A Randomized Study On The Outcomes Of Gonadotropin Priming And Nonpriming In In Vitro Maturation

2042 words - 9 pages

Polycystic ovarian syndrome (PCOS) patients are extremely sensitive to gonadotropin stimulation. Despite intensive monitoring and fine adjustment of gonadotropin dosage during ovarian stimulation, they still have significantly higher incidence of ovarian hyperstimulation syndrome (OHSS) compared with women with normal ovaries1. Limited or even no stimulation in IVM cycles help to eliminate this iatrogenic complication. According to this benefit and the reasonable pregnancy rate2, 3, in vitro maturation of oocytes (IVM) has become an alternative treatment of in vitro fertilization (IVF), especially for the women who are infertile due to PCOS.
Successful oocyte maturation includes complete maturation of three compartments, namely meiotic, cytoplasmic and molecular4, which are crucial for good embryo development. Gonadotropins that produced from pituitary are indispensable for oocyte maturation in vivo, however, in vitro its function might be different. Studies of hCG got similar conclusions that hCG priming not only promotes nuclear maturation and embryo cleavage rate5, 6, but also increases the number of oocyte recovered7. In contrast, the data regarding the benefits of FSH priming before oocyte recovery are debatable2, 8, 9. During folliculogenesis, FSH is essential for follicle development and oocyte maturation10. In sheep, FSH receptors are present as early as in the type 2 follicles11, which is equivalent to primary follicles in human. This suggests that FSH plays important roles in follicle development at gonadotropin responsive phase as well as the dependent phase12. In other words, cytoplasmic maturation, including the accumulation of protein and RNA during oocyte maturation is dependent on gonadotropin stimulation13, 14. Maturation of this compartment is critical to initiate proper embryonic genome at the right time. Hence, theoretically, FSH priming is beneficial in promoting oocyte maturation in both preantral and antral follicles. On the other hand, some studies working on the FSH priming did not find its profit in terms of oocyte maturation, cleavage or even pregnancy rate2, 8. Although many live births have been reported, the pregnancy rate and implantation rate are inconsistent3, 8, 15-17, since each study used different protocol for follicle development assessment and endometrial preparation, and studied in various populations. Proper adjustment of protocol is needed to optimize both the embryo development and the endometrial receptivity, and therefore, the pregnancy rate.
High insulin and androgen levels lead to antral follicle development arrests in PCOS00. Therefore, follicle response to FSH is assumed to be similar at anytime in follicular phase. The starting time of FSH priming can be adjusted. However, estrogen which is essential for endometrial thickening, is produced continuously. Longer preparation duration, such as 12 days follicular phase which is similar to normal menstrual cycle was proposed to offer better endometrial...

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