Elsevier

Fertility and Sterility

Volume 99, Issue 5, April 2013, Pages 1173-1181
Fertility and Sterility

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In vitro maturation of human immature oocytes for fertility preservation

https://doi.org/10.1016/j.fertnstert.2013.01.141Get rights and content

Cryopreservation of embryos, oocytes, or ovarian tissues is the main option for female fertility preservation. Oocyte cryopreservation has emerged as especially important: the dramatic increase in the number of infants born from vitrified oocytes indicates that it is becoming one of the most important intervention options. However, oocyte cryopreservation with standard controlled ovarian hyperstimulation may not be feasible for some cancer patients as there are serious concerns about the effect of ovarian stimulation with hormones on the risk of cancer recurrence. Also, urgent gonadotoxic cancer treatment may not allow sufficient time for a patient to undergo hormonal ovarian stimulation. Thus, immature oocyte retrieval from ovaries without ovarian stimulation followed by in vitro maturation and vitrification is a promising fertility preservation option for women who cannot undergo ovarian stimulation or cannot delay their gonadotoxic cancer treatment. Immature oocytes can be collected from the ovaries during both the follicular and luteal phases, which maximizes the possibility for fertility preservation. The combination of ovarian tissue cryopreservation with immature oocyte collection from the tissue followed by oocyte vitrification via in vitro maturation represents another promising approach of fertility preservation in young women with cancer.

Section snippets

Problems with hormonal ovarian stimulation in some cancer patients

Breast cancer remains the most common cancer in women, representing approximately 30% of all female cancers (13). A risk of breast cancer is associated with persistently elevated blood estrogen levels. Ovarian stimulation using FSH causes a state of high estrogen concentrations in serum (14), so the safety of ovarian stimulation with FSH in breast cancer patients is a primary concern, especially in women who have estrogen-positive breast cancer.

Although the special stimulation protocol with the

Development of IVM as infertility treatment

The first live birth from human IVF was produced from natural cycle IVF without ovarian stimulation (21). Later, natural cycle IVF was slowly replaced by ovarian stimulation IVF because it was believed that the number of oocytes retrieved relates to the number of embryos available to transfer, thus directly affecting the chance of a successful pregnancy 22, 23, 24. In the beginning, relatively inexpensive medication such as clomiphene citrate was used to stimulate the ovaries to produce

Safety issue with IVM oocytes

The number of live births from IVM oocytes has been increasing over the past two decades. There are many concerns about IVM infants as to obstetric and perinatal outcomes as well as long-term development. At the present, the issue of clinical safety of using IVM oocytes cannot be completely assessed because of the lack of well-controlled clinical trials. Several studies have reported that the mean birth weight and the incidence of congenital anomalies seem to be comparable with spontaneous

Vitrification of in vitro matured oocytes

Recent advances in vitrification techniques have markedly improved the efficacy of oocyte cryopreservation in terms of oocyte survival and pregnancy rates as well as live-birth rates that are now comparable to those achieved with fresh oocytes for IVF. The number of live births from vitrified oocytes has increased rapidly over the past decade. It has been estimated that worldwide several thousand babies have been born from cryopreserved oocytes. In Italy alone, approximately 2,000 babies have

Combination of ovarian tissue and IVM oocyte vitrification

Ovarian tissue cryopreservation has been the primary method of fertility preservation for prepubertal girls who are at risk of POF (93). Ovarian tissue cryopreservation followed by later transplantation may be offered as a method of fertility preservation for pubertal cancer patients who cannot receive ovarian stimulation due to time constraints or contraindications. Cryopreservation of ovarian tissues would only preserve primordial and primary follicles. It has been reported that immature

Conclusions

Retrieval of immature oocytes followed by IVM of oocytes or embryo vitrification provides the optimal option for female fertility preservation, especially for patients who cannot be stimulated with FSH or who have time constraints related to their cancer treatment. Immature oocytes can be collected from the ovaries in both the follicular and luteal phases, which maximizes the possibility of fertility preservation for cancer patients. The combination of ovarian tissue cryopreservation with

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    R.-C.C. has nothing to disclose. P.S.U. has nothing to disclose. G.N. has nothing to disclose.

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