we assessed the live birth rate per initiated IVM cycle in women eligible for in vitro fertilization/intracytoplasmic sperm injection (IVF/ ICSI) and at risk for OHSS. Furthermore, we followed women who were not pregnant after IVM and committed to a conventional IVF/ICSI procedure.
In this multicenter prospective cohort study, we started 76 IVM cycles using recombinant follicle stimulating hormone (rFSH) priming in 68 patients. There were 66 oocyte retrievals, in which a total of 628 oocytes were collected. We incubated the immature oocytes for 24-48 hours and fertilized those that reached metaphase II by ICSI.
Three hundred eighty six (61% oocytes) achieved metaphase II. The fertilization rate was 55%. We performed 59 embryo transfers (1.9 embryos per transfer) in 56 women, including 3 frozen embryo transfers. There were four ongoing pregnancies (5.3% per initiated cycle) leading to the birth of a healthy child at term. None of the patients developed OHSS. The ongoing pregnancy rate of the first conventional IVF/ICSI cycle after an unsuccessful IVM cycle was 44%, which was unexpectedly high.
We concluded that IVM led to live births but with low effectiveness in our study. Earlier reported IVM success rates are higher which can be caused by a more extended experience in these centers with the intricate laboratory process. However, a possible selection bias in these studies cannot be ruled out. Furthermore, IVM might have a beneficial effect on further IVF/ICSI treatments due to its "ovarian drilling" effect.
体外成熟（IVM）是一种辅助生殖技术，从未成熟的卵巢卵母细胞中获取卵母细胞，随后在体外使其成熟。IVM不需要卵巢过度刺激（OH），因此可避免卵巢过度刺激综合征（OHSS）的风险。在本研究中，我们评估了符合体外受精/卵胞浆内单精子注射（IVF/ICSI）条件且有OHSS风险的女性每个启动的IVM周期的活产率。此外，我们追踪了IVM后未怀孕且随后进行常规IVF/ICSI程序的女性。
在这项多中心前瞻性队列研究中，我们使用重组促卵泡激素（rFSH）启动了68例患者的76个IVM周期。共进行了66次取卵，收集到628个卵母细胞。我们将未成熟卵母细胞培养24 - 48小时，并对达到减数分裂中期II的卵母细胞进行ICSI受精。
386个（61%的卵母细胞）达到减数分裂中期II。受精率为55%。我们对56名女性进行了共59次胚胎移植（每次移植1.9个胚胎），其中包括3次冻融胚胎移植。有4例持续妊娠（每个启动周期为5.3%），最终足月分娩出健康婴儿。没有患者发生OHSS。IVM周期未成功后首次常规IVF/ICSI周期的持续妊娠率为44%，这一结果出乎意料地高。
我们得出结论，在我们的研究中IVM可实现活产，但效率较低。早期报道的IVM成功率较高，这可能是由于这些中心在复杂的实验室操作过程中有更丰富的经验。然而，不能排除这些研究中可能存在的选择偏倚。此外，由于其“卵巢打孔”效应，IVM可能对进一步的IVF/ICSI治疗有有益影响。
