IVM for High Responders to Gonadotropin Stimulation

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When patients receiving gonadotropins hyper-respond to treatment, there are no precise methods to completely prevent severe OHSS. However, the risk can be reduced by withholding the ovulation-inducing trigger of hCG (34). Thus, in conventional ovarian stimulation for IVF where there has been an over-response and there is a high chance of developing OHSS, the cycle would be cancelled. Immature oocyte retrieval followed by IVM and IVF may provide an alternative to cancellation of these cycles. Initially, one live birth was reported from immature oocytes collected from a patient at substantial risk of developing OHSS (35). More recently, Lim et al. (36) reported 17 patients with a high risk of developing OHSS during the course of their IVF cycles. Instead of canceling the cycles, they undertook immature oocyte collection followed by IVM. hCG was administered 36 hours before oocyte collection when the leading follicle had reached a mean diameter of 12-14 mm and indeed 11.6% of the oocytes had already reached the metaphase II stage at collection. Eight out of 17 (47.1%) clinical pregnancies were achieved in this group of patients. Even though the safest method of preventing OHSS is to withhold hCG administration (34), no cases of OHSS were reported among these patients, who were at a high risk of developing the syndrome (36). To date, more than 30 healthy live births have been reported from this group of patients following oocyte retrieval and IVM treatment (personal communication). Therefore, patients who are at risk of developing OHSS during controlled ovarian hyperstimulation can resort to immature oocyte retrieval followed by IVM as an alternative to canceling the cycle.

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