The use of immature oocytes subjected to in vitro maturation (IVM) opens interesting perspectives for fertility preservation where ovarian reserves are damaged by pathologies or therapies, as in PCO/PCOS and cancer patients. Human oocyte cryopreservation may offer some advantages compared to embryo freezing, such as fertility preservation in women at risk of losing fertility due to oncological treatment or chronic disease, egg donation and postponing childbirth. It also eliminates religious and/or other ethical, legal, and moral concerns of embryo freezing. In addition, a successful oocyte cryopreservation program could eliminate the need for donor and recipient menstrual cycle synchronization. Recent advances in vitrification technology have markedly improved the oocyte survival rate after warming, with fertilization and implantation rates comparable with those of fresh oocytes. Healthy live births can be achieved from the combination of IVM and vitrification, even if vitrification of in vivo matured oocytes is still more effective. Recently, attention is given to highlight whether vitrification procedures are more successful when performed before or after IVM, on immature GV-stage oocytes, or on in vitro matured MII-stage oocytes. In this review, we emphasize that, even if there are no differences in survival rates between oocytes vitrified prior to or post-IVM, reduced maturation rates of immature oocytes vitrified prior to IVM can be, at least in part, explained by underlying ultrastructural and biomolecular alterations.

Human sperm vitrification is a new cryopreservation method. This study compared the effects of rapid freezing and vitrification on various sperm parameters, hyaluronan-binding assay and DNA fragmentation and assessed the impact of cryoprotectant agents (CPA) with vitrification. A total of 30 normo-ejaculates were prepared by swim up and the motile sperm fraction was divided into four: fresh (control), rapid freezing, and two vitrification groups (a, lacking CPA; b, with CPA). For rapid freezing, a cryovial of sperm suspension was held just above the liquid nitrogen surface, and for vitrification, 30μl suspension was dropped directly into liquid nitrogen. Sperm parameters, including motility, viability and morphology, declined after cryopreservation in both groups. DNA fragmentation was not significantly higher in the vitrification (15.7±4.4%) or rapid freezing (16.6±5.6%) groups when compared with controls (11.6±4.5%). The rates of hyaluronan binding were similar between the control and cryopreserved groups. Moreover, addition of CPA for vitrification had a neutral effect on rates of sperm recovery. In conclusion, vitrification has great potential for human sperm cryopreservation and does not require CPA, with its possible toxicity. However, it is not superior to rapid cryopreservation regarding sperm recovery rate in normozoospermia. Human sperm vitrification is a new cryopreservation method that has been introduced recently. This study compared the effects of rapid freezing with vitrification on rates of sperm parameters, hyaluronan-binding assay and DNA fragmentation after thawing/warming and assessed the impact of cryoprotectant agent (CPA) on vitrification. The study was performed on 30 ejaculates prepared using the swim-up technique. Each motile sperm suspension was divided into four: control (fresh); rapid freezing; and two vitrification groups (a, lacking CPA; b, with CPA). For rapid freezing, a cryovial of sperm suspension was held above the surface of liquid nitrogen. For vitrification, 30μl sperm suspension was dropped into liquid nitrogen directly. The rates of progressive motility (86.6±5.9%) and viability (95.8±3.9%) in controls declined significantly, to 40.0±13.0% and 63.2±7.7% for rapid freezing and 41.9±10.3% and 64.4±10.0% for vitrification, respectively. Normal sperm morphology was also significantly decreased after cryopreservation in all groups. DNA fragmentation was higher with rapid freezing compared with fresh controls (16.6±5.6% vs. 11.6±4.5%, P=0.01), but DNA fragmentation did not increase significantly in vitrified samples (15.7±4.4%). The rates of hyaluronan binding were similar between the control and cryopreserved groups. Moreover, addition of CPA for vitrification had a neutral effect on rates of sperm recovery. In conclusion, vitrification has great potential for human sperm cryopreservation and does not require CPA, with its possible toxicity. However, it is not superior to rapid cryopreservation regarding sperm recovery rate in normozoospermia.

The aim of the present study was to investigate the relationship between the presence of the meiotic spindle and zona pellucida (ZP) birefringence with morphology of in vivo- and in vitro-matured human oocytes. Germinal vesicles (n=47) and MI (n=38) oocytes obtained from stimulated ovaries of patients undergoing intracytoplasmic sperm injection (ICSI) underwent IVM. Using a PolScope (OCTAX PolarAID; Octax, Herbon, Germany), the presence of spindles and ZP birefringence was assessed in both in vivo-matured (n=56) and IVM (n=56) oocytes. In addition, the morphology of each matured oocyte was evaluated microscopically. There were insignificant differences for ZP birefringence and meiotic spindle between the in vivo-matured and IVM MII oocytes. Subanalysis revealed that the rates of morphologically abnormal oocytes did not differ significantly between the two groups, except in the case of irregular shape (P=0.001), refractile body (P=0.001) and fragmented polar body (P=0.03), which were higher in IVM oocytes. In the case of in vivo-matured oocytes, a significantly higher percentage of oocytes with intracytoplasmic and both intra- and extracytoplasmic abnormalities have a low birefringent ZP (P=0.007 and P=0.02, respectively). There was no relationship between morphological abnormalities and spindle detection. The findings suggest that clinical IVM is a safe technology that maintains the high maturation rate and integrity of oocytes. In addition, the use of the non-invasive PolScope is recommended for the detection of oocytes most suitable for ICSI.

The aim was to investigate the relationship between the morphological parameters of metaphase II (MII) oocytes with morphokinetic variables of embryos following an intra-cytoplasmic sperm injection (ICSI) procedure. Morphokinetic behaviour and abnormal cleavage patterns of 334 zygotes were analyzed using time-lapse monitoring (TLM). In addition, oocyte morphology was assessed in relation to embryo morphokinetic (absolute time point, including time to second polar body (PB) extrusion (ESPB), pronuclei (PN) appearance (PNA), PN fading (PNF), time to 2-cells (t2), 3c (t3), 4c (t4), 5c (t5), 6c (t6), 7c (t7), 8c (t8) and relative timing parameters (S1, S2, CC2 and CC3). Also, cleavage patterns (uneven blastomeres, reverse, direct and arbitrary) were assessed. The data showed that 79% of the normal fertilized oocytes had at least one abnormal morphological characteristic. Intra-cytoplasmic abnormalities were observed in 12% of the oocytes. Also, extra-cytoplasmic abnormalities were noticed in 29%, while combined intra- and extra-cytoplasmic abnormalities were responsible for the remaining 38% of the oocytes. Nearly all cleavage and interval times, except extrusion of the ESPB time (P = 0.003), were similar between normal and abnormal morphologic oocytes (P < 0.05). Moreover, there was significant relationship for oocyte morphology abnormalities and cleavage patterns, including uneven blastomere (P = 0.037), reverse cleavage (RC) (P = 0.0), direct (P = 0.001) and arbitrary cleavages (P = 0.001). Using TLM, the cleavage patterns of embryos were affected by the quality of MII oocytes in the ICSI cycles. So, evaluation of oocyte morphology with subsequent embryo morphokinetics is recommended in assisted reproductive programmes.