Correspondence
Priming with Human Chorionic Gonadotropin before Retrieval of Immature Oocytes in Women with Infertility Due to the Polycystic Ovary Syndrome
N Engl J Med 1999; 341:1624-1626November 18, 1999
- Article
To the Editor:
Women who have infertility due to anovulation in association with the polycystic ovary syndrome are particularly difficult to treat. A substantial proportion have no response to the induction of ovulation, and those who do have a response are at increased risk for the ovarian hyperstimulation syndrome. This syndrome is characterized by massive ovarian enlargement, ascites, pleural effusion, oliguria, hydrothorax, hemoconcentration, electrolyte disturbances, and in the most severe cases, thromboembolic phenomena related to coagulation disturbances. A woman with the polycystic ovary syndrome who became pregnant after in vitro maturation of oocytes and in vitro fertilization was described in 1994.1 Subsequently, very few pregnancies have been reported in such women, largely because the maturation and fertilization rates of these immature oocytes have been low.2 We report the results of 25 cycles of in vitro fertilization in 20 women with the polycystic ovary syndrome. There was in vitro maturation of immature oocytes retrieved from all 20 women after priming with human chorionic gonadotropin.
The patients were less than 41 years of age (mean age, 35.4) and had not become pregnant after at least six cycles in which either clomiphene citrate or menotropins were given to induce ovulation. To initiate the treatment cycle, the patients received intravaginal progesterone suppositories at a dose of 300 mg for 10 nights to induce withdrawal menstrual bleeding. Retrieval of immature oocytes was scheduled on day 10 to 14 of the cycle, and 10,000 IU of human chorionic gonadotropin was administered 36 hours before the retrieval. Immature oocytes were cultured in an organ–tissue culture dish (60 by 15 mm) containing 1 ml of maturation medium, TC-199 medium supplemented with the patient's own serum at a concentration of 20 percent (inactivated by incubation at 56°C for 30 minutes), 25 mM pyruvic acid, and 75 mIU of menotropins per milliliter (follicle-stimulating hormone and luteinizing hormone; Humegon) for 24 or 48 hours at 37°C in an atmosphere of 5 percent carbon dioxide and 95 percent air with high humidity. The mature oocytes were then inseminated by intracytoplasmic sperm injection, and the embryos were transferred two or three days later.
The results are shown in Table 1Table 1
Results of in Vitro Maturation and Fertilization of Oocytes Followed by Embryo Transfer in 20 Women with the Polycystic Ovary Syndrome.. The oocyte-maturation rate of 84 percent (209 of 249 oocytes) was higher than previously reported rates.3,4 Ten women became pregnant, three of whom had not conceived during previous cycles of conventional in vitro fertilization. As of September 1999, three of the women had given birth, two had had miscarriages, and five were still pregnant. A total of four healthy infants have been born (one set of twins and two singletons). These results provide evidence that priming with human chorionic gonadotropin before the retrieval of immature oocytes has a role in the treatment of women with infertility due to anovulation in association with the polycystic ovary syndrome.4 ReferencesRi-Cheng Chian, Ph.D.
Bülent Gülekli, M.D.
William M. Buckett, M.D.
Seang-Lin Tan, M.D.
Royal Victoria Hospital, Montreal, QC H3A 1A1, Canada1
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;62:353-362
Web of Science | Medline2
Cha KY ,Chian RC . Maturation in vitro of immature human oocytes for clinical use. Hum Reprod Update 1998;4:103-120
CrossRef | Web of Science | Medline3
Barnes FL ,Crombie A ,Gardner DK , et al. Blastocyst development and birth after in-vitro maturation of human primary oocytes, intracytoplasmic sperm injection and assisted hatching. Hum Reprod 1995;10:3243-3247
Web of Science | Medline4
Barnes FL ,Kausche A ,Tiglias J ,Wood C ,Wilton L ,Trounson A . Production of embryos from in vitro-matured primary human oocytes. Fertil Steril 1996;65:1151-1156
Web of Science | Medline
- Citing Articles (42)
Citing Articles
1
Bulent Gulekli, Muge Kovali, Fulya Aydiner, Sule Dogan, Seda S. Dogan. (2011) IVM is an alternative for patients with PCO after failed conventional IVF attempt. Journal of Assisted Reproduction and Genetics 28:6, 495-499
CrossRef2
Asangla Ao, Xiao Yun Zhang, Seang Lin Tan. (2011) First successful pregnancy following PGD for chromosome translocation on embryos generated from in-vitro matured oocytes: a case report. Reproductive BioMedicine Online 22:4, 371-375
CrossRef3
M. Grynberg, L. Hesters, J. Bénard, R. Trèves, R. Fanchin, R. Frydman, N. Frydman. (2011) Préservation de la fertilité féminine : place de la maturation ovocytaire in vitro. Journal de Gynécologie Obstétrique et Biologie de la Reproduction 40:2, 103-108
CrossRef4
Ettie Maman, Dror Meirow, Masha Brengauz, Hila Raanani, Jehushua Dor, Ariel Hourvitz. (2011) Luteal phase oocyte retrieval and in vitro maturation is an optional procedure for urgent fertility preservation. Fertility and Sterility 95:1, 64-67
CrossRef5
BARIS ATA, EINAT SHALOM-PAZ, RI-CHENG CHIAN, SEANG LIN TAN. (2010) In Vitro Maturation of Oocytes as a Strategy for Fertility Preservation. Clinical Obstetrics and Gynecology 53:4, 775-786
CrossRef6
Jack Yu Jen Huang, Ri-Cheng Chian, Lucy Gilbert, David Fleiszer, Hananel Holzer, Ezgi Dermitas, Shai Elazar Elizur, Yariv Gidoni, Dan Levin, Weon-Young Son, Seang Lin Tan. (2010) Retrieval of immature oocytes from unstimulated ovaries followed by in vitro maturation and vitrification: A novel strategy of fertility preservation for breast cancer patients. The American Journal of Surgery 200:1, 177-183
CrossRef7
Baris Ata, Ri-Cheng Chian, Seang Lin Tan. (2010) Cryopreservation of oocytes and embryos for fertility preservation for female cancer patients. Best Practice & Research Clinical Obstetrics & Gynaecology 24:1, 101-112
CrossRef8
Shai E. Elizur, Togas Tulandi, Sarkis Meterissian, Jack Y. J. Huang, Dan Levin, Seang Lin Tan. (2009) Fertility Preservation for Young Women with Rectal Cancer—A Combined Approach from One Referral Center. Journal of Gastrointestinal Surgery 13:6, 1111-1115
CrossRef9
Ri-Cheng Chian, Lucy Gilbert, Jack Y.J. Huang, Ezgi Demirtas, Hananel Holzer, Alice Benjamin, William M. Buckett, Togas Tulandi, Seang Lin Tan. (2009) Live birth after vitrification of in vitro matured human oocytes. Fertility and Sterility 91:2, 372-376
CrossRef10
Charalambos S Siristatidis, Abha Maheshwari, Siladitya Bhattacharya, Charalambos S Siristatidis. 2009. In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction. .
CrossRef11
M.F.G. Verberg, N.S. Macklon, G. Nargund, R. Frydman, P. Devroey, F.J. Broekmans, B.C.J.M. Fauser. (2008) Mild ovarian stimulation for IVF. Human Reproduction Update 15:1, 13-29
CrossRef12
Hiroyuki Kanaya, Aisaku Fukuda, Shu Hashimoto, Yoshihiko Hosoi, Yoshiharu Morimoto. (2008) In Vitro Maturation of Human Immature Oocytes in Culture Medium Supplemented with Patient's Own Serum or Donor Follicular Fluid. Journal of Mammalian Ova Research 25:3, 163-166
CrossRef13
Ezgi Demirtas, Hananel Holzer, Weon-Young Son, Shai Elizur, Dan Levin, Ri-Cheng Chian, Seang Lin Tan. (2008) Will in vitro maturation ever be used in all IVF patients?. Expert Review of Obstetrics & Gynecology 3:5, 627-634
CrossRef14
S. E. Elizur, R. C. Chian, C. A. Pineau, W. Y. Son, H. E. G. Holzer, J. Y. J. Huang, Y. Gidoni, D. Levin, E. Demirtas, S. L. Tan. (2008) Fertility preservation treatment for young women with autoimmune diseases facing treatment with gonadotoxic agents. Rheumatology 47:10, 1506-1509
CrossRef15
W.-Y. Son, J.-T. Chung, R.-C. Chian, B. Herrero, E. Demirtas, S. Elizur, Y. Gidoni, C. Sylvestre, N. Dean, S. L. Tan. (2008) A 38 h interval between hCG priming and oocyte retrieval increases in vivo and in vitro oocyte maturation rate in programmed IVM cycles. Human Reproduction 23:9, 2010-2016
CrossRef16
Jack Y.J. Huang, Togas Tulandi, Hananel Holzer, Seang Lin Tan, Ri-Cheng Chian. (2008) Combining ovarian tissue cryobanking with retrieval of immature oocytes followed by in vitro maturation and vitrification: an additional strategy of fertility preservation. Fertility and Sterility 89:3, 567-572
CrossRef17
Weon-Young Son, Jin-Tae Chung, Ezgi Demirtas, Hananel Holzer, Camille Sylvestre, William Buckett, Ri-Cheng Chian, Seang Lin Tan. (2008) Comparison of in-vitro maturation cycles with and without in-vivo matured oocytes retrieved. Reproductive BioMedicine Online 17:1, 59-67
CrossRef18
Ezgi Demirtas, Shai Elazar Elizur, Hananel Holzer, Yariv Gidoni, Weon-Young Son, Ri-Cheng Chian, Seang Lin Tan. (2008) Immature oocyte retrieval in the luteal phase to preserve fertility in cancer patients. Reproductive BioMedicine Online 17:4, 520-523
CrossRef19
Kutluk Oktay, Ezgi Demirtas, Weon-Young Son, Kathy Lostritto, Ri-Cheng Chian, Seang Lin Tan. (2008) In vitro maturation of germinal vesicle oocytes recovered after premature luteinizing hormone surge: description of a novel approach to fertility preservation. Fertility and Sterility 89:1, 228.e19-228.e22
CrossRef20
William M. Buckett, Ri-Cheng Chian, Hananel Holzer, Nicola Dean, Robert Usher, Seang Lin Tan. (2007) Obstetric Outcomes and Congenital Abnormalities After In Vitro Maturation, In Vitro Fertilization, and Intracytoplasmic Sperm Injection. Obstetrics & Gynecology 110:4, 885-891
CrossRef21
CS Siristatidis, S Bhattacharya, A Maheshwari, Charalambos Siristatidis. 2007. In vitro maturation in sub fertile patients with polycystic ovarian syndrome undergoing assisted reproduction. .
CrossRef22
Hananel Holzer, Eleanor Scharf, Ri-Cheng Chian, Ezgi Demirtas, William Buckett, Seang Lin Tan. (2007) In vitro maturation of oocytes collected from unstimulated ovaries for oocyte donation. Fertility and Sterility 88:1, 62-67
CrossRef23
Mohammed Al-Sunaidi, Togas Tulandi, Hananel Holzer, Camille Sylvestre, Ri-Cheng Chian, Seang Lin Tan. (2007) Repeated pregnancies and live births after in vitro maturation treatment. Fertility and Sterility 87:5, 1212.e9-1212.e12
CrossRef24
Jin-Ho Lim, Seong-Ho Yang, Ri-Cheng Chian. (2007) New alternative to infertility treatment for women without ovarian stimulation. Reproductive BioMedicine Online 14:5, 547-549
CrossRef25
Chikako Sato, Masayuki Shimada, Takahide Mori, Youko Kumasako, Eiko Otsu, Hirohiko Watanabe, Takafumi Utsunomiya. (2007) Assessment of human oocyte developmental competence by cumulus cell morphology and circulating hormone profile. Reproductive BioMedicine Online 14:1, 49-56
CrossRef26
Asangla Ao, Shaoguang Jin, Durga Rao, Weon-Young Son, Ri-Cheng Chian, Seang Lin Tan. (2006) First successful pregnancy outcome after preimplantation genetic diagnosis for aneuploidy screening in embryos generated from natural-cycle in vitro fertilization combined with an in vitro maturation procedure. Fertility and Sterility 85:5, 1510.e9-1510.e11
CrossRef27
Yuan Li, Huai-Liang Feng, Yi-Juan Cao, Guang-Juan Zheng, Yong Yang, Steve Mullen, John K. Critser, Zi-Jiang Chen. (2006) Confocal microscopic analysis of the spindle and chromosome configurations of human oocytes matured in vitro. Fertility and Sterility 85:4, 827-832
CrossRef28
EG Papanikolaou, P Platteau, C Albano, D Nogueira, R Cortvrindt, P Devroey, J Smitz. (2005) Immature oocyte in-vitro maturation: clinical aspects. Reproductive BioMedicine Online 10:5, 587-592
CrossRef29
Anne Lis Mikkelsen. (2005) Strategies in human in-vitro maturation and their clinical outcome. Reproductive BioMedicine Online 10:5, 593-599
CrossRef30
Bulent Gulekli, William M. Buckett, Ri-Cheng Chian, Timothy J. Child, A.Kamal Abdul-Jalil, Seang Lin Tan. (2004) Randomized, controlled trial of priming with 10,000 IU versus 20,000 IU of human chorionic gonadotropin in women with polycystic ovary syndrome who are undergoing in vitro maturation. Fertility and Sterility 82:5, 1458-1459
CrossRef31
Ri-Cheng Chian, Jin-Ho Lim, Seang-Lin Tan. (2004) State of the art in in-vitro oocyte maturation. Current Opinion in Obstetrics and Gynecology 16:3, 211-219
CrossRef32
Jiayin Liu, Yun Qian, Yundong Mao, Wei Ding. (2004) Reply of the Authors:. Fertility and Sterility 81:2, 479-480
CrossRef33
Ri-Cheng Chian. (2004) In-vitro maturation of immature oocytes for infertile women with PCOS. Reproductive BioMedicine Online 8:5, 547-552
CrossRef34
Ri-Cheng Chian, William M Buckett, Seang-Lin Tan. (2004) In-vitro maturation of human oocytes. Reproductive BioMedicine Online 8:2, 148-166
CrossRef35
Zeev Blumenfeld. (2003) Gynaecologic concerns for young women exposed to gonadotoxic chemotherapy. Current Opinion in Obstetrics and Gynecology 15:5, 359-370
CrossRef36
Jiayin Liu, Guangxiu Lu, Yun Qian, Yundong Mao, Wei Ding. (2003) Pregnancies and births achieved from in vitro matured oocytes retrieved from poor responders undergoing stimulation in in vitro fertilization cycles. Fertility and Sterility 80:2, 447-449
CrossRef37
DOUGLAS T. CARRELL, SERGEY MOSKOVTSEV, KAZIM R. CHOHAN, MATTHEW C. PETERSON. (2003) Ovarian Folliculogenesis: Emerging Role of In Vitro Maturation of Oocytes and Follicles in Clinical Practice. Clinical Obstetrics and Gynecology 46:2, 239-253
CrossRef38
Ri-Cheng Chian, Jin-Tae Chung, Bruce R Downey, Seang Lin Tan. (2002) Maturational and developmental competence of immature oocytes retrieved from bovine ovaries at different phases of folliculogenesis. Reproductive BioMedicine Online 4:2, 127-132
CrossRef39
Tim J. Child, Ahmad Kamal Abdul-Jalil, Bulent Gulekli, Seang Lin Tan. (2001) In vitro maturation and fertilization of oocytes from unstimulated normal ovaries, polycystic ovaries, and women with polycystic ovary syndrome. Fertility and Sterility 76:5, 936-942
CrossRef40
Tim J. Child, Seang Lin Tan. (2001) Endometriosis. Drugs 61:12, 1735-1750
CrossRef41
Roger G Gosden, Seang Lin Tan, Kutluk Oktay. (2000) Oocytes for late starters and posterity: are we on to something good or bad?. Fertility and Sterility 74:5, 1057
CrossRef42
Geeta Nargund. (2000) Current status of subfertility care: Time to rationalize treatment options. Current Opinion in Obstetrics and Gynecology 12:3, 199-200
CrossRef
