Maturation arrest of human oocytes as a cause of infertility: Case report

Abstract

Maturation arrest of human oocytes may occur at various stages of the cell cycle. A total failure of human oocytes to complete meiosis is rarely observed during assisted conception cycles. We describe here a case series of infertile couples for whom all oocytes repeatedly failed to mature during IVF/ICSI. Eight couples, all presenting with unexplained infertility, underwent controlled ovarian stimulation followed by oocyte retrieval and IVF/ICSI. The oocytes were stripped of cumulus cells prior to the ICSI procedure and their maturity status was defined. In each couple, oocyte maturation was repeatedly arrested at the germinal vesicle (GV) (n = 1), metaphase I (MI) (n = 4) and metaphase II (MII) (n = 3) stage. Oocyte maturation arrest may be the cause of infertility in some couples previously classified as having unexplained infertility. The recognition of oocyte maturation arrest as a specific medical condition may contribute to the characterization of the yet poorly defined entity currently known as 'oocyte factor'. The cellular and genetic mechanisms causing oocyte maturation arrest should be the subject of further investigation.

Successful Pregnancy Following Dual Triggering Concept (rhCG + GnRH Agonist) in a Patient Showing Repetitive Inmature Oocytes and Empty Follicle Syndrome: Case Report

“…Interestingly, the protocol used in cases previously reporting MI arrest was the long protocol [13]. The same happened in our case, the fourth initial attempts were conducted under the long agonist protocol.…”

“…maturation failure has been reported previously, still the exact incidence remains unknown [13,16]. Failure to resume meiosis in vivo may arise at one of the following three levels: (1) absent or incomplete LH surge; (2) derangements in the signaling mechanisms from the surrounding cumulus cells; and (3) intrinsic oocyte factor [13]. Specifically, metaphase I arrest is suggested to occur due to (a) when collected, oocytes still did not attain the full competence to mature; (b) this arrest may result from the absence of meiotic recombination, which, under normal conditions, occurs in pachytene stage; and (c) may be in an inability of oocytes to produce the key cell cycle regulating factors [17].…”

“…maturation failure has been reported previously, still the exact incidence remains unknown [13,16]. Failure to resume meiosis in vivo may arise at one of the following three levels: (1) absent or incomplete LH surge; (2) derangements in the signaling mechanisms from the surrounding cumulus cells; and (3) intrinsic oocyte factor [13].…”

“…In the natural cycle, the resumption of oocyte meiotic maturation and ovulation process is controlled by the midcycle secretion gonadotrophins by the hypophysis; this preovulatory gonadotrophin surge is thought to be the primary stimulus by which oocyte maturation is reinitiated [13]. In vivo, this surge lasts about 48 hours.…”

“…Levran et al (2002) [13] described 8 cases of oocyte maturation arrest and more recently Beck-Fruchter et al (2012) [14] described EFS treatment including a complete review of the literature. However, our group is not aware of any publication showing both anomalies: oocyte maturation and EFS occurring in the same patient as in the case described herein.…”