Dávila GSA, Santos HR, García VG, Lara REL, Sepúlveda GJ, Díaz SP

Language: Spanish
References: 10
Page: 82-85
PDF size: 108.97 Kb.

ABSTRACT

Background: The natural cycle combined with in vitro maturation (IVM) is an alternative to conventional protocols of in vitro fertilization (IVF). In Mexico, where controlled ovarian stimulation accounts for 30 to 40% of treatment cost, this strategy is an attractive option for reducing erogation.
Objective: To report the initial experience of the natural cycle of in vitro fertilization combined with in vitro maturation in patients with ovulation and infertility caused by several factors.
Patients and method: We did a prospective and case series study, which included 10 infertile patients, with normal menstruation and younger than 35 years. We used the protocol described by Lim and Chiang (2009), in which only hCG was administered when the dominant follicle reached a diameter of 14 mm. We analyzed the maturing rate, clinical pregnancy and implantation rate. Each mature oocyte was inseminated by ICSI.
Results: Sixty-nine oocytes were recovered, 12 mature and 57 immature, of which 33 (58%) matured in vitro and 19 (57%) were fertilized after ICSI; there was not a canceled cycle. All patients underwent embryo transfer (in three cases with an oocyte-derived embryo of the dominant follicle, and the remaining seven embryos generated from mature and immature oocytes). The implantation rate was 13%, with ongoing clinical pregnancy of 30% (not included biochemical pregnancy). There were not significant differences in age or in concentrations of follicle-stimulating hormone on the third day in the non-pregnant group compared with the pregnant group (30.5 vs 31 years old and 6.4 vs 7.4 mIU/dL, respectively). Significant differences in the size of dominant follicles were observed in the non-pregnant group (7.5 ± 1.1 mm vs 9.3 ± 1.1 mm, p ‹ 0.04).
Conclusions: The natural cycle of in vitro fertilization combined with in vitro maturation is an effective and attractive option for couples who can not afford conventional treatment. Additional advantages of this approach include reduced risk of multiple pregnancy and ovarian hyperstimulation.

REFERENCES

1. Albuz FK, Sasseville M, Lane M, Armstrong DT, et al. Simulated physiological oocyte maturation (SPOM): a novel in vitro maturation system that substantially improves embryo yield and pregnancy outcomes. Hum Reprod 2010;25(12):2999-3011.

2. Jurema M, Nogueira D. In vitro maturation of human oocytes for assisted reproduction. Fertil Steril 2006;86(5):1277-1291.

3. Suikkari AM. In vitro maturation: its role in infertility treatment. Curr Opin Obstet Gynecol 2008;20:242-248.

4. Tur R, Martínez F, Arroyo G, Carreras O, et al. Estado actual de la maduración in vitro (MIV). Rev Iberoam Fertil Reprod Hum 2007;24(2):113-122.

5. Zhao J. In vitro maturation and fertilization from unestimulated ovaries in infertile women with polycystic ovary syndrome. Fertil Steril 2009;91(6):2568-2571.

6. Li J, Xu Y, Zhou G, Guo J. Clinical outcomes for various causes of infertility with natural cycle in vitro fertilization combined with in vitro maturation of immature oocytes. Fertil Steril 2010;94(2):770-780.

7. Lim J, Yang S, Xu Y, Yoon S, Chian R. Selection patients for natural cycle in vitro fertilization combined with in vitro maturation of immature oocytes. Fertil Steril 2009;91(4):1050-1055.

8. Chian RC. In vitro maturation of human oocytes. Reprod Biomed Online 2004;8(2):148-166.

9. le Du A, Kadoch IJ, Bourcigaux N, Doumerc S, et al. In vitro oocyte maturation for the treatment of infertility associated with polycystic ovarian syndrome: the French experience. Hum Reprod 2005;20(2):420-424.

10. Zhang XY, Ata B, Son WY, Tan SL, et al. Chromosome abnormality rates in human embryos obtained from in vitro maturation and IVF treatment cycles. Reprod Biomed Online 2010;21(4):552-559.