Drug-free In Vitro Activation of Ovarian Follicles and Fresh Tissue Autotransplantation in Patients with Poor ovarian response and Premature Ovarian Insufficiency.

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 (AFC), anti-Müllerian hormone (AMH) levels, ovarian volume, Doppler indices, oocyte retrieval rates, and embryo cryopreservation.

Result(s): Following drug-free IVA, AFC increased in 71% of POR patients and 50% of POI patients, while AMH levels improved in 57% of POR patients and 7% of POI patients (p < 0.05). A significant increase in ovarian volume was noted in POR patients and in POI patients who exhibited follicle growth following IVA. Doppler indices revealed no significant changes in ovarian blood flow. Follicle development was achieved in all POR patients and 10 of 14 POI patients, facilitating successful oocyte retrieval in all POR patients and 7 of 14 POI cases. Fertilization rates were 72% and 59% for POR and POI patients, respectively. All POR patients and 5 of 14 POI patients had at least one embryo cryopreserved. Among the 11 patients who underwent frozen embryo transfer, two clinical pregnancies were achieved, resulting in one 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.