prof. Dr. Bulent Gulikli
Dokuz Eylul University Faculty of Medicine
Department of Obstetrics and Gynecology and
Reproductive Endocrinology Department lecturer
Today, in-vitro fertilization and embryo transfer (IVF-ET) treatment is a proven technique. As an alternative to this technique, in-vitro maturation (IVM) of immature oocytes from unstimulated ovaries without the use of FSH or other ovulation-stimulating drugs is a reproductive technology of increasing interest. The advantages of IVM are that it does not require the use of drugs, reduces the treatment costs, and does not have weight gain, abdominal swelling, breast tenderness, nausea, mood changes, and most importantly, ovarian hyperstimulation syndrome (OHSS), which are the side effects associated with the use of gonadotropins. There are conflicting publications on the relationship between ovarian stimulation and ovarian cancer that may occur after a long time. This contradiction is eliminated with IVM.
IVM was first successfully applied to immature oocytes obtained from ovarian biopsy performed during cesarean section by Cha. Trounson et al., on the other hand, introduced IVM into clinical practice by reporting the first pregnancy they had obtained from immature oocytes under the guidance of transvaginal ultrasound from a patient with polycystic ovary (PCO). This technique, which was not very popular due to the low pregnancy rates at the beginning, has gained popularity again with the publications published in recent years, especially in women with PCO.
Even if they do not have polycystic ovary syndrome (PCOS) clinically (amenorrhoea, oligomenorrhoea, hirsutism) and endocrine (high LH and androgens, increased LH/FSH ratio) patients with PCO detected on ultrasonography, they are at increased risk for the development of OHSS. In a prospective study, we demonstrated that this technique is an alternative to IVF in patients with PCOS, by publishing a 40% clinical pregnancy rate with 10,000 IU hCG administration before oocyte retrieval in 25 IVM cycles performed in 20 women with PCOS. The answer to the question of whether obtaining this number of oocytes without using any medication in patients who respond poorly to conventional IVF treatment (removal of 4 or fewer oocytes) can put IVM into clinical use as a treatment alternative has been sought. The drugs used in IVF and the side effects that may arise from them prevent a group of volunteers from donating oocyte just for this reason. For these, IVM is an attractive alternative. Another practice in the clinic was achieved by the birth of healthy babies after the embryos obtained from oocytes matured in vitro were frozen and thawed.
In recent years, there have been publications about the desire for less aggressive ovarian stimulation protocols created with the use of low doses of gonadotropins, and even the necessity of completely eliminating the ideal ovarian stimulation. We revealed that at the end of IVM performed in women with normal ovaries, polycystic ovaries and polycystic ovary syndrome in unstimulated cycle, women with normal ovaries showed significant differences in terms of oocyte and pregnancy obtained from PCO and PCOS groups. When IVF and IVM applications were compared in patients with polycystic ovary, we found that although more oocytes were shed in IVF compared to IVM, there was no statistical difference in clinical pregnancy and live birth rates. Together with a group of researchers, I also explained that for which patients the in vitro oocyte maturation method is a suitable method, or in other words, it is possible to predict how many oocytes can be obtained in that cycle with early follicular phase ultrasonography. Ultrasonography to be performed on the day of embryo transfer, as well as early follicular phase ultrasonography, is necessary for the success of the IVM program in terms of giving endometrial evaluation.
For today, IVM stands before us as a treatment modality that can be an alternative to IVF in some cases with its clinical applications listed above, promising for the future but needing more clinical studies.
prof. Dr. Bulent Gulikli