In vitro maturation (IVM) of oocytes in PCOS

Oocyte in vitro maturation (IVM) is an assisted reproductive technology (ART) designed to obtain mature oocytes following in-vitro culture of immature cumulus–oocyte complexes collected from antral follicles. Oocyte maturation rates in vitro are generally lower than maturation rates of oocytes retrieved in a conventional IVF programme after administration of an ovulation trigger, and the number of useable embryos is also lower. With current IVM systems, a considerable proportion of immature oocytes from small antral follicles wo not acquire meiotic competence and would have required more time within their follicular environment to accomplish physiological nuclear and cytoplasmic maturation. As a result, pregnancy rates after IVM are generally lower compared to conventional IVF, and IVM is not widely used. Moreover, there are very few large-scale clinical trials that have compared the efficiency of IVM and conventional IVF. Nevertheless, the endeavors of a group of centers with expertise in IVM have reported acceptable pregnancy rates and provided reassuring safety data for mothers and children, and IVM has recently been endorsed as a non-experimental treatment by the ASRM. According to the 2023 international evidence-based guideline for the management of PCOS, subfertile women who are most suitable for IVM are those with

an unacceptably high risk of OHSS.

In this talk, I will give an overview of the available data supporting the use of IVM in selected women with PCOS and I will identify the gaps of knowledge that impede a more widespread uptake of this technology.