In Vitro Maturation for Infertility in Polyendocrine Metabolic Ovarian Syndrome: A Systematic Review of Treatment Protocols and Outcomes
A systematic review of in vitro maturation (IVM) protocols and outcomes in women with polyendocrine metabolic ovarian syndrome (PMOS) has been conducted. The review aimed to identify determinants of success and standardize IVM protocols for PMOS.
Women with polyendocrine metabolic ovarian syndrome (PMOS) are at risk of ovarian hyperstimulation syndrome (OHSS) when undergoing in vitro fertilization (IVF) treatments. In vitro maturation (IVM) is an alternative approach that involves the retrieval of immature oocytes from unstimulated or minimally primed antral follicles, with maturation completed in culture.
IVM protocols differ in priming strategies and culture systems. The priming strategies include human chorionic gonadotropin (hCG), follicle-stimulating hormone (FSH), or no priming. The culture systems include standard and biphasic capacitation (CAPA-IVM). The systematic review of published data on IVM protocols in women with PMOS identified that all IVM protocols essentially eliminated OHSS.
The maturation rates varied by priming strategy and culture system. The standard IVM protocol resulted in a maturation rate of approximately 50%, while the hCG-primed or biphasic protocols achieved maturation rates of 60-70%. The live birth rate after a single retrieval ranged from 20-48%.
The CAPA-IVM protocol was associated with the highest maturation and embryo yield. A randomized trial reported that a fully hormone-free CAPA-IVM protocol is feasible. Obstetric, neonatal, epigenetic, and child-neurodevelopmental outcomes reported up to age 5-7 years are reassuring.
However, clinical and methodological heterogeneity precluded statistical pooling of data, and the evidence remains dominated by single-center cohorts, with few randomized trials. This article summarizes protocol-specific outcomes, identifies determinants of success, and defines priorities for standardizing IVM and generating higher-quality evidence for the use of IVM in PMOS.
### IVM Protocols and Outcomes
| Protocol | Maturation Rate | Live Birth Rate | | --- | --- | --- | | Standard IVM | 50% | 20-48% | | hCG-primed IVM | 60-70% | 20-48% | | Biphasic IVM | 60-70% | 20-48% | | CAPA-IVM | 60-70% | 20-48% |
### Determinants of Success and Standardization of IVM
The systematic review identified determinants of success and priorities for standardizing IVM protocols for PMOS. The review aimed to provide a comprehensive overview of IVM protocols and outcomes in women with PMOS, and to identify areas for future research and standardization.
### Future Directions
The review highlights the need for higher-quality evidence and standardization of IVM protocols for PMOS. Future studies should aim to address the clinical and methodological heterogeneity in IVM protocols and outcomes, and to provide more robust evidence for the use of IVM in PMOS.
