Hakan Özörnek EUROFERTIL IVF Center Turkey

 No or minimal stimulation  Low cost  Less monitoring  Less side effects (OHSS)  Acceptable pregnancy rate  High patient compliance

 Natural cycle  Mild stimulation  IVM

 Lower pregnancy rate than classic IVF  OPU more difficult  Lab more busy  Less embryo quality  No long term follow up data on IVM children

 No short or long term side effects of gonadotropins  Prevention of OHSS  No extensive monitoring  No expensive stimulation  Simpler therapy, less stress  No need for waiting between cycles

 Starting the IVM program in January 2008  Age ≤ 38  FSH ≤ 12 mIU/ml  AFC ≥ 7

 PCO/PCOS  Male infertility  Unexplained infertility

 HCG priming initiates oocyte maturation in vivo and produces a favourable outcome in IVM.  Priming with FSH for 3 days in PCOS patients may improve the maturational potential of the oocytes.  No beneficial effect of FSH priming has been observed in regular cycling women.

 HCG Priming DAYS Ultrasound OPUHCG

 FSH/HCG Priming DAYS USUS OPU rFSH 75 HCG

DAYS Ultrasound TRANSFER +2 βhCG test +14 Progesterone 600 mg/die Oestradiol 6 mg/die - Endometrium ≥6 mm - Leading follicle mm ICSI 0 OPU

 24 patients 1 patient no oocyte retrieved  Mean age 30.0 years  Mean FSH 6.04 mIU/ml  Mean AFC 9.6  11 PCO/PCOS  13 normocycle women

 General anestasia  19 G needle  80 mmHg aspiration pressure  Medium with heparin for pick up  Multipuncture technique

 Mean Nr of oocytes 7.6 [2-14]  Mean Nr of injected oocytes 5.52  Maturation rate 72.6 %  Mean Nr of fertilised oocytes 4.16  Fertilisation rate 75.4%

 ET day 2 after ICSI  Nr of transfered embryos 2.2 [1-4]  Clinical pregnancy rate 17.4% (4/23)

 Optimization of culture systems and clinical management of IVM cycles will enhance pregnancy outcome, so that IVM might replace conventional IVF in selected patients.  More studies are needed for improving the success of IVM.