SamenvattingOocyte in vitro maturation (IVM) is an artificial reproductive technology
(ART) where oocytes are retrieved from antral follicles, typically from
unstimulated or minimally stimulated ovaries, and cultured, matured and
fertilized in vitro. Clinical outcomes are inferior compared to conventional
ART based on controlled ovarian stimulation (COS), although modifications
to the in vitro culture system and the clinical protocol have resulted in
improved success rates. Because of the low hormonal burden and the
minimal need for cycle monitoring compared to COS, IVM has been
advocated as a more “patient-friendly” ART, especially in patients with
PCOS. Recently, there has been an emerging role for IVM in fertility
preservation for cancer patients who have no time to undergo COS.
With this doctoral study, multiple endeavors to enhance the clinical
application of IVM in patients with PCOS are described. That observation that
in a non-hCG-triggered IVM system, vitrified-warmed embryo transfer
performs better than fresh embryo transfer has led us to suggest that
endometrial receptivity in IVM cycles may be impaired. This observation was
supported by immunohistochemical studies of steroid receptor expression in
the endometrium during the IVM cycle, showing that the mid-secretory
signature of the endometrium on day 5 or 6 after IVM is absent in patients
with PCOS and women with normo-ovulatory cycles.
Analysis of the endocrine profile in patients with PCOS who underwent egg
retrieval for IVM demonstrated a significant, but transient impact on serum
androgen and AMH levels.
|17 dec 2019