Effect of different gonadotrophin priming on IVM of oocytes from women with normal ovaries: a prospective randomized study

Abstract

This study was designed to determine if the efficiency of in-vitro maturation (IVM) in women with normal ovaries can be improved by gonadotrophin administration. 400 women were randomly allocated in four groups: group A, non-primed cycles; group B, human chorionic gonadotrophin (HCG)-primed cycles; group C, FSH-primed cycles; and group D, FSH- plus HCG-primed cycles. There were significant differences in the IVM rate among the groups. In groups where HCG was used, the overall maturation rate was higher (57.9% in group B and 77.4% in group D; 48.4% in group A and 50.8% in group C) and the percentage of total available metaphase II-stage oocytes was higher (60.4% in group B and 82.1% in group D; 48.4% in group A and 50.8% in group C). The overall clinical pregnancy rate per transfer (CPR) was 18.3% and the implantation rate (IR) was 10.6%. There was a difference in CPR among the groups: group D (29.9%) versus group A (15.3%), P = 0.023; group D versus group B (7.6%), P < 0.0001; group D versus group C (17.3%), P = 0.046. The results of this study are clearly in favour of FSH plus HCG priming. FSH priming and HCG priming alone showed no significant effects on clinical outcome.

What is the optimal threshold of serum Anti-Müllerian hormone (AMH) necessary for IVM treatments?

“…Patients underwent an IVM cycle according to a previously described protocol [9]. Briefly, a baseline evaluation including an hormonal profile (AMH, FSH, estradiol and progesterone levels) and an ultrasound scan were performed on day 2-3 of the menstrual cycle.…”

“…ROC curves were calculated in an attempt to determine a cutoff value for the serum AMH level with the first criterion of analysis being the retrieval of at least 5 immature oocytes. This oocyte number was considered as critical based on previous recent studies which have suggested that recovery of at least 5 immature oocytes are necessary to ensure the chances of achieving a pregnancy [9]. P-values<0.05 were considered significant.…”

“…In view of the low pregnancy rate with IVM, a reliable and available tool needs to be discovered which is capable of predicting a subgroup of patients most likely to benefit from this novel treatment. Recent studies have shown that the number of retrieved oocytes is the most significant predictive factor of successful IVM treatments [9].…”

Embryo transfer following in vitro maturation and cryopreservation of oocytes recovered from antral follicles during conservative surgery for ovarian cancer

“…Originally, it was developed as a milder treatment for infertility. In fact, immature oocytes can be retrieved in the absence of or after minimal ovarian stimulation [7]. In a fertility preservation context, this makes IVM particularly appropriate in cases in which the type of cancer and/or schedule of radio-chemotherapy discourage the application of a conventional ovarian stimulation regimen [5].…”

“…IVM was carried out using a single well petri dish containing 0.5 ml of IVM medium (Origio, Måløv, Denmark) supplemented with recombinant FSH 0.075 IU/ml (Merck Serono, Rome, Italy) and HCG 0.10 IU/ml (Merck Serono, Rome, Italy) [7]. After 30 h of culture, COCs were treated with 40 IU/ml cumulase solution (Origio, Måløv, Denmark) to remove cumulus cells.…”