ABSTRACT
IVM was originally applied in patients with PCOS without gonadotropin stimulation to avoid OHSS caused by controlled ovarian hyperstimulation (COH) (5,6). IVM is indicated not only for patients with PCOS, but also for women with polycystic ovary (PCO) who are at a higher risk of OHSS by standard COH compared with the regular cycling women. IVM should also be considered in patients who are anxious about the long-term side effects of gonadotropin, since some patients worry about not only the stimulating effect of gonadotropins but also about the prospective events after aging (7,8). Regular cycling women are also successfully treated with IVM with or without gonadotropin administration, but its
indication for regular cycling women remains controversial due to the lower number of oocytes available (9-18). The clinical benefi ts of administering follicle-stimulating hormone (FSH) to regular cycling women are yet to be determined (19,20). Poor embryo quality or repeated failures by conventional IVF is another proposed indication for IVM. Women with the so-called egg factor in which no mature eggs are found in repeated cycles (germinal vesicles only), recurrent fertilization failure, or very poor-quality embryos are also IVM targets (21). Patients who repeatedly failed IVF without distinct causes should also be considered for IVM (22,23). We achieved 88 clinical pregnancies by IVM from 1999 to 2008. Twenty-one pregnancies (24%) resulted from repeated IVF failures. Eight of these 21 pregnancies (38%) were treated by IVM due to poor-quality embryos generated by IVF. Figure 11.1 shows the number of failed IVF cycles and IVM cycles to achieve pregnancy in 18 ongoing cases. They failed 4.9 times with IVF and needed IVM 2.3 times to achieve pregnancy. In conclusion, the primary indication for IVM is PCOS or PCO with high risk of OHSS. Other indications are patients demand not to undergo gonadotropin administration and repeated IVF failures due to impaired oocyte or embryo qualities. IVM is an alternative to the conventional assisted reproductive technique (ART).
