Maturation of human oocytes in vitro
Abstract
Background: Immature oocyte retrieval followed by in vitro maturation is a promising infertility treatment option. In patients with morphologically normal ovaries and regular menstrual cycles and in patients with polycystic ovary syndrome (PCOS) we attempted to assess the success of oocyte in vitro maturation in in vitro fertilization (IVF) procedures.
Methods: Retrospectively we analyzed 87 IVF procedures with in vitro maturation of oocytes carried out in 73 infertile couples treated at the Maribor Teaching Hospital. We compared the success following three different hormone priming protocols: regular cycling patients with normal ovaries and without hormone priming (Group A, n = 27); patients with PCOS and hormone priming with follitropin (follicle stimulating hormone, FSH) (Group B, n = 22); patients with PCOS and hormone priming with human chorionic gonadotrophin (hCG) (Group C, n = 38). Success of the procedure was evaluated on the basis of the ability of oocytes to mature, fertilize and develop into embryos, and on the basis of the quality of embryos and their ability to implant in the uterus.
Results: In regular cycling patients with normal ovaries (n = 27) we obtained a significantly lower number of immature oocytes (3.2 ± 2.5) compared with patients with PCOS and FSH priming (11.7 ± 7.2) or those with PCOS and hCG priming (10.4 ± 7.2). The oocyte maturation rate, the fertilization rate and the embryo cleavage rate were as follows: in Group A 57.7 %, 63.2 % and 91.7 %, in Group B 57.6 %, 66.2 % and 90.0 %, and in Group C 58.0 %, 66.2 % and 91.0 % (the differences between groups were not statistically significant). Six pregnancies were recorded only in patients with PCOS. The pregnancy rate per embryo transfer was 1/20 (5.0 %) in patients with FSH priming, and 5/33 (15.2 %) in patients with hCG priming.
Conclusions: Oocyte in vitro maturation is successful in patients with normal ovaries and regular menstrual cycle as well as in those with polycystic ovary syndrome. Clinically the method of in vitro maturation of oocytes in IVF procedures is particularly justified in patients with PCOS. The hCG priming protocol proved the most successful hormone priming protocol for patients prior to puncture of immature follicles.
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References
Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrom (OHSS): a review. Hum Reprod Update 2002; 8: 559–77.
Mikkelsen AL, Smith S, Lindenberg S. Possible factors affecting the development of oocytes in in-vitro maturation. Hum Reprod 2000; 15: 11–7.
Requena A, Neuspiller F, Cobo AC, Aragones M, Remohi J, Simon C, Pellicer A. The potential use of maturation in vitro of human oocytes in low responder patients. J Assist Reprod Genet 2000; 17: 239–44.
Friden B, Hreinsson J, Hovatta O. Birth of a healthy infant after in vitro oocyte maturation and ICSI in a woman with diminished ovarian response: case report. Hum Reprod 2005; 20: 2556–8.
Chian RC, Buckett WM, Abdul-Jalil AK, Son WY, Sylvestre C, Rao D, Tan SL. Natural-cycle in vitro fertilization combined with in vitro maturation of immature oocytes is a potential approach in infertility treatment. Fertil Steril 2004; 82: 1675–8.
Mikkelsen AL, Smith SD, Lindenberg S. In-vitro maturation of human oocytes from regularly menstruating women may be successful without follicle stimulating hormone priming. Hum Reprod 1999; 14: 1847–51.
Chian RC, Gulekli B, Buckett WM, Tan SL. Priming with human chorionic gonadotrophin before retrieval of immature oocytes in women with infertility due to the polycystic ovary syndrome. New Engl J Med 1999; 341: 1624–6.
Chian RC, Buckett WM, Tulandi T, Tan SL. Prospective randomized study of human chorionic gonadotrophin priming before immature oocyte retrieval from unstimulated women with polycystic ovarian syndrome. Hum Reprod 2000; 15: 165–70.
Mikkelsen AL, Lindenberg S. Benefit of FSH priming of women with PCOS to the in vitro maturation procedure and the outcome: a randomized prospective study. Reproduction 2001; 122: 587–92.
Wynn P, Picton HM, Krapez JA, Rutherford AJ, Balen AH, Gosden RG. Pretreatment with follicle stimulating hormone promotes the numbers of human oocytes reaching metaphase II by in vitro maturation. Hum Reprod 1998; 13: 3132–8.
Child TJ, Phillips SJ, Abdul-Jalil AK, Gulekli B, Tan SL. A comparison of in vitro maturation and in vitro fertilization for women with polycystic ovaries. Obstet Gynecol 2002; 100: 665–70.
Suikkari AM, Tulppala M, Tuuri T, Hovatta O, Barnes F. Luteal phase start of low-dose FSH priming of follicles results in an efficient recovery, maturation and fertilization of immature human oocytes. Hum Reprod 2000; 15: 747–51.
Mikkelsen AL, Host E, Blaabjerg J, Lindenberg S. Maternal serum supplementation in culture medium benefits maturation of immature human oocytes. Reprod Biomed Online 2001; 3: 112–6.
Vlaisavljević V, Kovačič B. Naše prve izkušnje s tehniko direktnega vnosa semenčice v citoplazmo jajčne celice (ICSI) pri zdravljenju moške neplodnosti. Zdrav Vestn 1995; 64: 677–9.
Moriwaki T, Suganuma N, Hayakawa M, Hibi H, Katsumata Y, Oguci H, Furuhashi M. Embryo evaluation by analyzing blastomere nuclei. Hum Reprod 2004; 19: 152–6.
Cha KY, Koo JJ, Ko JJ, Choi DH, Han SY, Yoon TK. Pregnancy after in vitro fertilization of human follicular oocytes collected from non-stimulated cycles, their culture in vitro and their transfer in a donor oocyte program. Fertil Steril 1991; 55: 109–13
Hwang JL, Lin YH, Tsai YL. Pregnancy after immature oocyte donation and intracytoplasmic sperm injection. Fertil Steril 1997; 68: 1139–40.
Trounson A, Wood C, Kausche A. In vitro maturation and the fertilization and developmental competence of oocytes recovered from untreated polycystic ovarian patients. Fertil Steril 1994; 62: 353–62.
Barnes FL, Crombie A, Gardner DK, Kausche A, Lacham-Kaplan O, Suikkari AM, et al. Blastocyst development and birth after in vitro maturation of human primary oocytes, intracytoplasmic sperm injection and assisted hatching. Hum Reprod 1995; 10: 3243–7.
Russell JB, Knezevich KM, Fabian KF, Dickson JA. Unstimulated immature oocyte retrieval: early versus midfollicular endometrial priming. Fertil Steril 1997; 67: 616–20.
Child TJ, Abdul-Jalil AK, Gulekli B, Tan SL. In vitro maturation and fertilization of oocytes from unstimulated normal ovaries, polycystic ovaries, and women with polycystic ovary syndrome. Fertil Steril 2001; 76: 936–42.
Mikkelsen AL. Strategies in human in-vitro maturation and their clinical outcome. Reprod Biomed Online 2005; 10: 593–9.
Cha KY, Chian RC. Maturation in vitro of immature human oocytes for clinical use. Hum Reprod Update 1998; 4: 103–20.
Trounson A, Anderiesz C, Jones G. Maturation of human oocytes in vitro and their developmental competence. Reproduction 2001; 121: 51–75.
Cha KY, Han SY, Chung HM, Choi DH, Lim JM, Lee WS, et al. Pregnancies and deliveries after in vitro maturation culture followed by in vitro fertilization and embryo transfer without stimulation in women with polycystic ovary syndrome. Fertil Steril 2000; 73: 978–83.
Vlaisavljević V, Kovačič B, Reljič M, Gavrić-Lovrec V, Čižek-Sajko M. Results of intracytoplasmic sperm injection of single oocyte in 362 unstimulated cycles. J Assist Reprod Genet 2002; 19: 127–31.
Hreinsson J, Rosenlund B, Friden B, Levkov L, Ek I, Suikkari AM, et al. Recombinant LH equally effective as recombinant hCG in promoting oocyte maturation in a clinical in-vitro maturation programme: a randomized study. Hum Reprod 2003; 18: 2131–6.
Mikkelsen AL, Lindenberg S. Morphology of in-vitro matured oocytes: impact on fertility potential and embryo quality. Hum Reprod 2001; 16: 1714–8.
Vlaisavljević V, Kovačič B, Gavrić-Lovrec V, Reljič M. Simplification of the clinical phase of IVF and ICSI treatment in programmed cycles. Int J Gynecol Obstet 2000; 69: 135–42.
Van Royen E, Mangelschots K, Vercruyssen M, De Neubourg D, Valkenburg M, Ryckaert G, Gerris J. Multinucleation in cleavage stage embryos. Hum Reprod 2003; 18: 1062–9.
Balakier H, Cadesky K. The frequency and developmental capability of human embryos containing multinucleated blastomeres. Hum Reprod 1997; 12: 800–4.
Hardarson T, Hanson C, Sjogren A, Lundin K. Human embryos with unevenly sized blastomeres have lower pregnancy and implantation rates: indications for aneuploidy and multinucleation. Hum Reprod 2001; 16: 313–8.
Čižek-Sajko M, Kovač V, Vlaisavljević V. Multinucleation and cleavage of embryos derived from in vitro-matured oocytes. Hum Reprod 2005; 20 (Abstract book): 103 (P-277).
Staessen C, Van Steirteghem A. The genetic constitution of multinuclear blastomeres and their derivative daughter blastomeres. Hum Reprod 1998; 13: 1625–31.
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