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'''In vitro maturation''' ('''IVM''') is the technique of letting [[ovarian follicle]]s mature [[in vitro]].
'''In vitro maturation''' ('''IVM''') is the technique of letting [[ovarian follicle]]s mature [[in vitro]].
==== History of IVM: ====
In 1935 Pincus & Enzmann, did the first experiment on immature rabbit oocyte, showing in vitro spontaneous maturation and fertilization<ref name=":0">{{Cite journal|last=Pincus|first=Gregory|last2=Enzmann|first2=E. V.|date=1935-11-01|title=The Comparative Behavior of Mammalian Eggs in Vivo and in Vitro|url=http://jem.rupress.org/content/62/5/665|journal=Journal of Experimental Medicine|language=en|volume=62|issue=5|pages=665–675|doi=10.1084/jem.62.5.665|issn=0022-1007|pmid=19870440}}</ref>. They showed maturation occurs in isolation from normal follicular environment<ref name=":0" />. In 1965 Edwards then continued IVM studies in mouse, sheep, cow, pig, rhesus monkey and human<ref>{{Cite journal|last=Edwards|year=1965|title=Maturation in vitro of mouse, sheep, cow, pig, rhesus monkey and human ovarian oocytes.|journal=Nature|volume=208(5008)|pages=349-351}}</ref><ref name=":1">{{Cite journal|last=Edwards|first=R. G.|date=1965-11-06|title=Maturation in vitro of human ovarian oöcytes|url=https://www.ncbi.nlm.nih.gov/pubmed/4165802|journal=Lancet (London, England)|volume=2|issue=7419|pages=926–929|issn=0140-6736|pmid=4165802}}</ref>. By 1991, the first pregnancy was recorded using IVM followed by IVF<ref>{{Cite journal|last=Cha|first=K. Y.|last2=Koo|first2=J. J.|last3=Ko|first3=J. J.|last4=Choi|first4=D. H.|last5=Han|first5=S. Y.|last6=Yoon|first6=T. K.|date=1991-01-01|title=Pregnancy after in vitro fertilization of human follicular oocytes collected from nonstimulated cycles, their culture in vitro and their transfer in a donor oocyte program|url=https://www.ncbi.nlm.nih.gov/pubmed/1986950|journal=Fertility and Sterility|volume=55|issue=1|pages=109–113|issn=0015-0282|pmid=1986950}}</ref>, and in 1994 the first birth using IVM oocytes from [[Polycystic ovary syndrome|polycystic ovarian syndrome]] patients was recorded highlighting that PCOS patient’s oocytes are capable of maturation<ref>{{Cite journal|last=Trounson|first=Alan|last2=Wood|first2=Carl|last3=Kausche|first3=Annette|date=1994-08-01|title=In vitro maturation and the fertilization and developmental competence of oocytes recovered from untreated polycystic ovarian patients*|url=http://www.sciencedirect.com/science/article/pii/S0015028216568915|journal=Fertility and Sterility|volume=62|issue=2|pages=353–362|doi=10.1016/S0015-0282(16)56891-5}}</ref>.

==== Background ====
[[Oogenesis]] takes place during fetal life, in which primordial germ cells undergo [[mitosis]] until a few weeks prior to birth, forming [[Oogonium|oogonia]]. These then begin meiosis to form the oocyte within the primordial follicle<ref name=":2">{{Cite journal|last=Dunlop|first=Cheryl E.|last2=Anderson|first2=Richard A.|date=2014-08-01|title=The regulation and assessment of follicular growth|url=http://dx.doi.org/10.3109/00365513.2014.936674|journal=Scandinavian Journal of Clinical and Laboratory Investigation|volume=74|issue=sup244|pages=13–17|doi=10.3109/00365513.2014.936674|issn=0036-5513}}</ref>. This follicle consists of the oocyte surrounded by flattened pregranulosa cells. Babies are born with 1-2 million primordial follicles, and by puberty have around 300,000 <ref name=":2" />. Of these primordial follicles, only around 400 mature oocytes are released and could be potentially fertilised, with the rest undergoing atresia<ref name=":3">{{Cite journal|last=Chian|first=Ri-Cheng|last2=Lim|first2=Jin-Ho|last3=Tan|first3=Seang-Lin|date=2004-06-01|title=State of the art in in-vitro oocyte maturation|url=https://www.ncbi.nlm.nih.gov/pubmed/15129050|journal=Current Opinion in Obstetrics & Gynecology|volume=16|issue=3|pages=211–219|issn=1040-872X|pmid=15129050}}</ref>.

‘Maturation’ of an oocyte is the process by which an ‘oocyte attains the competence to be fertilised and undergo embryogenesis’ <ref name=":4">{{Cite journal|last=Hardy, Wright, Franks, Winston|year=2000|title=In vitro maturation of oocytes|journal=British medical bulletin|volume=56(3)|page=588-602}}</ref>.

[[Folliculogenesis]] is the mechanism by which the ovarian follicles mature. This can take many months in vivo and involves primordial follicle growth and differentiation<ref name=":4" />.[[File:Follicle_Maturation.png|link=|220x220px]]

Primordial follicles containing the primary oocyte, arrested at prophase of meiosis I<ref name=":4" />, develop into primary follicle containing cuboidal granulosa cells. A secondary follicle is formed with a few granulosa cell layers, as well as a theca layer. Finally before ovulation, a tertiary follicle is formed containing a follicular-fluid filled antrum<ref name=":2" />. Of these small antral follicles, 1 will become dominant and ovulate (in monoovulatory species). During ovulation, the primary oocyte will resume meiosis in response to signals, arresting in metaphase meiosis II, ready for fertilization<ref name=":1" />. The dominant follicle contains the mature oocyte. Follicular development is directly under gonadotropins control, LH and FSH. These use cAMP as an intracellular second messenger, with growth factors and cytokines also influencing their development in vivo<ref name=":3" />.

Through in vitro maturation, folliculogenesis and latter parts of oogenesis are being mimicked outside of the ovaries- trying to recreate the conditions for these processes.


==Techniques available==
==Techniques available==

Revision as of 10:36, 28 September 2016

In vitro maturation (IVM) is the technique of letting ovarian follicles mature in vitro.

History of IVM:

In 1935 Pincus & Enzmann, did the first experiment on immature rabbit oocyte, showing in vitro spontaneous maturation and fertilization[1]. They showed maturation occurs in isolation from normal follicular environment[1]. In 1965 Edwards then continued IVM studies in mouse, sheep, cow, pig, rhesus monkey and human[2][3]. By 1991, the first pregnancy was recorded using IVM followed by IVF[4], and in 1994 the first birth using IVM oocytes from polycystic ovarian syndrome patients was recorded highlighting that PCOS patient’s oocytes are capable of maturation[5].

Background

Oogenesis takes place during fetal life, in which primordial germ cells undergo mitosis until a few weeks prior to birth, forming oogonia. These then begin meiosis to form the oocyte within the primordial follicle[6]. This follicle consists of the oocyte surrounded by flattened pregranulosa cells. Babies are born with 1-2 million primordial follicles, and by puberty have around 300,000 [6]. Of these primordial follicles, only around 400 mature oocytes are released and could be potentially fertilised, with the rest undergoing atresia[7].

‘Maturation’ of an oocyte is the process by which an ‘oocyte attains the competence to be fertilised and undergo embryogenesis’ [8].

Folliculogenesis is the mechanism by which the ovarian follicles mature. This can take many months in vivo and involves primordial follicle growth and differentiation[8].File:Follicle Maturation.png

Primordial follicles containing the primary oocyte, arrested at prophase of meiosis I[8], develop into primary follicle containing cuboidal granulosa cells. A secondary follicle is formed with a few granulosa cell layers, as well as a theca layer. Finally before ovulation, a tertiary follicle is formed containing a follicular-fluid filled antrum[6]. Of these small antral follicles, 1 will become dominant and ovulate (in monoovulatory species). During ovulation, the primary oocyte will resume meiosis in response to signals, arresting in metaphase meiosis II, ready for fertilization[3]. The dominant follicle contains the mature oocyte. Follicular development is directly under gonadotropins control, LH and FSH. These use cAMP as an intracellular second messenger, with growth factors and cytokines also influencing their development in vivo[7].

Through in vitro maturation, folliculogenesis and latter parts of oogenesis are being mimicked outside of the ovaries- trying to recreate the conditions for these processes.

Techniques available

The ability of in IVM depends on how mature the follicle already is. There are several stages in folliculogenesis, starting with a primordial follicle, which then becomes a primary, secondary, early tertiary (antral), late tertiary and eventually a preovulatory follicle. If a follicle has reached the early tertiary or antral stage, IVM can be carried out. A few live births have already been made[9] by taking small early tertiary follicles, letting them mature in vitro and subsequently fertilizing them. However, for follicles that haven't reached the early tertiary stage, IVM is still under development. There are a lot of cellular changes in the oocyte and the rest of the cells in the follicle, which makes it very susceptible. Nevertheless, it is possible to let a primordial follicle mature to a secondary follicle outside the body by growing it in a slice of ovarian tissue.[9] The subsequent maturity from secondary to early tertiary stage can then be supported in test-tubes.[9] It has been suggested that photoirradiation of granulosa cells and oocytes may facilitate IVM.[10]

IVM can be expanded with hCG-priming, which is exposing the ovarian tissue to human chorionic gonadotropin (hCG). This results in an expanding or dispersed pattern of the cumulus oophorus around the egg cell, facilitating its identification within follicular fluid.[11] However, the evidence of a clinical effect of hCG priming is still lacking.[11] IVM can also be expanded with intracytoplasmic sperm injection (ICSI), which should be performed at least one hour (and optimally two to four hours) after the first polar body extrusion.[12]

Clinical applications of IVM

In vitro maturation is an assistive reproductive technique (ART) typically used in patients with fertility issues including polycystic ovary syndrome (PCOS), high antral follicle counts and ovarian hyper-responsiveness[1][3]. However, more recently IVM has also become widely utilised in areas such as fertility preservation in cancer patient who have undergone treatment involving gonadotoxic therapies[1].There have been over 1000 live births recorded from mothers using IVM[3].

Polycystic Ovary Syndrome

PCOS is a common disorder involving dysfunction of the endocrine system associated with female reproduction. PCOS involves discrepancies in the Hyphophyseal-pituitary-gonadal endocrine axis which can result in hormonal dysfunction, excess androgens (e.g. testosterone) and frequent anovulatory menstrual cycles[6]. Therefore, it is common for women suffering from PCOS to require assistance in order to conceive[6][7][13]In these patients IVM can be used to mature oocytes and aid conception[6][7].

Comparison to IVF

The use of in vitro maturation in assisted reproduction has advantages over standard ART procedures. In typical IVF practice, supraphysiological levels of gonadotropins are administered to the patient in order to hyperstimulate the antral follicles and hence induce oocyte maturation to metaphase ii at a rate that is above normal physiological capabilities[3]. This practice can be disadvantageous in several ways: It is very costly, can become complicated and may also predispose to several undesirable side effects, such as ovarian hyperstimulation syndrome (OHSS)[3][7].

In IVM, immature oocytes are removed from the antral follicle of a woman and then are matured in vitro in a culture rich in gonadotrophins[3]. This hence negates (or significantly reduces) the need for gonadotrophin stimulation[7].

IVM is not an entirely perfected technique. Pregnancy rates are lower in IVM than in standard IVF[3]. There is also research required into whether or not babies born to mothers who have undergone IVM have any health concerns (e.g. developmental issues) later in life[3].

Ovarian hyperstimulation syndrome (OHSS)

The hyperstimulation of the ovaries in practices like IVF can result in mild ovarian hyperstimulation syndrome (OHSS) in more than 20% of cases[3]. This same hyperstimulation can cause severe OHSS in up to 2% of cases[3]. OHSS can have serious consequences, including respiratory problems, renal impairment and even stroke[3].

Patients with PCOS and younger women are at an increased risk of OHSS[7]. In these women, it may be even more beneficial to employ IVM rather than conventional IVF treatment[3][7].

Oestrogen associated risk factors

Women with a personal or family history of an oestrogen associated thrombus, or of severe cardiovascular disease, may also benefit from IVM[3] (2). This is because conventional IVF, with its hyperstimulation of the ovaries, has the potential to stimulate mass synthesis of oestrogen via the stimulation of granulosa cell oestrogen production[3].

Empty Follicle Syndrome

IVM may also be an important consideration for female patients diagnosed with empty follicle syndrome (EFS)[7]. In EFS, no oocytes are retrieved from mature ovarian follicles despite the application of supraphysiological levels of gonadotrophins[7]. A woman can be diagnosed with EFS after she has undergone multiple rounds of IVF with total (or near total) failure in each round[7].

Rescue IVM

Rescue IVM is a variant of classical In vitro maturation that involves attempting to mature immature oocytes that have been removed from a patient secondary to ovarian hyperstimulation in standard IVF practice[3].  Therefore allowing for more oocytes to mature to the developmental stage where they can be developmentally viable. However, rescue IVM has been considered  a controversial field: If oocytes have not matured sufficiently in vivo – despite exposure to significant levels of gonadotrophins- it may be indicative of dysmaturity and of a limited potential developmentally[3].

Success rate and future uses

  • In an experiment by Segers I et al. (2015), the overall maturation rate after IVM of oocytes recovered from ovariectomy specimens in laboratory was 36%. The maturation rate correlated with the age of patient and duration of IVM. With the 8 couples with embryo cryopreservation, there was a 65% fertilisation rate. At least one good quality day 3 embryo was cryopreserved in 7/8 couples. This experiment shows that IVM of oocytes obtained ex vivo during the processing of ovarian cortex prior to cryopreservation is a promising solution for patients at risk for fertility loss[14].
  • The success of embryo production in vitro depends upon the use of an efficient oocyte retrieval technique and the best results have been obtained by laparoscopic aspiration[15].

Limitations

  • The obstetric and perinatal outcomes of births from IVM cycles are similar to those with ICSI treatments [1]. However, IVM involves the use of invasive techniques, this may harm the mother. Furthermore, embryological outcome of IVM is not established [1]. A more comprehensive appraisal of health status of IVM children will demand larger prospective studies [3]. The potential of cryopreserved IVM oocytes from cancer patients remain unknown. The optimal number of IVM oocytes frozen in candidates for fertility preservation (FP) is unknown. FP oocytes  of infertile PCOS women have decreased competence compared to oocytes recovered after ovarian stimulation. The FP strategy of cryopreservation of oocytes after IVM should only be considered should ovarian stimulation is unfeasible [16].
  • In norma-ovulatory women, the success rate of IVM is lower than conventional ovarian stimulation regimens with poorer implantation and pregnancy rates. IVM is suboptimal and influenced by several factors. However, IVM is a milder approach to assisted reproduction treatment and an alternative procedure for specific conditions.Accurate patient selection can improve IVM clinical outcome [3].

Improvements

  • IVM of oocytes cryopreserved may assist urgent fertility preservation in cancer patients. However, there is insufficient data regarding this outcome. Improving the culture conditions may increase the maturation rates and the potential of IVM oocytes [17]. 
  • Besides that, in mouse oocytes, I-Carnitine (LC) supplementation during vitrification of germinal vesicle (GV) and their subsequent IVM improved nuclear maturation as well as meiotic spindle assembly and mitochondrial distribution in MII oocytes. However, no data to date has proven this benefit in fetal development and birth of healthy offspring after embryo transfer to surrogate females. However, this protocol could potentially improve the quality of vitrified human oocytes and embryos during IVM [18]. In a research by Wang X et al. (2014), Gonadotropins have an impact on oocyte maturation, fertilisation and developmental competence in vitro. The responsiveness of bovine oocytes to gonadotropins in vitro depends on the relative concentrations (FSH/LH) for optimal oocyte development  developmental competence. Optimal FSH/LH concentrations could improve therapeutic clinical stimulation protocols and IVF success rates [19].

References

  1. ^ a b c d e f Pincus, Gregory; Enzmann, E. V. (1935-11-01). "The Comparative Behavior of Mammalian Eggs in Vivo and in Vitro". Journal of Experimental Medicine. 62 (5): 665–675. doi:10.1084/jem.62.5.665. ISSN 0022-1007. PMID 19870440. Cite error: The named reference ":0" was defined multiple times with different content (see the help page).
  2. ^ Edwards (1965). "Maturation in vitro of mouse, sheep, cow, pig, rhesus monkey and human ovarian oocytes". Nature. 208(5008): 349–351.
  3. ^ a b c d e f g h i j k l m n o p q r s Edwards, R. G. (1965-11-06). "Maturation in vitro of human ovarian oöcytes". Lancet (London, England). 2 (7419): 926–929. ISSN 0140-6736. PMID 4165802. Cite error: The named reference ":1" was defined multiple times with different content (see the help page).
  4. ^ Cha, K. Y.; Koo, J. J.; Ko, J. J.; Choi, D. H.; Han, S. Y.; Yoon, T. K. (1991-01-01). "Pregnancy after in vitro fertilization of human follicular oocytes collected from nonstimulated cycles, their culture in vitro and their transfer in a donor oocyte program". Fertility and Sterility. 55 (1): 109–113. ISSN 0015-0282. PMID 1986950.
  5. ^ Trounson, Alan; Wood, Carl; Kausche, Annette (1994-08-01). "In vitro maturation and the fertilization and developmental competence of oocytes recovered from untreated polycystic ovarian patients*". Fertility and Sterility. 62 (2): 353–362. doi:10.1016/S0015-0282(16)56891-5.
  6. ^ a b c d e f Dunlop, Cheryl E.; Anderson, Richard A. (2014-08-01). "The regulation and assessment of follicular growth". Scandinavian Journal of Clinical and Laboratory Investigation. 74 (sup244): 13–17. doi:10.3109/00365513.2014.936674. ISSN 0036-5513. Cite error: The named reference ":2" was defined multiple times with different content (see the help page).
  7. ^ a b c d e f g h i j k Chian, Ri-Cheng; Lim, Jin-Ho; Tan, Seang-Lin (2004-06-01). "State of the art in in-vitro oocyte maturation". Current Opinion in Obstetrics & Gynecology. 16 (3): 211–219. ISSN 1040-872X. PMID 15129050. Cite error: The named reference ":3" was defined multiple times with different content (see the help page).
  8. ^ a b c Hardy, Wright, Franks, Winston (2000). "In vitro maturation of oocytes". British medical bulletin. 56(3): 588-602.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ^ a b c NCBI:In vitro maturation of oocytes. Hardy K, Wright CS, Franks S, Winston RM
  10. ^ Kannan, S., Mehta, A., Simha, V., Reddy, O., Kaur, B., Onteru, S., Singh, D. (2014). Photoinduction of granulosa cell and oocyte co-culture to influence in vitro maturation and fertilisation. Hypothesis, 12(1): e7.
  11. ^ a b Son, W. -Y.; Tan, S. L. (2010). "Laboratory and embryological aspects of hCG-primed in vitro maturation cycles for patients with polycystic ovaries". Human Reproduction Update. 16 (6): 675–689. doi:10.1093/humupd/dmq014. PMID 20504873.
  12. ^ Hyun, Chang-Seop; Cha, Jung-Ho; Son, Weon-Young; Yoon, San-Hyun; Kim, Kyung-Ae; Lim, Jin-Ho (2007-07-07). "Optimal ICSI timing after the first polar body extrusion in in vitro matured human oocytes". Human Reproduction. 22 (7): 1991–1995. doi:10.1093/humrep/dem124. PMID 17513319. Retrieved 2012-07-14.
  13. ^ Dunaif, A. (1997-12-01). "Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis". Endocrine Reviews. 18 (6): 774–800. doi:10.1210/edrv.18.6.0318. ISSN 0163-769X. PMID 9408743.
  14. ^ Segers, Ingrid; Mateizel, Ileana; Van Moer, Ellen; Smitz, Johan; Tournaye, Herman; Verheyen, Greta; De Vos, Michel (2015-08-01). "In vitro maturation (IVM) of oocytes recovered from ovariectomy specimens in the laboratory: a promising "ex vivo" method of oocyte cryopreservation resulting in the first report of an ongoing pregnancy in Europe". Journal of Assisted Reproduction and Genetics. 32 (8): 1221–1231. doi:10.1007/s10815-015-0528-9. ISSN 1058-0468. PMC 4554385. PMID 26253691.
  15. ^ Padilha, Lc; Teixeira, Ppm; Pires-Buttler, Ea; Apparício, M; Motheo, Tf; Savi, Pap; Nakaghi, Eyo; Alves, Ae; Vicente, Wrr (2014-04-01). "In vitro Maturation of Oocytes from Santa Ines Ewes Subjected to Consecutive Sessions of Follicular Aspiration by Laparoscopy". Reproduction in Domestic Animals. 49 (2): 243–248. doi:10.1111/rda.12261. ISSN 1439-0531.
  16. ^ Sonigo, C.; Simon, C.; Boubaya, M.; Benoit, A.; Sifer, C.; Sermondade, N.; Grynberg, M. (2016-07-01). "What threshold values of antral follicle count and serum AMH levels should be considered for oocyte cryopreservation after in vitro maturation?". Human Reproduction (Oxford, England). 31 (7): 1493–1500. doi:10.1093/humrep/dew102. ISSN 1460-2350. PMID 27165625.
  17. ^ Grynberg, M.; Poulain, M.; le Parco, S.; Sifer, C.; Fanchin, R.; Frydman, N. (2016-03-01). "Similar in vitro maturation rates of oocytes retrieved during the follicular or luteal phase offer flexible options for urgent fertility preservation in breast cancer patients". Human Reproduction (Oxford, England). 31 (3): 623–629. doi:10.1093/humrep/dev325. ISSN 1460-2350. PMID 26759139.
  18. ^ Moawad, Adel R.; Xu, Baozeng; Tan, Seang Lin; Taketo, Teruko (2014-10-10). "l-carnitine supplementation during vitrification of mouse germinal vesicle stage-oocytes and their subsequent in vitro maturation improves meiotic spindle configuration and mitochondrial distribution in metaphase II oocytes". Human Reproduction (Oxford, England). 29 (10): 2256–2268. doi:10.1093/humrep/deu201. ISSN 1460-2350. PMID 25113843.
  19. ^ Wang, Xuemei; Tsai, Tony; Qiao, Jie; Zhang, Zhan; Feng, Huai L. (2014-06-01). "Impact of gonadotropins on oocyte maturation, fertilisation and developmental competence in vitro". Reproduction, Fertility, and Development. 26 (5): 752–757. doi:10.1071/RD13024. ISSN 1031-3613. PMID 23726536.
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