In-vitro maturation of oocytes from unstimulated polycystic ovaries

In-vitro fertilization (IVF), an established treatment for infertility, may result in pregnancy and live-birth rates higher than following natural conception in fertile couples. However, IVF is associated with two major complications, namely, multiple pregnancy and ovarian hyperstimulation syndrome. The latter is a consequence of the ovarian stimulation required for IVF. Women with polycystic ovaries (PCO) are at increased risk of developing this complication. Ovarian stimulation is not required for in-vitro maturation (IVM) of immature oocytes. This approach is therefore both cheaper and safer than IVF, particularly for women with PCO. It has been found that the IVM pregnancy rate is correlated with the number of antral follicles present, the peak ovarian stromal blood flow velocity at the baseline ultrasound scan, the number of immature oocytes collected, absence of a dominant follicle at the time of immature oocyte retrieval, and endometrial thickness at embryo transfer. The indications for IVM at present would include women requiring IVF who have PCO, those with primarily poor quality embryos in repeated previous IVF cycles for no apparent reason, poor responders to high dose gonadotrophin stimulation for IVF, and finally, women with PCO who are considering egg donation.