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Successful Pregnancy Reported with Immature Oocytes
Title:Unstimulated immature oocyte retrieval: early vs midfollicular endometrial priming
Author: J. Russell et al
Address:Newark, Deleware
Source: Fertility and Sterility 67:4;616-620 (April)
Synopsis: This study assessed the ability to retrieve transvaginally understimulated immature oocytes from 14 patients who had failed at least one IVF cycle. It was hypothesized that change in preparation of the endometrium may improve pregnancy rates. Group A contributed 83 oocytes and early follicular priming was initiated on cycle day 3 with 2 mg oral estradiol twice a day. Group B contributed 78 oocytes and midfollicular endometrial priming was initiated with 1-2 mg/day of oral estradiol between cycle days 5 and 7 and increased by 1-2 mg/d until the oocyte retrieval. An average of 11-12 oocytes were obtained from each group. Media was supplemented with FSH and LH. Fertilization rate was indentical at 75%; cleavage arrest 36%(group A) vs 8.3 (groupB), embryos transferred 1.8 (group A) vs 4.0 (group)B. One pregnancy was achieved in group B.
Comment: Treatment of patients with previously failed IVF cycles is extremely challenging. Many patients will be successful in subsequent cycles, while others fail despite all attempts. Everyone is looking for new technologies for these patients; especially, if the cost of ovarian stimulation, in terms of monetary inconvenience, risks of hyperstimulation and multiple gestations, can be lessened. This technique of immature oocyte aspiration has been very much in the news and virtually all IVF centers are discussing its implications. The overall success rate with technique at all centers is low, as attested by a single pregnancy in 14 patients in the present study. As proposed by the above authors, proper endometrial priming possibly could improve success rates. No doubt immature occyte utilization is in the future of IVF technology. Patients should be very cautious about premature conclusions of its usefulness of this technique until it has been confirmed in other studies.