Published date: Jul 27 2021

Journal Title: International Journal of Reproductive BioMedicine

Issue title: International Journal of Reproductive BioMedicine (IJRM): Volume 19, Issue No. 6

Pages: 569–574

DOI: 10.18502/ijrm.v19i6.9378

Maryam EftekharResearch and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Banafsheh Mohammadibanafsheh.mo1360@gmail.comResearch and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Nasim TabibnejadResearch and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Mohammad Hossein RaziResearch and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Background: Some women represent the inability to respond to endogenous and exogenous gonadotropins during in vitro fertilization/intracytoplasmic sperm injection cycles leading to the follicular developmental arrest. The women with resistant ovaries could benefit from in vitro maturation.

Case: This case-series presents pregnancies resulting from initially scheduled conventional in vitro fertilization which led to arrested cycles because of resistant ovary syndrome. The protocol was changed to early oocyte triggering for 15 women due to the small follicles ≤ 12 mm in diameter on day 15 after stimulation with high doses of exogenous gonadotrophins instead of cycle cancellation. Germinal vesicle and metaphase I oocytes that were retrieved from follicles were matured in vitro and inseminated by intracytoplasmic sperm injection. Twenty formed embryos were transferred on day 3 after oocyte retrieval. This resulted in a 30.76% chemical pregnancy out of which no abortion occurred. Therefore, we reported a 30.76% singleton ongoing pregnancy.

Conclusion: It seems that early oocyte triggering followed by in vitro maturation may be considered as a good modality in women experiencing follicular resistance to gonadotropins. These cycles can be rescued from cancellation with satisfactory clinical outcomes.

Key words: Arrested stimulation cycle, Early oocyte triggering, In vitro maturation, Clinical outcome.

[1] Arici A, Matalliotakis IM, Koumantakis GE, Goumenou AG, Neonaki MA, Koumantakis EE. Diagnostic role of inhibin B in resistant ovary syndrome associated with secondary amenorrhea. Fertil Steril 2002; 78: 1324– 1326.

[2] Grynberg M, Peltoketo H, Christin-Maitre S, Poulain M, Bouchard P, Fanchin R. First birth achieved after in vitro maturation of oocytes from a woman endowed with multiple antral follicles unresponsive to folliclestimulating hormone. J Clin Endocrinol Metab 2013; 98: 4493–4498.

[3] Katz S, Marshall J, Khorram O. An unusual case of ovarian resistance syndrome. Obstet Gynecol 2003; 101: 1078–1082.

[4] Liu J, Lu G, Qian Y, Mao Y, Ding W. Pregnancies and births achieved from in vitro matured oocytes retrieved from poor responders undergoing stimulation in in vitro fertilization cycles. Fertil Steril 2003; 80: 447–449.

[5] Yalcinkaya E, Caliskan E, Budak O. In vitro maturation may prevent the cancellation of in vitro fertilization cycles in poor responder patients: A case report. J Turk Ger Gynecol Assoc 2013; 14: 235–237.

[6] Practice Committees of the American Society for Reproductive M, the Society for Assisted Reproductive Technology. In vitro maturation: A committee opinion. Fertil Steril 2013; 99: 663–666.

[7] Son WY, Tan SL. Laboratory and embryological aspects of hCG-primed in vitro maturation cycles for patients with polycystic ovaries. Hum Reprod Update 2010; 16: 675–689.

[8] Hatırnaz Ş, Akarsu S, Işık AZ, Dahan MH. The use of in vitro maturation in stimulated antagonist in vitro fertilization cycles of normo-hyperresponder women due to arrested follicular development: A rescue procedure. Turk J Obstet Gynecol 2018; 15: 141– 146.

[9] Li Y, Pan P, Yuan P, Qiu Q, Yang D. Successful live birth in a woman with resistant ovary syndrome following in vitro maturation of oocytes. J Ovarian Res 2016; 9: 54. 1–6.

[10] Galvao A, Segers I, Smitz J, Tournaye H, De Vos M. In vitro maturation (IVM) of oocytes in patients with resistant ovary syndrome and in patients with repeated deficient oocyte maturation. J Assist Reprod Genet 2018; 35: 2161–2171.

[11] Dahan MH, Zhang L, Chen HY, Tan SL. Early short stimulation modified natural cycle IVF With GnRH agonist trigger and in vitro maturation in a woman with polycystic ovary syndrome: A case report. J Obstet Gynaecol Can 2016; 38: 465–469.