The Role of IVM in Oocyte

of Endometriosis Patients

Ita Fauzia Hanoum

Instalasi Kesehatan Reproduksi (IKR)
RSUP DR Sardjito Djogdjakarta
 Introduction
Endometriosis is ascosiated with marked subfertility
Various causes had been studied:
- altered folliculogenesis
- ovulatary disfunction
- reduced preovulatory steroidogenesis of granulosa cells
- sperm phagocytosis
- impaired fertilization
- embryo toxicity againts early embrionic development
- defective implantation
- alteration within the oocyte
Peritoneal Fluid of Endometriosis Patients and Sperm Motion

Rerata motilitas sperma secara signifikan turun saat diinkubasi

dengan cairan endometriosis. Endometriosis derajat 1 memberikan
dampak negatif paling besar (Dewanto, 2004). Derajat 1 mengandung
makrofag paling banyak ( Adiyono, 2003; Khan et al, 2004).
Peritoneal Fluid of Endometriosis Patients, Blastocyst Rate and Hatching
Blastocyst rate

Pada model mencit, blastocyst rate dan hatching

blastocyst rate lebih rendah saat diinkubasikan di
dalam cairan endometriosis (Oktavianus, 2009)
 Endometriosis is ascosiated with marked subfertility
Various causes had been studied:
- altered folliculogenesis IL1; IL6; IL8; IL10 >>> on serum, PF, FF
- ovulatary disfunction altered GC cycle altered folliclgns
- reduced preovulatory steroidogenesis of granulosa cells
- sperm phagocytosis
- impaired fertilization
- embryo toxicity againts early embrionic development
- defective implantation
- alteration within the oocyte

(Saito et al, 2002)

 Ekspresi p53 dan Bax
pada pasien OPK

Supresi protein p53

supresi family Bcl2 (Bax)
apoptosis <<
rekruitment terganggu

(Rahmi, 2013)
 A proposal of IVM procedure for endometriosis
patients undergoing ART program
Addition of CM-MSC (Laqif, 2015)
 Patients indications
Admitted for ART Program - RSUP DR Sardjito 2015

Data for PERFITRI 2015

 IVM (In Vitro Maturation)
for Endometriosis Patients
avoiding Granulosa Cells Apoptosis in the
Folliculogenesis
IVM
The first IVM from ovary (Cha et al 1991).
IVM could be a major advance in ART procedure
(reduce cost and simplify treatment).
The target is to avoid OHSS in the PCOS.
(Cha, 2000; Child, 2002; Lin, 2003, Ledu 2005)
Or to propose IVM for all patients
(Mikkelsen, 1999, 2000, 2001; Child 2001; Yoon, 2001;
Soderstrom Antilla 2005)
13
 Rescue of oocytes which have failed to mature in
stimulated cycles (Liu et al, 2003)
Unexplained primarily poor-quality embryos (Tan
et al, 2003)
Oocytes donation (Tan et al, 2004)
Oocytes preservation before sterilizating
treatment (Oktay et al, 2004)
Prior Cancer Therapy

14
 Conventional IVF COH versus IVM
Traditional IVF
Relatively many oocytes/embryos
High pregnancy rate / OPU
Down regulation
Daily hormone injections
hCG injection
Emotional stress
Long treatment time - 4-6 weeks
Potential side effects (e.g. OHSS)
IVM
Fewer mature oocytes and embryos
Lower pregnancy rate / OPU - BUT
No down regulation, no manipulation of
hormone balance
No hormone injections or
Minimal hormone injections (PCOS)
(No hCG injection)
Reduced psychological impact
Reduced treatment time 2 weeks
Reduced interference with daily life
No known side effects (e.g. OHSS)
15
 Development of an Ovarian Follicle
IVM

IVF

Modified from Ross et al. Histology A Text and Atlas, 3rd Ed. 16
Follicle Selection and Atresia

Natural
ovulation

IVM

Geneva Foundation for Medical Education and Research

17
Unstimulated
IVM cycle
Day -1
Day 0 Day 2 or day 3
Day 1

Estradiol

Cycle day 8-11 Progesterone -

Cycle day endometrial
US scanning (lead
3 Cycle day 7-10 priming
follicle 10-14 mm)
US scanning US scanning Blood sample
(Blood (Blood sample) Oocyte pick-up 18
sample)
Common Protocol for IVM in The Laboratory

19
Cell Culture Laboratory RSUP DR Sardjito Djogdjakarta
Retrieved OCC on OPU IVM

24h maturation Denuded MII for ICSI

Embryogenesis of endometriosis patient, conventional IVF
IVM program
24/ 31 1/6 2 3 4 5 6 7 8 9
10
HPM hCG hCG hCG

5000 5000 5000

OPU

9 OCC 4 M II 2 MII
(2 ICSI ICSI
degenerat
ed)
FSH LH
serum
IVM cycle of endometriosis patient (same patient)
2 embryos (above) AH ET
2 embryos (below freezed)
Video (Klik) :

E2 Post IVM

AH Alvita_Chosa

Maryama
 E2 Post IVM

AH Alvita_Chosa

Maryama
 E2 Post IVM

AH Alvita_Chosa

Maryama
 E2 Post IVM

AH Alvita_Chosa

Maryama

2015.05.10_Maryama29032015.avi
Current Criticism of IVM

Lower fertilization rate

Lower pregnancy & implantation rates
Higher pregnancy loss
Inadequate neonatal and postnatal data
Possible genetic and epigenetic changes
Thank you