Comparison of GnRH agonist and hCG for priming in vitro maturation cycles in cancer patients undergoing urgent fertility preservation

Hachem, Hady El; Sonigo, Charlotte; Benard, Julie; Pressé, Marion; Sifer, C.; Sermondade, Nathalie; Grynberg, Michaël

doi:10.1371/journal.pone.0208576

Cited by 13 publications

(3 citation statements)

References 63 publications

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“…Thus, early suppression by estrogen could alter the dominance of follicles and viability of oocytes 18,19 . FSH priming in IVM usually enhances the retrieval of immature and mature oocytes simply by increasing the size of follicles and making them more easily accessible for pickup 20 . FSH priming also induces the secretion of estrogen by granulosa cells and this estrogen protects oocytes from undergoing premature nuclear maturation by providing sufficient cytoplasmic maturation 21,22 .…”

Section: Discussionmentioning

confidence: 99%

The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation

Hatırnaz¹,

Hatırnaz²,

Kanat-Pektaş

et al. 2021

J of Obstet and Gynaecol

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Objective This study aims to determine the effects of early and late onset estrogen supplementation on the immature oocyte retrieval, fertilization and clinical pregnancy rates in follicle stimulating hormone (FSH) and human chorionic hormone (hCG) primed in vitro maturation (IVM) cycles of the patients with polycystic ovary syndrome (PCOS). Methods This is a retrospective analysis of 161 patients with PCOS who underwent FSH and hCG primed IVM. Group 1 included 120 patients who received early onset estrogen supplementation while group 2 consisted of 41 patients who had late onset estrogen supplementation in primed IVM cycles. Immature oocyte (germinal vesicle and/or metaphase I) retrieval and fertilization rates were the primary outcomes, whereas clinical pregnancy and live rates were the secondary outcomes. Results Group 1 patients had significantly higher body mass index and more previous IVF attempts (p = 0.001 and p = 0.008, respectively). All of the retrieved oocytes from the PCOS patients were either germinal vesicle or metaphase I oocytes and there were no metaphase II oocytes among the retrieved oocytes. Both groups had statistically similar numbers of metaphase I and fertilized oocytes (p > 0.05 for both). However, group 1 patients had significantly lower number of germinal vesicle oocytes but significantly higher number of metaphase II oocytes (p = 0.001 for both). Both groups had statistically similar fertilization (85.0% vs 78.0%), clinical pregnancy (49.2% vs 43.9%) and live birth (37.5% vs 39.0%) rates (p > 0.05 for all). Conclusion Early onset estrogen supplementation appears to improve the quality of retrieved immature oocytes and contribute to the maturation of oocytes in stimulated IVM cycles.

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Section: Discussionmentioning

confidence: 99%

The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation

Hatırnaz¹,

Hatırnaz²,

Kanat-Pektaş

et al. 2021

J of Obstet and Gynaecol

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“…Data are far from robust and are limited to rates of oocyte recovery and maturation. Reported oocyte maturation rates after 24–48 h culture vary from 23% to 62% from studies involving ‘ex vivo’ extracted oocytes from ovarian tissue [ 13 , 17 , 20 , 21 , 22 ] and between 48 and 67% from immature oocytes collected from transvaginal follicle aspiration [ 7 , 8 , 9 , 10 , 23 , 24 , 25 ]. Therefore, an improved understanding of the outcomes of using IVM in specific patients that require oncological treatment is needed.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Different In Vitro Maturation Procedures for Oocyte Cryopreservation for Fertility Preservation and yet Another Live Birth in a Cancer Patient

Nogueira

Fajau-Prevot²,

Clouet³

et al. 2023

Life

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To ensure patient care in an oncological fertility preservation (FP) programme, specialists must provide technology that best suits the patients’ clinical conditions. In vitro oocyte maturation (IVM) and ovarian tissue cryopreservation (OTC) are possible fertility preservation treatments for women in need of urgent oncological treatment. IVM consists of the retrieval of immature oocytes from small antral follicles, with no or minimal ovarian stimulation by gonadotropins. Therefore, IVM has become a pertinent option for fertility preservation, especially for cases whereby ovarian stimulation is unfeasible or contra-indicated. Existing data on immature oocytes, retrieved transvaginally (OPU-IVM) or extracted from ovarian tissue ‘ex vivo’ (OTO-IVM), are still limited on technical consistency, efficacy, and safety. The present retrospective cohort study includes 89 women undergoing fertility preservation using IVM methodologies and 26 women undergoing ovarian stimulation (OS) in concomitant period. In total, 533 immature oocytes were collected from IVM patients, achieving a maturation rate of 57% and 70% in OTO-IVM and 73% and 82% in OPU-IVM at 24 h and 48 h in culture, respectively. The observed high maturation rates might be due to the use of patients’ serum in its innate status, i.e., without heat-inactivation. This permitted 7.6 ± 5.7 and 4.6 ± 4.9 oocytes to be vitrified in OTO-IVM and OPU-IVM, respectively, compared to 6.8 ± 4.6 from OS patients. Regarding OS patients, two of them underwent embryo transfer following the insemination of warmed oocytes after complete remission, resulting in a single live birth from one patient. Upon follow-up of two OTO-IVM patients after the termination of their oncological treatment, a total of 11 warmed oocytes lead to a transfer of a single embryo, but pregnancy was not achieved. From OPU-IVM, six embryos were transferred in three patients 4.25 years after oocyte vitrification, leading to the live birth of a healthy boy. The present case of live birth is among the first the cases reported so far and supports the notion that IVM might be a relevant and safe FP option for cancer patients when oocyte preservation is required but ovarian stimulation is contra-indicated.

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“…Interestingly, it was suggested that it may promote oocyte nuclear maturation, that is, resumption of meiosis and cumulus expansion [ 6 ]. It was recently suggested that triggering final oocyte maturation with GnRH-a versus hCG in IVM cycles among breast cancer patients undergoing fertility preservation could be beneficial, as evidenced by the number of mature oocytes and cryopreserved embryos [ 7 ]. Therefore, it seems that this case report may add to existing knowledge regarding the beneficial effect of GnRh-a as a triggering approach in consecutive IVM cycles performed for fertility preservation in patients with malignancies or uncommon indications.…”

Section: Introductionmentioning

confidence: 99%

Priming with a gonadotropin-releasing hormone agonist before immature oocyte retrieval may improve maturity of oocytes and outcome in in vitro maturation (IVM) cycle: a case report

et al. 2021

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Background The concept of using a gonadotropin-releasing hormone agonist (GnRH-a) instead of human chorionic gonadotropin for triggering ovulation in patients treated with an antagonist protocol for in vitro fertilization (IVF) has become a routine clinical practice. It may promote oocyte nuclear maturation, resumption of meiosis and cumulus expansion. It seems that this attempt could be beneficial in an in vitro maturation (IVM) oocyte cycle performed for polycystic ovarian syndrome as well as for other indications such as urgent fertility preservation in patients with malignancies or unusual indications. Case presentation We present the case of a Caucasian patient who needed fertility preservation when routine natural IVF treatment did not yield oocyte retrieval, followed by three IVM cycles, priming ovulation with a GnRH-a. In total, 12 oocytes were obtained, all matured 4.5 hours after incubation in maturation media. The fertilization rate after intracytoplasmic sperm injection was 83%. Six good-quality embryos were vitrified. Conclusions It seems that triggering with a GnRH-a in selected cases may replace human chorionic gonadotropin in IVM of oocytes and could be highly beneficial in terms of obtaining high-grade embryos and possible pregnancy.

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Comparison of GnRH agonist and hCG for priming in vitro maturation cycles in cancer patients undergoing urgent fertility preservation

Cited by 13 publications

References 63 publications

The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation

The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation

Outcomes of Different In Vitro Maturation Procedures for Oocyte Cryopreservation for Fertility Preservation and yet Another Live Birth in a Cancer Patient

Priming with a gonadotropin-releasing hormone agonist before immature oocyte retrieval may improve maturity of oocytes and outcome in in vitro maturation (IVM) cycle: a case report

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