Maximizing IVF egg production for women with low ovarian reserve

This study compared in vitro maturation (IVM) to double ovarian stimulation (DuoStim) for women expected to have a poor outcome from in vitro fertilization (IVF). It found that both methods increased the number of eggs compared to standard IVF, and that DuoStim may be more effective.

The first step of the infertility treatment IVF is to use ovarian stimulation (OS) medications to develop and collect multiple oocytes (eggs). For women over 40 years old or those with a diminished ovarian reserve, fewer oocytes are typically collected.

In addition to mature oocytes, immature oocytes are also obtained during OS and collection. Rescue IVM uses a specialized growth medium to mature these additional oocytes in the laboratory. DuoStim is another method to maximize oocytes per cycle. Traditional IVF encourages multiple ovarian follicles to develop during the first part of the menstrual cycle, the follicular phase. DuoStim IVF uses two rounds of OS in one menstrual cycle: one during the follicular phase (before ovulation), and a second round during the luteal phase (after ovulation).

Both rescue IVM and DuoStim can increase the number of oocytes collected per cycle. It is not clear which method is more effective.

This study included 146 women undergoing IVF. All patients were either over age 40, or had a diminished ovarian reserve (DOR). 50 patients used rescue IVM, and 96 used DuoStim. Patients chose which treatment to use. All of the embryos were frozen.

The IVM patients had an average of 5.24 oocytes from standard OS, and an additional 1.86 oocytes which were matured through IVM. The DuoStim patients had an average of 2.15 oocytes collected through the follicular OS and an additional 3.19 oocytes collected through luteal OS. Significantly fewer of the oocytes collected through IVM led to top-quality embryos, compared to mature oocytes (34.78% vs. 53.33%).

Oocytes from the two collection cycles of DuoStim led to a similar number of top-quality embryos (61.54% – follicular; 58.72% – luteal). Patients using DuoStim had 10.68% of cycles canceled due to a lack of an embryo, while patients using rescue IVM had 11.76% of cycles canceled. Both of these cancelation rates were reduced from what they would have been with follicular mature oocytes alone (DuoStim group – 33.98%; IVM group – 23.53%).

11 frozen embryos derived from IVM oocytes were transferred to the uterus, as were 69 luteal DuoStim embryos. Significantly more of the luteal phase embryos survived thawing (100% vs. 85.71%). More patients became pregnant using luteal phase embryos than IVM embryos (20.29% vs. 9.09%). However, this may have been due to chance, since a small number of patients used IVM embryos.

This study found that both rescue IVM and DuoStim increase the number of embryos compared to conventional IVF for women with a poor expected outcome. DuoStim may improve outcomes more than rescue IVM.

Because the patients chose their treatment, the two groups may have different characteristics. Further studies are needed.