Drug-free in vitro activation of ovarian follicles and fresh tissue autotransplantation in patients with poor ovarian response and premature ovarian insufficiency.

F&S science Pub Date : 2025-04-30 DOI:10.1016/j.xfss.2025.04.002

Leonti Grin, Roza Berkovitz-Shperling, Gal Goldstein, Yulia Michailov, Ofer Gemer, Eyal Anteby, Kazuhiro Kawamura, Bozhena Saar-Ryss, Shevach Friedler

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Abstract

Objective: To determine whether drug-free in vitro activation (IVA) with immediate autotransplantation improves reproductive outcomes and ovarian blood flow in patients with poor ovarian response (POR) and premature ovarian insufficiency (POI).

Design: A clinical trial.

Setting: A tertiary university-affiliated hospital.

Patient(s): Twenty-one women diagnosed with POR (n = 7) and POI (n = 14).

Intervention(s): Drug-free IVA through mechanical ovarian tissue disruption and immediate autotransplantation.

Main outcome measure(s): Changes in antral follicle count, antimüllerian hormone levels, ovarian volume, Doppler indices, oocyte retrieval rates, and embryo cryopreservation.

Result(s): After drug-free IVA, the antral follicle count increased in 71% of patients with POR and 50% of patients with POI, whereas the antimüllerian hormone levels improved in 57% of patients with POR and 7% of patients with POI. A significant increase in ovarian volume was noted in patients with POR and in patients with POI who exhibited follicle growth after IVA. Doppler indices revealed no significant changes in ovarian blood flow. Follicle development was achieved in all patients with POR and 10 of 14 patients with POI, facilitating successful oocyte retrieval in all patients with POR and 7 of 14 patients with POI. The fertilization rates were 72% and 59% for patients with POR and POI, respectively. All patients with POR and 5 of 14 patients with POI had at least 1 embryo cryopreserved. Among the 11 patients who underwent frozen embryo transfer, 2 clinical pregnancies were achieved, resulting in 1 live birth.

Conclusion(s): Drug-free IVA demonstrates potential in improving follicular activity, oocyte retrieval, and embryo cryopreservation. However, clinical application remains challenging due to modest success rates, necessitating further protocol refinements and long-term outcome evaluations.

Trial registration: ClinicalTrials.gov (Identifier: NCT04024722).

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卵巢反应差和卵巢功能不全患者的无药体外激活卵泡和新鲜组织自体移植。

目的：探讨无药物体外激活（IVA）和即刻自体移植是否能改善卵巢反应不良（POR）和卵巢功能不全（POI）患者的生殖结局和卵巢血流量。设计：临床试验环境：一所第三大学附属医院。患者：21名诊断为POR （n=7）和POI （n=14）的女性。干预措施：通过机械卵巢组织破坏和立即自体移植进行无药物体外受精。主要观察指标：卵巢体积、多普勒指数、卵母细胞回收率、胚胎冷冻保存的变化。结果：无药物体外受精后，71%的POR患者和50%的POI患者的AFC升高，57%的POR患者和7%的POI患者的AMH升高（p < 0.05）。在IVA后表现出卵泡生长的POR患者和POI患者中，卵巢体积显著增加。多普勒指数显示卵巢血流无明显变化。所有POR患者和14例POI患者中有10例实现了卵泡发育，所有POR患者和14例POI患者中有7例成功获得卵母细胞。POR和POI患者受精率分别为72%和59%。所有POR患者和14例POI患者中的5例至少有一个胚胎冷冻保存。在接受冷冻胚胎移植的11例患者中，实现了2例临床妊娠，1例活产。结论：(5)：无药物IVA具有改善卵泡活性、卵母细胞回收和胚胎冷冻保存的潜力。然而，由于成功率不高，临床应用仍然具有挑战性，需要进一步改进方案和长期结果评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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