ABSTRACT
To date, assisted reproductive technology (ART) has helped thousands and thousands of women to overcome infertility problems. Although initial attempts at human oocytes with in-vitro maturation (IVM) and in-vitro fertilization (IVF) were undertaken as far back as the 1940s1,2, it was not until the 1960s that landmark work was done on IVM of immature human oocytes3-5. Laparoscopy was introduced in the late 1960s to collect human oocytes from the Graafian follicle, resulting in the first live birth from human IVF produced from an in-vivo matured oocyte6. This natural cycle IVF treatment was gradually replaced by ovarian stimulation IVF because it was believed that the number of oocytes retrieved relate to the embryos available for transfer which, in turn, directly affected the achievement of a successful pregnancy. At the beginning, relatively inexpensive medications, such as clomiphene citrate, were used to stimulate ovaries to produce multiple follicles. However, current ovarian stimulation protocols use the much more expensive gonadotropinreleasing hormone (GnRH) agonists or antagonists in combination with gonadotropins to generate multiple follicles in the ovaries. Some women are extremely sensitive to stimulation
with exogenous gonadotropins and are at an increased risk of developing ovarian hyperstimulation syndrome (OHSS), which is a life-threatening condition7. In addition, there is concern that the long-term side-effects of repeated ovarian stimulation may increase the risk of ovarian, endometrial, and breast cancers8,9.
