Page 22 - Focus on reproduction january 2016

Europe’s first live birth in Brussels

fertilised - and result in live births.11 This combined application of fertility preservation methods may increase hope of delayed childbearing to young cancer patients who undergo ovarian cortex cryopreservation before gonadotoxic treatment.
4. IVM of oocytes can be a last resort in infertile patients who have consistently high circulating levels of FSH and a normal antral follicle count with antral follicles unresponsive to FSH.
Although IVM research has not yet revolutionised IVM systems in the clinical setting, improved IVM systems are under way. Lessons have been learnt from experiments in animal models, where modulation of the maturation process in vitro through cAMP- mediated systems or the addition of oocyte growth factors, such as Growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15), can result in substantially higher numbers of blastocysts. However, progress is slow, partly because of licensing and regulatory hurdles required in the development of culture media.
Nevertheless, it’s my belief that the time has now come to embrace IVM as a useful additional tool in modern ART practice. IVM requires no major modifications in the ART laboratory; however, because of the complexity of physiological oocyte maturation, our current IVM systems, which are not physiological, do require further refinement. The promisingly good clinical outcomes obtained in some pioneering IVM centres, after proper patient selection, illustrate how IVM has the potential to grow to full maturity in the future.

References
1. Gameiro S, Boivin J, Peronace L, Verhaak CM. Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Hum Reprod Update 2012; 18: 652–669.
2. Edwards RG. Are minimal stimulation IVF and IVM set to replace routine IVF? Reprod Biomed Online 2007; 14: 267–270.
3. Junk SM, Yeap D. Improved implantation and ongoing pregnancy rates after single-embryo transfer with an optimized protocol for in vitro oocyte maturation in women with polycystic ovaries and polycystic ovary syndrome. Fertil Steril 2012; 98: 888-892.
4. Grynberg M, Poulain M, Le Parco S, et al. Similar in vitro maturation rates of oocytes retrieved during the follicular or luteal phase offers flexible options for urgent fertility preservation in breast cancer patients, Human Reprod. In press.
5. Guzman L, Ortega-Hrepich C, Polyzos NP, et al. A prediction model to select PCOS patients suitable for IVM treatment based on anti-Mullerian hormone and antral follicle count. Human Reprod 2013; 28: 1261–1266.
6. Rose BI, Laky D. A comparison of the Cook single lumen immature ovum IVM needle to the Steiner-Tan pseudo double lumen flushing needle for oocyte retrieval for IVM. J Assist Reprod Genetics 2013; 30: 855–860.
7 Walls ML, Hunter T, Ryan JP, et al. In vitro maturation as an alternative to standard in vitro fertilization for patients diagnosed with polycystic ovaries: a comparative analysis of fresh, frozen and cumulative cycle outcomes. Human Reprod 2015; 30: 88-96.
8. Spits C, Guzman L, Mertzanidou A, et al. Chromosome constitution of human embryos generated after in vitro maturation including 3-isobutyl-1-methylxanthine in the oocyte collection medium. Hum Reprod 2015; 30: 653-663.
9. The Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. In vitro maturation: a committee opinion. Fertil Steril 2013; 99: 663-666.
10. Coticchio G, Dal Canto M, Guglielmo M-C, et al. Double- strand DNA breaks and repair response in human immature oocytes and their relevance to meiotic resumption. J Assist Reprod Genetics 2015; 32: 1509-1516.
11. Segers I, Mateizel I, Van Moer E, et al. In vitro maturation (IVM) of oocytes recovered from ovariectomy specimens in the laboratory: a promising “ex vivo” method of oocyte cryopreservation resulting in the first report of an ongoing pregnancy in Europe. J Assist Reprod Genetics 2015; 32: 1221–1231.
22 Focus on Reproduction // JANUARY 2016