Page 19 - Focus on reproduction january 2016

COVER STORY
The maturity of in vitro maturation
Immature oocytes from antral follicles after minimal or no gonadotrophin administration
Studies now indicate that individualised ovarian stimulation programmes in modern ART practice can produce cohorts of mature oocytes able to yield cumulative live birth rates above 40% after fertilisation in vitro. However, the picture is not all sunshine and rainbows. There is a substantial proportion of infertile patients who decline conventional ‘hormone driven’ IVF and seek alternative approaches. They may consider IVF as too cumbersome - the need for frequent monitoring of ovarian stimulation or because of hormonal side effects. These side effects range from abdominal discomfort and emotional disturbance to full-blown ovarian hyperstimulation syndrome (OHSS).
Some patients have a narrow window of optimal ovarian response to gonadotrophins, either because of a non-linear dose-response, as observed in patients with polycystic ovary syndrome (PCOS), or because of premature luteinisation leading to endometrial advancement. Others may find it hard to combine fertility treatment with everyday life and struggle to commute between home, work and the fertility centre. Some may live in rural areas and have to travel long distances, or may face hours of dense traffic in metropolitan areas.
Any or all of the above may be reasons for IVF’s lack of appeal, or may lead to treatment termination before a successful pregnancy is achieved.1 Some patients will prefer an alternative simplified, low-burden ART. However, whether they would accept this at a cost, or
A shift at last from hype to hope
Following Europe’s first IVM live birth in Brussels, programme leader Michel De Vos argues that it’s now time ‘to embrace IVM’ as a useful approach in modern ART.
with a lower chance of pregnancy, is currently unknown.
Current status of IVM
Oocyte in vitro maturation (IVM) has been proposed as one alternative to conventional IVF, and, because of its reduced hormonal burden for the patient, has been described as a ‘patient-friendly’ treatment. But how did IVM evolve and what is its current status in human reproduction?
IVM is a fertility treatment which obviates the need for ovarian stimulation with gonadotrophins to produce mature oocytes ready for fertilisation. The
JANUARY 2016 // Focus on Reproduction 19