Ivm Treatment Outcome

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Pregnancy rates with IVM are correlated with the number of immature oocytes retrieved. In women younger than 35 years from whom we retrieved more than 10 immature GV oocytes, we have achieved a clinical pregnancy rate of 38% per cycle. With an oocyte retrieval rate of more than 50% from the follicles present, women with 20 or more follicles at the baseline scan for IVM would be the best candidates for IVM. Our implantation rates are approximately 12%. As with IVF, clinical pregnancy and implantation rates decrease with increasing age. In women younger than 35 years, we have

Figure 1 Immature human oocyte retrieved from a follicle at 4 mm in diameter. The oocyte with several layers of compacting cumulus cells. Source: From R.C. Chian, with permission.

achieved a clinical pregnancy rate of 38% per oocyte retrieval and an implantation rate of 13%. In women between 36 and 40 years old, the clinical pregnancy rate is 21% per retrieval and the implantation rate 5% (Table 2). Based on more than 1000 IVM cycles in four centers performing IVM cycles with hCG priming before oocyte collection, the pregnancy rates reached 30-35% and the implantation rates 10-15% (63). Some authors have expressed concerns regarding the safety of IVM, especially in relation to imprinting gene disorders (64-66). In various published series, no increased

Table 2 Results of Fresh In Vitro Maturation Cycles Excluding Oocyte Donation Cycles

Age

<35

35-40

Oocyte collections

46

19

Embryo transfers

45

17

Number of oocytes collected (mean)

15.0

13.2

Number of embryos transferred (mean)

3.7

4.5

Pregnancy rate per collection (%)

41.3

21.1

Pregnancy rate per embryo transfer (%)

42.2

23.5

Implantation rate (%)

14.4

5.2

Live birth rate per collection (%)

21.7

15.8

Live birth rate per embryo transfer (%)

22.2

17.6

Number of babies born

12

3

Singletons

6

3

Twins

3

0

Source: McGill Reproductive Center.

Source: McGill Reproductive Center.

rates of congenital malformations have been reported with IVM (67,68). A recent analysis of the obstetrical, neonatal, and infant outcome in our IVM conceptions showed pregnancy rates of 73% singleton, 24% twin, and 2.7% triplet. The median gestation age was 39 weeks for singletons and 37 weeks for multiple pregnancies. There were only two malformations, including a ventriculo septal defect and a congenital dislocation of the hips (69). There was no increased relative risk of malformations when IVM pregnancies were compared with IVF and spontaneous pregnancies (70). Similar reassuring results have been published by others (71).

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Pregnancy And Childbirth

Pregnancy And Childbirth

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