Priming in vitro maturation cycles with gonadotropins: Salvage treatment for nonresponding patients

Objective: To compare the treatment outcomes in in vitro maturation (IVM) cycles primed with human menopausal gonadotropin with those for pure IVM cycles in patients with polycystic ovary syndrome. Design: Prospective observational. Setting: University-based tertiary medical center. Patient(s): Patients undergoing IVM cycles (primed IVM, 47; pure IVM, 118). Intervention(s): IVM treatment with and without human menopausal gonadotropin stimulation. Main Outcome Measure(s): Pregnancy rates. Result(s): The clinical pregnancy rate demonstrated a tendency toward improvement in the primed IVM group (53.1% versus 43.2%, respectively) with better implantation and delivery rates (20.1% versus 14.4%; 95% confidence intervals 1.0-3.06 and 40.4% versus 24.6%; 95% confidence intervals 0.1-0.8, respectively). We found no significant difference in pure IVM compared with primed IVM in the number of eggs collected, size of leading follicle, fertility rate, cleavage rate, and the number of embryos transferred. Total mature eggs and maturation rate were significantly higher in the group of pure IVM (11 ± 2.1 versus 8.7 ± 0.5 and 68.5% ± 17.5% versus 60.9% ± 0.4%, respectively). Importantly, the endometrial thickness was significantly improved in primed IVM cycles (7.9 ± 1.9 mm versus 7.1 ± 0.8 mm), possibly leading to better implantation and pregnancy rates. Conclusion(s): Patients who fail to demonstrate endometrial or follicular growth during IVM cycles may benefit from gonadotropin priming during the same cycle.