Drug-free in-vitro activation of follicles for infertility treatment in poor ovarian response patients with decreased ovarian reserve

REPRODUCTIVE BIOMEDICINE ONLINE

卷:40

Article

Kawamura, Kazuhiro¹  Ishizuka, Bunpei²  Hsueh, Aaron J. W.³ 

[1] Adv Reprod Res Ctr, Dept Obstet & Gynecol, Narita, Chiba 2868686, Japan

[2] Rose Ladies Clin, Tokyo 1580082, Japan

[3] Stanford Univ, Sch Med, Dept Ob Gyn, Stanford, CA 94305 USA

关键词: Follicles;    Hippo signalling;    Infertility;    In-vitro activation;    Oocyte;    Ovary;   

DOI  :  10.1016/j.rbmo.2019.09.007

来源: Elsevier

【 摘 要 】

Research question: The recently developed in-vitro activation (IVA) approach provides a promising infertility treatment for patients with premature ovarian insufficiency. The IVA method promotes growth of residual ovarian follicles following ovarian tissue fragmentation leading to Hippo signalling disruption, together with in-vitro incubation with Akt stimulators. As poor ovarian response (POR) patients with decreased ovarian reserve (DOR) have multiple secondary follicles, this study tested whether Hippo signalling disruption alone using in-vitro ovarian cortical fragmentation, followed by autologous grafting, was sufficient to promote follicle growth. Design: A case series study. Results: In 9 out of 11 POR patients with DOR treated with a simplified IVA procedure, increases in antral follicle numbers in multiple growth waves were detected following FSH treatment. Subsequent injection with human chorionic gonadotrophin allowed retrieval of more mature oocytes for IVF (median antral follicle counts before and after IVA per ovarian stimulation: 1.0 versus 2.6) with 68.7% fertilization rates and 56.9% showing high-quality embryonic development. One natural conception and 16 embryo transfers in five patients resulted in one live birth, two ongoing pregnancies and one miscarriage. Three additional patients and the miscarriage patient have cryopreserved embryos for future transfer. Conclusions: The present drug-free IVA approach may be suitable for POR patients with DOR, as it increased the number of antral follicles. The procedure also eliminated the need for 2-day incubation with drugs and required only one surgery. This approach could allow the retrieval of more oocytes in middle-aged women to achieve higher pregnancy rates and deserves proper evaluation in future randomized controlled trials.

【 授权许可】

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