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Prediction and Management of Ovarian Hyperstimulation Syndrome
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Mohamed A. Youssef, Abdel Maguid Ramzy, Botros Rizk
In vitro maturation (IVM) has been proposed to reduce the risk of OHSS in women with PCOS. IVM involves earlier retrieval of immature oocytes, from the germinal vesicle stage, that may or may not have been exposed to gonadotropins, followed by their maturation in the laboratory until the metaphase II stage and they are ready to undergo fertilization [54]. IVM treatment is still considered to be experimental, and currently, there is no evidence to base any practice recommendation regarding IVM before IVF/ICSI [55].
Fertility preservation in pediatric and adolescent girls
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Reproductive researchers continue to explore fertility preservation techniques that can both reduce patient risk and minimize treatment delays. One experimental technique, in vitro oocyte maturation (IVM), involves removal of immature oocytes either via transvaginal oocyte retrieval or from surgically resected ovarian tissue, then maturing these oocytes in the laboratory so they can be cryopreserved as mature oocytes or fertilized for embryo cryopreservation. Compared to conventional ovarian stimulation for oocyte cryopreservation, IVM results in less cost and time for patients because it obviates the need for stimulation medications and multiple monitoring visits, in addition to avoiding exposure to large doses of gonadotropins and resultant elevated estradiol levels.52 Research is also being conducted to advance methods of isolating and maturing oocytes at all stages of development from both fresh and cryopreserved–thawed ovarian tissue.7 To date, there have not been any live births reported from IVM of immature oocytes obtained at the time of harvesting ovarian tissue for cryopreservation, although this is an area of ongoing investigation, as is cryopreservation of immature oocytes for later IVM.42,57 Development of techniques to successfully grow and mature oocytes in vitro would be particularly pertinent to cancer patients, as it could mitigate the potential risks associated with autotransplantation of cryopreserved ovarian tissue, such as reintroduction of malignant cells and need for multiple surgeries due to shortened graft life.
Use of in vitro maturation in a clinical setting Patient populations and outcomes
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Yoshiharu Morimoto, Aisaku Fukuda, Manabu Satou
We have achieved 88 clinical pregnancies by IVM from 1999 to 2008. Twenty-one pregnancies (24%) resulted after repeated IVF failures. Eight of these 21 pregnancies (38%) were treated by IVM due to poor-quality embryos generated by IVF. Figure 10.1 shows the number of failed IVF cycles and IVM cycles to achieve pregnancy in 18 ongoing cases. They failed 4.9 times with IVF and needed IVM 2.3 times to achieve pregnancy. In conclusion, the primary indication for IVM is PCOS or PCOs with a high risk of OHSS. Other indications are patients who desire not to undergo gonadotropin administration, and repeated IVF failure due to impaired oocyte or embryo qualities. IVM is an alternative to conventional assisted reproduction technology (ART).
Expert consensus on fertility preservation in hematopoietic stem cell transplantation in girls in China
Published in Gynecological Endocrinology, 2023
In children undergoing OTC, immature follicles can be isolated from antral follicles visible on the ovarian surface [46], culture fluid used in the preparation of ovarian cortex [47] and ovarian medulla [48]. Cryopreservation of the mature oocyte can be obtained from IVM and in vitro fertilization–embryo transfer (IVF-ET) can be performed when fertility is required, which can further increase the fertility potential especially for patients with malignant hematological diseases. Oocyte retrieval can be performed during the follicular or luteal phase without ovulation induction. The time of oocyte retrieval does not affect follicular maturation rate. Therefore, OTC combined with IVM can preserve the girl’s reproductive potential to the maximum extent without delaying the subsequent treatment. However, there are still some problems with the use of IVM for fertility protection of girls. First of all, oocytes retrieved by IVM is very limited and IVM rate (IVMR) is not desirable. IVMR in postmenarche women is about 28%, only 10% to 15% in premenarche children and only 4.6% in girls under 5 years old [47–49]. Second, vitrification-thawing may impair the reproductive potential of IVM oocytes. Fertilization and embryo cleavage rates, clinical pregnancy and live birth rates were significantly lower in the vitrified-freezing oocytes compared to fresh IVM oocytes [50]. Based on aforementioned reasons, IVM alone is not effective enough in preserving girl’s fertility. IVM should combine with OTC to protect the fertility.
Ivermectin: recent approaches in the design of novel veterinary and human medicines
Published in Pharmaceutical Development and Technology, 2022
Maiara Callegaro Velho, Diego Fontana de Andrade, Ruy Carlos Ruver Beck
The global health crisis related to COVID-19 has sparked an emerging search for potential treatments using well-known drugs. As a result, some political leaders and regulatory agencies have authorized the use of antiparasitic IVM for emergency use in unproven COVID-19 treatments (Roman et al. 2022). This is based on theoretical and experimental considerations related to the study of Caly et al. (2020), who reported the ability of IVM to inhibit the causative virus SARS-CoV-2, providing an in vitro antiviral action. However, in many cases, IVM prescriptions are in multiple and higher doses than those approved and recognized as safe (single dose of IVM 0.2 mg/kg). This situation has triggered an alert related to the safety of IVM, especially concerning its use at high doses for longer periods than those usually recommended. Additionally, IVM formulations have been investigated as a therapeutic option for cancer treatment and for other viral diseases, such as HIV-1, dengue, influenza, Zika virus, respiratory syndrome virus (RSV), and rabies (Heidary and Gharebaghi 2020). Hence, obtaining more information about IVM’s toxicity profile is essential.
Gonadotropin releasing hormone agonist triggering for in vitro maturation cycles
Published in Human Fertility, 2022
Anat Hershko Klement, Daniella Navve, Yehudith Ghetler, Amir Wiser, Tal Shavit, Omer Weitzner, Adrian Shulman
In vitro maturation (IVM) is a relatively new technique among assisted reproductive technologies. It was originally the term attributed to eggs which have not been exposed to either exogenous luteinizing hormone (LH) or human chorionic gonadotropin (hCG) prior to their retrieval (Practice Committees of the American Society for Reproductive, 2013; Yang & Chian, 2017). The essence of the concept was defined as in vitro maturation of the eggs from prophase I (GV) through meiosis I stage and eventually to metaphase II (MII). We have learnt that a truly competent and mature egg should acquire a synchronised maturation of both nucleus and cytoplasm (Practice Committees of the American Society for Reproductive, 2013) and later on, utilisation of LH or hCG was introduced in order to increase the proportion of usable oocytes, but has not been acceptable by all (Son & Tan, 2010). Various IVM protocols have been introduced, with or without FSH priming and with or without ovulation triggering, but few reports discuss the efficacy of IVM after gonadotropin releasing hormone agonist (GnRH-ag) triggering (Dahan et al., 2016).