Hakan Özörnek EUROFERTIL IVF Center Turkey. No or minimal stimulation Low cost Less monitoring Less side effects (OHSS) Acceptable pregnancy.

USE OF IVM TECHNOLOGY

İN EUROPE

Hakan Özörnek

EUROFERTIL

IVF Center

Turkey

Patient friendly IVF Patient friendly IVF

No or minimal stimulation Low cost Less monitoring Less side effects (OHSS) Acceptable pregnancy rate High patient compliance

Patient friendly IVFPatient friendly IVF

Natural cycle

Mild stimulation

IVM

Negative remarksNegative remarks

Lower pregnancy rate than classic IVF OPU more difficult Lab more busy Less embryo quality No long term follow up data on IVM

children

Positive remarksPositive remarks

No short or long term side effects of gonadotropins

Prevention of OHSS No extensive monitoring No expensive stimulation Simpler therapy, less stress No need for waiting between cycles

IVM program in EUROFERTILIVM program in EUROFERTIL

Starting the IVM program in January 2008

Age ≤ 38

FSH ≤ 12 mIU/ml

AFC ≥ 7

PatientsPatients

PCO/PCOS

Male infertility

Unexplained infertility

PrimingPriming

HCG priming initiates oocyte maturation in vivo and produces a favourable outcome in IVM.

Priming with FSH for 3 days in PCOS patients may improve the maturational potential of the oocytes.

No beneficial effect of FSH priming has been observed in regular cycling women.

Protokol (Non PCO/PCOS)Protokol (Non PCO/PCOS) HCG Priming

DAYS 3 4 5 6 7 8 9

Ultrasound

OPUHCG

Protokol (PCO/PCOS)Protokol (PCO/PCOS)

FSH/HCG Priming

DAYS 3 4 5 6 7 8 9

US

OPU

rFSH 75

HCG

DAYS

Ultrasound

ProtokolProtokol

TRANSFER

+2

βhCG test

+14

Progesterone 600 mg/die

Oestradiol 6 mg/die

- Endometrium ≥6 mm - Leading follicle 10-14 mm

ICSI

0

OPU

-1

EUROFERTIL IVMEUROFERTIL IVM

24 patients1 patient no oocyte retrieved

Mean age 30.0 years Mean FSH 6.04 mIU/ml Mean AFC 9.6

11 PCO/PCOS 13 normocycle women

Oocyte collectionOocyte collection

General anestasia

19 G needle

80 mmHg aspiration pressure

Medium with heparin for pick up

Multipuncture technique

Mean Nr of oocytesMean Nr of oocytes

EUROFERTIL IVMEUROFERTIL IVM

Mean Nr of oocytes 7.6 [2-14]

Mean Nr of injected oocytes 5.52

Maturation rate 72.6 %

Mean Nr of fertilised oocytes 4.16

Fertilisation rate 75.4%

IVM ResultsIVM Results

EUROFERTIL IVMEUROFERTIL IVM

ET day 2 after ICSI

Nr of transfered embryos 2.2 [1-4]

Clinical pregnancy rate 17.4% (4/23)

PCO/PCOS patientsPCO/PCOS patients

Regular cycle patientsRegular cycle patients

ConclusionConclusion

Optimization of culture systems and clinical management of IVM cycles will enhance pregnancy outcome, so that IVM might replace conventional IVF in selected patients.

More studies are needed for improving the success of IVM.