Transcript IVM presentation

History and Fundamentals of Oocyte
Maturation in Vitro
H. I. Nielsen
Libya
日本国
H. 2007
I. Nielsen
2007
History of IVM
1935
1965
1983
1989
1993
1994
1995
From
Pincus & Enzmann
Edwards
Veeck
Cha et al.
IVM in rabbit
IVM of human oocytes
First IVM baby (‘GV rescue‘)
First IVM babies (triplets)
(unstimulated, donor)
Cha et al.
Further 4 IVM babies
Trounson et al.
First IVM baby from PCOS
Barnes et al.
PCOS
1996 Increasing number of groups worldwide
End of 2006: Probably around 500 IVM babies worldwide
- so we thought!
Deliveries and ongoing pregnancies
(facts and educated guesses)
Countries
Scandinavia
Italy
France
Germany
Rest of Europe
Total Europe
Deliveries and ongoing
pregnancies
150
77
40
20
33
320
Deliveries and ongoing pregnancies
(facts and educated guesses)
Countries
Middle East
Japan
Vietnam
China (incl. HK)
Korea (Cha Hosp.)
Korea (Maria Cl.)
Rest of Asia
Total Asia
Deliveries and
ongoing pregnancies
21
100
26
60
57
≈ 400
15
679
Deliveries and ongoing pregnancies
(facts and educated guesses)
Countries
Canada
USA
Australia
Total
Deliveries and ongoing
pregnancies
120
5
5
130
Deliveries and ongoing pregnancies
(facts and educated guesses)
Countries
Asia
Europe
North America
Australia
Grand Total
Deliveries and ongoing
pregnancies
679
320
125
5
1129
Why do IVM ?
Safety
Ethics
OHSS in PCO(S) patients
male factor
Costs
• patients
• community
• IVF Center
Why do IVM ?
Another
chance
• Poor (slow) responders
• Repeated poor embryo quality
• Repeated failure of ovulation
induction
Extension of
fertility
• Cryopreservation prior to
cancer treatment
• Career and life style
considerations
Why do IVM ? - future
Post-OPU
maturation
GV rescue
GV oocytes from stimulated cycles
Primary oocytes /
primordial
follicles
Ovarian biopsies
Stimulated cycles
Scientific background for IVM
Oogenesis
Follicular development
Follicular selection
Follicular atresia
Gametogenesis
Mitosis
Initiation of meiosis
Gametogenesis
Mitosis
Initiation of meiosis
Arrest
Resumption of
meiosis
Arrest
Gametogenesis
Mitosis
Arrest
Arrest
Resumption of
meiosis
Arrest
Initiation of meiosis
Gametogenesis
Mitosis
Initiation of meiosis
Arrest
IVM
Resumption of
meiosis
Arrest
IVF
Development of an
Ovarian Follicle
IVM
IVF
Modified from Ross et al. Histology A Text and
Atlas, 3rd Ed.
Follicle selection and atresia
Natural
ovulation
IVM
Geneva Foundation for Medical Education and Research
Unstimulated
IVM cycle
Day -1
Day 2 or day 3
Day 0
Day 1
Estradiol
Cycle day 8-11
Cycle day 3
Cycle day 7-10
US scanning (lead
follicle 10-14 mm)
US scanning
US scanning
Blood sample
(Blood sample)
(Blood sample)
Oocyte pick-up
Progesterone -
endometrial priming
Traditional IVF versus IVM
Traditional IVF
IVM®
•
•
•
Relatively many oocytes/embryos
’High’ pregnancy rate / OPU
Down regulation
•
•
•
•
Daily hormone injections
•
•
•
•
•
hCG injection
Emotional stress
Long treatment time - 4-6 weeks
•
Potential side effects (e.g. OHSS)
•
•
•
•
•
Fewer oocytes and embryos
Lower pregnancy rate / OPU - BUT
No down regulation, no
manipulation of hormone balance
No hormone injections – or
Minimal hormone injections
(PCOS)
(No hCG injection)
Reduced psychological impact
Reduced treatment time – 2 weeks
Reduced interference with daily life
No known side effects (e.g. OHSS)
Average
3.0
29
Average
2.0
20
What needs to be improved in IVM?
• IVM has a lower pregnancy rate per OPU - due to lower no.
of oocytes/embryos resulting in lower transfer rate
• IVM has a lower pregnancy rate per ET - due to lower no. of
embryos resulting in lack of selection possibilities, and
possibly in a smaller no. of embryos transferred
• IVM has a lower implantation rate - due to lower no. of
embryos resulting in lack of selection possibilities
• IVM has probably a higher rate of early pregnancy loss?
Shukran