R. Fanchin

First Birth Achieved After In Vitro Maturation of Oocytes From a Woman Endowed With Multiple Antral Follicles Unresponsive to Follicle-stimulating Hormone

CONTEXT The association of primary amenorrhea, gonadotropin levels at menopausal range, and normal antral follicle endowment is a rare clinical condition that suggests unresponsiveness of antral follicles to FSH. This affection is frequently misdiagnosed ovarian failure and patients are referred to egg donation to treat their infertility. Because these patients notably have an age-compatible number of antral follicles, we hypothesized that in vitro maturation (IVM) of oocytes might constitute a useful approach for treating their infertility. OBJECTIVE We report the first pregnancy and live birth obtained after IVM of oocytes in a 29-year-old patient suffering from ovarian resistance to FSH. DESIGN This is a case report. SETTING The work was conducted in a university hospital. PATIENT Whereas serum FSH (40.3 and 38.4 mIU/mL) and LH (35.7 and 31.7 mIU/mL) levels were repeatedly around the menopausal range, serum anti-Müllerian hormone (4.50 and 4.36 ng/mL) levels and total counting of antral follicles (23 and 18 follicles) remained normal. INTERVENTION We aspirated antral-stage follicles and subsequently matured the oocytes in vitro. MAIN OUTCOME MEASURE We assessed the competence of oocytes retrieved in a patient suffering from ovarian resistance to FSH. RESULTS Aspiration of antral-stage follicles allowed the retrieval of 15 immature oocytes. Following IVM, 12 of them reached metaphase II. Seven embryos were obtained and three of them were transferred into the uterus. This patient became pregnant and delivered a healthy baby at term. CONCLUSIONS We report the first pregnancy and live birth achieved using IVM in a woman whose ovaries were resistant to FSH. This approach was based on the remarkable normalcy of AMH and antral follicle measurements in this patient. Therefore, IVM is a viable alternative to egg donation for women suffering from resistance to FSH. Importantly, this condition should be looked for as it may lurk undetected in women wrongly diagnosed with ovarian failure.

Préservation de la fertilité féminine : place de la maturation ovocytaire in vitro

Although female cancer incidence may be on rise, antineoplastic regimens have become more successful. As a result, an increasing number of women with cancer survive to endure the long-term consequences of chemotherapy. One of the most important long-term consequences of cancers treatments in young female is premature ovarian failure and infertility. Because of the increasing survival rates, many of these young women are seeking methods to preserve their fertility. Currently, embryo/oocytes cryoporeservation obtained after ovarian stimulation appears to provide the best fertility preservation option. However, patients may not have sufficient time to undergo ovarian stimulation prior to chemotherapy and/or the hormones used in ovarian stimulation are contra-indicated for estrogen-dependant tumors. In vitro maturation of oocytes (IVM) has been suggested to avoid ovarian stimulation and time requirement in patients with cancer, and can be combined with ovarian tissue cryobanking. In this review, we will discuss the position of IVM in the strategy of fertility preservation in young women.

Live birth after frozen-thawed oocytes matured in vitro in a PCOS patient: a model for improving implantation rates in IVM cycles and objectively assessing the real potential of development of frozen oocytes matured in vitro

Abstract Over the past 20 years, in vitro maturation (IVM) of oocytes has emerged in the strategy of infertility treatment, with the main indication being in patients suffering from polycystic ovarian syndrome (PCOS). More recently, IVM has been proposed as an option for fertility preservation in women having to undergo gonadotoxic treatments. However, despite the increasing application of IVM, the potential of development of in vitro matured oocytes after thawing remains ill-established and few pregnancies have been reported so far. We report herein a case of live birth after frozen-thawed oocytes matured in vitro and embryo transfer during an artificial cycle in a 29-year-old patient with primary infertility due to PCOS. The present case demonstrates that the transfer of frozen-thawed IVM oocytes during an artificial cycle in PCOS patients is feasible and leads to pregnancy and live birth. This strategy may also be an interesting option to objectively assess the developmental potential of these oocytes after freezing and thawing, which is a major concern for physicians who include the IVM approach in their fertility preservation program.

GnRH agonist (GnRHa) priming increases the number of in vitro matured (IVM) oocytes available for cryopreservation in cancer patients seeking urgent fertility preservation (FP)

E2 and follicular size and may complicate clinical decision making. This study seeks to determine whether continuous AI use throughout stimulation impacts oocyte maturity and function. DESIGN: Retrospective. MATERIALS AND METHODS: FP patients with breast cancer treated with an AI (letrozole) were compared to FP patients with other malignancies not using AIs. The AI group had oocyte maturation induced when leading follicles reached 20mm as suggested by Oktay et al, compared with the standard of 18mm. Endocrine levels, oocyte maturity (MII/retrieved oocytes), MII yield (MII/follicles R14mm) and fertilization rates were compared. RESULTS: 24 AI patients were compared with 22 controls. The age, AMH, and antral follicle counts were equivalent. In contrast to prior reports, total gonadotropin usage was similar. The AI group had lower peak E2 levels (536 vs 1972 pg/mL; P 400 pg/mL). The AI group had higher peak P levels (1.1 vs 0.7 ng/mL; P<0.01) and a trend toward a higher risk of premature P rise R1.5 ng/mL (29% vs 5%; P1⁄40.06). Despite larger follicles, the AI group had a lower maturity rate (68% vs 80%; P<0.001). The MII yield was lower in the AI group (P1⁄40.04). Among those who underwent ICSI (15 AI, 14 noAI), the fertilization rate was lower in the AI group (76% vs 84%; P1⁄40.03). CONCLUSION: Despite efforts to prevent supraphysiologicE2 inbreast cancer FP cycles, most AI stimulations result in elevated E2 levels. Although the impact of elevated P on oocyte quality in FP cycles is not established, it may reflect an altered intrafollicular endocrine milieu and post-maturity. Caution shouldbe exercisedwhenchangingdecisionmaking inFPpatients receivingAIs.