Facilitation of Ovarian Response by Mechanical Force—Latest Insight on Fertility Improvement in Women with Poor Ovarian Response or Primary Ovarian Insufficiency

Abstract

The decline in fertility in aging women, especially those with poor ovarian response (POR) or primary ovarian insufficiency (POI), is a major concern for modern IVF centers. Fertility treatments have traditionally relied on gonadotropin- and steroid-hormone-based IVF practices, but these methods have limitations, especially for women with aging ovaries. Researchers have been motivated to explore alternative approaches. Ovarian aging is a complicated process, and the deterioration of oocytes, follicular cells, the extracellular matrix (ECM), and the stromal compartment can all contribute to declining fertility. Adjunct interventions that involve the use of hormones, steroids, and cofactors and gamete engineering are two major research areas aimed to improve fertility in aging women. Additionally, mechanical procedures including the In Vitro Activation (IVA) procedure, which combines pharmacological activators and fragmentation of ovarian strips, and the Whole Ovary Laparoscopic Incision (WOLI) procedure that solely relies on mechanical manipulation in vivo have shown promising results in improving follicle growth and fertility in women with POR and POI. Advances in the use of mechanical procedures have brought exciting opportunities to improve fertility outcomes in aging women with POR or POI. While the lack of a comprehensive understanding of the molecular mechanisms that lead to fertility decline in aging women remains a major challenge for further improvement of mechanical-manipulation-based approaches, recent progress has provided a better view of how these procedures promote folliculogenesis in the fibrotic and avascular aging ovaries. In this review, we first provide a brief overview of the potential mechanisms that contribute to ovarian aging in POI and POR patients, followed by a discussion of measures that aim to improve ovarian folliculogenesis in aging women. At last, we discuss the likely mechanisms that contribute to the outcomes of IVA and WOLI procedures and potential future directions.

The remodeling of ovarian function: targeted delivery strategies for mesenchymal stem cells and their derived extracellular vesicles

“…However, HRP is not effective in restoring ovarian function and even has the risk of inducing estrogen-dependent tumors [ 5 , 6 ]. Although assisted reproductive technology (ART) such as in vitro fertilization-embryo transfer (IVF-ET) is very well established, it is not suitable for the treatment of POI because it requires women to provide high-quality oocytes [ 7 ]. For POI patients who desperately want to have offspring, in vitro activation (IVA) can be performed by surgically removing a portion of the ovarian cortex, activating the primordial follicle in vitro, and transplanting it back into the body to continue development and ovulation [ 8 ].…”

Pulsed Low-Intensity Focused Ultrasound (LIFU) Activation of Ovarian Follicles

“…According to some reports, the incidence of PCOS may vary between 10 to 20 % [2], [3]. Studies have shown that surgical mechanical stimulation of POI ovaries can activate dormant follicle development [4] , [5], but this technique is invasive and can lead to complications [6]. As a result, extensive research has been conducted in the realm of reproductive medicine pertaining to the stimulation of inactive follicles in the ovaries of individuals diagnosed with POI and the stimulation of antral follicles in the ovaries of individuals diagnosed with PCOS.…”