OP-IVM: Combining In vitro Maturation after Oocyte Retrieval with Gynecological Surgery

Summary

In vitro maturation (IVM) before gynecological operation (OP-IVM) combines IVM following oocyte retrieval with routine gynecological surgery and serves as an extension of conventional IVM applications for fertility preservation.

Abstract

The use of in vitro maturation (IVM) before gynecological operation (OP-IVM) is an extension of conventional IVM that combines IVM following oocyte retrieval with routine gynecological surgery. OP-IVM is suitable for patients undergoing benign gynecological surgery who have the need for fertility preservation (FP) or infertility treatments such as in vitro fertilization and embryo transfer (IVF-ET). In the operating room, patients undergoing benign gynecological surgery are first anesthetized and receive ultrasound-guided immature follicle aspiration (IMFA) treatment. As the subsequent gynecological surgery is performed, the cumulus-oocyte complexes (COCs) are examined, and the immature COCs are transferred into the IVM medium and cultured for 28-32 hours in the IVF laboratory. After assessment, mature oocytes in the MII stage will be selected and cryopreserved in liquid nitrogen for FP or fertilized by intracytoplasmic sperm injection (ICSI) for IVF-ET. By combining IVM with gynecological surgery, immature oocytes that would have been discarded can be saved and used for assisted reproductive technology (ART). The procedure, significance and critical aspects of OP-IVM are described in this article.

Introduction

IVM is an ART in which human immature oocytes are cultured in vitro to maturation for IVF-ET or FP. In IVM, ovulation induction medications are not used, thus reducing pain, financial burden, and complications such as ovarian hyperstimulation syndrome (OHSS)^1,2. In addition, IVM is particularly suitable for the FP of cancer patients and the infertility treatment of hormone-sensitive patients who may be unable to or have no time to receive ovulation induction therapy³. Therefore, although the number of oocytes retrieved, clinical pregnancy rate (CPR), and live birth rate (LBR) are lower ....

Protocol

NOTE: Studies related to the OP-IVM method have been approved by the institutional review board (IRB) of Peking University Third Hospital and the Ethics Committee of Peking University (2014S2004). A summary of OP-IVM is shown in Figure 1. The step-by-step procedure will be introduced in the following section.

1. Introduction of OP-IVM to appropriate patients

1. Identify potential patients who may benefit from OP-IVM such as those described in steps 1.1.1-1.1.3.:
   1. Polycystic ovarian syndrome (PCOS) patients with clomiphene resistance who need laparoscopic ovarian drilling surgery.
   2. ....

Results

Until December 2019, OP-IVM was used for fertility preservation of 274 patients. Embryological and reproductive outcomes of 158 patients between 2014 to 2016 were published in a previous paper⁸. The following example discusses the procedure followed for a PCOS patient receiving OP-IVM in 2016. The patient is a 28-year-old diagnosed with primary infertility, left adnexal cyst, and PCOS. She received laparoscopic cystectomy and OP-IVM on September 28^th, 20.......

Discussion

The OP-IVM method described in this article extends to conventional IVM applications and combines IVM after oocyte retrieval with routine gynecological surgery. Oocytes that would have been lost in the gynecological surgery can now be used for IVF-ET or FP without additional surgical risks. OP-IVM was first used to retrieve oocytes before ovarian drilling in PCOS patients. Its application soon expanded to infertile patients who need benign gynecological surgery and cancer or hematological disease patients who need chemor.......

Materials

Name	Company	Catalog Number	Comments
19 G single-lumen aspiration needles	Cook, Australia	K-OPS-7035-REH-ET
4-well plate	Corning
70 μm nylon cell strainer	Falcon, USA	352350
CO2 Incubator	Thermo
Culture oil	Vitrolife, Sweden	10029,OVOIL	Step 3.2.
FSH & LH	Ferring Reproductive Health, Germany	MENOPUR®
Glass Pasteur pipette	Hilgenberg GmbH, Germany	3154102-26
G-MOPS medium			pH-stable handling medium for washing the needle before puncturing
IVM medium	Origio, Denmark	ART-1600-B
Laminar Flow Clean Benches	ESCO
Petri dish	Thermo Fisher Scientific, Denmark	263991
pH stable handing media designed to support the handling and manipulation of oocytes and embryos outside the incubator	Vitrolife, Sweden	10130, G-MOPS PLUS	Step 7.1.
Rinse solution	Cook, Australia	K-SIFB-100
Stereoscope	Nikon