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  • Title: Clinical procedures for in vitro maturation treatment.
    Author: Vos M, Segers I, Yuan Y, Gilchrist RB, Kramme CC.
    Journal: Fertil Steril; 2024 Oct; 122(4):753-755. PubMed ID: 38838807.
    Abstract:
    OBJECTIVE: To demonstrate clinical techniques for in vitro maturation (IVM) treatment, including stimulation recommendations, small follicle pick-up procedures, and compact cumulus-oocyte complex (COC) search practice. DESIGN: This video utilizes live-action footage from surgery and embryology practice for a representative IVM treatment cycle, with step-by-step instructions and recommendations for practice procedures. SETTING: In vitro fertilization (IVF) clinic. PATIENT(S): Patients undergoing IVM treatment. The patient(s) included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites, and other applicable sites. INTERVENTION(S): Identification of treatment cohorts, IVM definitions, and recommendations for stimulation treatments. A visual demonstration of COC extraction techniques from small antral follicles includes tubing, needle types, considerations when using double lumen or sheath needles, needle pressure, ultrasound, needle flushing, and aspiration technique. Visual demonstration of oocyte search and IVM preparation, including filtering follicular aspirate, prevention of COC cooling, identification of compact COCs, and general parameters of different IVM approaches. MAIN OUTCOME MEASURE(S): Clinical techniques for small follicle ovum pick up and compact COC identification for IVM treatment. RESULTS: Successful IVM treatment of patients can be achieved using minimal ovarian stimulation, effective small follicle retrieval, and efficient compact COC identification with flexibility in approach depending on clinical constraints and preference. CONCLUSION(S): In vitro maturation treatment is an efficacious and safe treatment for high ovarian reserve and hyper-responding patients undergoing IVF treatment, in which the retrieval of multiple immature COCs and their ex vivo maturation can be achieved with little to no in vivo stimulation. Practice procedures vary between treatment centers and IVM techniques. This video provides practice recommendations paired with a visual demonstration of techniques to assist in standardizing the approach and expanding the practice to more centers.
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