OP-IVM: Combining In vitro Maturation after Oocyte Retrieval with Gynecological Surgery
May 9th, 2021
In vitro maturation (IVM) before gynecological operation (OP-IVM) combines IVM following oocyte retrieval with routine gynecological surgery and serves as an extension of conventional IVM applications for fertility preservation.
The technology, OP-IVM, is an extension of conventional IVM protocol that combines IVM following oocyte retrieval with routine gynecological surgery. It is suitable for infertile or subfertile women who need to receive gynecological surgery before ART treatment or fertility preservation, polycystic ovary syndrome patients with clomiphene resistance who need a laparoscopic ovarian drilling surgery, infertile patients who are in need of benign gynecologic surgeries such as hysteroscopic myomectomy, polypectomy, transthoracic resection of septum, and the laparoscopic tube surgery, and the oophorocystectomy before ART treatment, and also patients with cancer and hematologic disease who are receiving chemoradiotherapy or radiotherapy, they can do this surgery for fertility preservation. Place the ultrasound probe inside the vagina to scan and record the number of follicles in both ovaries.
Find the location closest to the ovary as the puncture site, avoiding the intestine, bladder, and large blood vessels. Wash the 19 gauge single lumen aspiration needle with a pH stable handling medium, then inject the needle into the ovaries under the guidance of ultrasound. Aspirate follicular fluid with the needle under a pressure of 80 to 90 millimeters of mercury, rotating the needle slightly to aspirate as much follicular fluid as possible.
Use heparin to reduce follicular fluid viscosity during the aspiration. Adjust the probe's position to keep it as close as possible to the ovaries at all times and press the vaginal fornix with the proper force to reduce injury and bleeding. Make sure to complete follicular fluid aspiration within 25 to 30 minutes.
Pull out the needle after finishing in one ovary, wash the needle with the handling medium, and puncture the other side using the same method. Working in a 37 degrees Celsius homothermal flat, prepare the handling media, Petri dish, and cell strainer. Rinse the culture tube and strainer with pre-warmed pH stable handling media.
Filter the aspirated follicle fluid with a 70 micrometer nylon cell strainer, repeatedly rinsing the culture tube and strainer with pre-warmed pH stable handling medium. Ensure that all immature COCs are completely transferred to the culture dish. Transfer the blood into clean handling media.
Then, transfer the cell strainer to a new dish and wash it. Aspirate and transfer the handling media with the COCs, granulosa cells and tissues to a new dish. Examine the COCs under the stereoscope with 40 times magnification.
Quickly transfer the immatures into a pre-warmed IVM oocyte medium. Next, examine the COCs in the blood clot and in the cell strainer. Transfer the COCs and handling media into pre-warmed IVM oocyte medium.
Culture the immature COCs for 28 to 32 hours at 37 degrees Celsius in humidified air containing 5%carbon dioxide and 5%oxygen. By December 2019, OP-IVM had been used for fertility preservation of 274 patients. One example was a 28 year old patient who was diagnosed with primary infertility, left adnexal cyst, and PCOS.
She received laparoscopic cystectomy and OP-IVM in September 2016 and 27 immature COCs were obtained. After 28 hours in culture, seven oocytes in the MII stage were selected and fertilized by ICSI. After five days, two blastocysts were frozen.
One was thawed in February 2017 and transferred into the uterus. The patient delivered a healthy girl in November. OP-IVM was first applied to the oocyte retrieval of infertile women with PCOS who are undergoing ovarian drilling operation, and now its applications can be expanded to the subfertile women who need to receive benign gynecological operation, even cancer women for fertility preservation.
It indicates that the application range of IVM can be expanded by combining it with other traditional gynecological operations for female fertility preservation.
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Overview
OP-IVM is an innovative approach that combines in vitro maturation (IVM) of oocytes with routine gynecological surgery. This method is particularly beneficial for women facing infertility or subfertility who require surgical intervention prior to ART treatment.
Key Study Components
Area of Science
- Reproductive Medicine
- Gynecology
- Fertility Preservation
Background
- IVM is a technique used to mature oocytes outside the body.
- OP-IVM extends IVM applications to include surgical procedures.
- This method addresses the needs of women with various reproductive health issues.
- It is particularly relevant for patients undergoing treatments that may affect fertility.
Purpose of Study
- To provide a fertility preservation option for women needing gynecological surgery.
- To improve outcomes for patients with conditions like polycystic ovary syndrome.
- To facilitate ART treatments post-surgery.
Methods Used
- Ultrasound-guided oocyte retrieval from ovaries.
- Use of a 19 gauge single lumen aspiration needle for follicular fluid aspiration.
- Monitoring of follicle count and health prior to surgery.
- Assessment of patient eligibility based on medical history and surgical needs.
Main Results
- Successful retrieval of oocytes in patients undergoing gynecological procedures.
- Improved fertility preservation outcomes for patients with cancer or other fertility-compromising conditions.
- Demonstrated feasibility of combining IVM with surgical interventions.
- Positive feedback from patients regarding the dual approach.
Conclusions
- OP-IVM represents a significant advancement in fertility preservation strategies.
- This method can be a viable option for women requiring gynecological surgery.
- Further research is needed to optimize protocols and outcomes.
Frequently Asked Questions
Executive Industry Relevance
OP-IVM extends in vitro maturation (IVM) to integrate with routine gynecological surgery, enabling fertility preservation for patients undergoing benign surgical procedures. This approach addresses a critical gap in reproductive medicine by salvaging immature oocytes that would otherwise be discarded during surgery, thereby expanding the pool of viable gametes for assisted reproductive technology (ART). By combining oocyte retrieval with scheduled gynecologic interventions, OP-IVM enhances clinical efficiency and supports patient-centered fertility preservation strategies in oncology and benign disease settings.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Enables interrogation of oocyte maturation pathways under physiologically relevant conditions following surgical stress.
- Operational Value: Provides a reproducible model to study cumulus-oocyte complex (COC) recovery and maturation efficiency post-aspiration.
Screening & Assay Development
- Scientific Value: Supports development of standardized assays for oocyte quality assessment using morphonuclear selection post-IVM culture.
- Operational Value: Facilitates scalable cryopreservation workflows for mature oocytes (MII stage) derived from surgical settings.
Translational & Preclinical Research
- Scientific Value: Offers a disease-relevant system to evaluate fertility preservation efficacy in conditions like PCOS and oncologic therapies.
- Operational Value: Demonstrates translational continuity from oocyte retrieval through IVM, cryopreservation, and subsequent ART outcomes.
Pipeline & Workflow Integration
OP-IVM positions oocyte maturation as a bridge between diagnostic gynecologic procedures and downstream ART workflows, enabling seamless integration of fertility preservation into surgical care pathways.
- Discovery Biology: Supports hypothesis testing on follicular responsiveness to hormonal and surgical stimuli via immature COC yield and maturation rates.
- Screening: Enables assay readiness for oocyte competency evaluation through standardized IVM culture (28–32 hours) and MII-stage selection.
- Analytics: Generates quantitative outputs including oocyte yield, maturation percentage, and cryopreservation survival rates for cross-condition comparison.
- Translational Research: Connects surgical intervention to preclinical continuity by validating oocyte usability in IVF-ET models post-thaw.
- Enterprise Reuse: Establishes a reusable platform for fertility preservation across diverse gynecologic indications, reducing procedural redundancy.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in fertility preservation by utilizing otherwise discarded immature oocytes.
- Operational Value: Standardizes oocyte retrieval and maturation protocols across surgical and laboratory settings.
- Strategic Value: Improves go/no-go decisions in fertility treatment planning by expanding accessible oocyte pools pre-ART.
- Portfolio Impact: Enables risk-adjusted prioritization of fertility preservation interventions in oncology and benign disease cohorts.
Implementation Considerations
- Requires expertise in reproductive endocrinology, ultrasound-guided aspiration, and embryology laboratory techniques.
- Depends on access to IVM-capable incubators, handling media, and stereoscopic evaluation tools.
- Necessitates coordination between surgical, anesthesia, and IVF laboratory teams for timed oocyte transfer.
- Involves adaptation of handling media and strainer protocols across variable follicular fluid volumes and viscosities.
- Limited by patient-specific factors such as ovarian accessibility, follicle count, and surgical duration constraints.
