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In vitro maturation of oocytes as a promising treatment option for
infertile couples: a transdisciplinary study
Beum Soo An, Junling Chen
Xi-Kuan Chen, Jack Huang
Se-Hyung Park, Qiuying Yang
Mar 20,06 OMNI 2
Background
In-vitro maturation (IVM) Immature eggs are retrieved from ovary
and mature in laboratory.Once eggs are matured, in vitro
fertilization (IVF) is then performed.
Mar 20,06 OMNI 3
Background
In vitro maturation (IVM) of oocytes vs. conventional in vitro fertilization (IVF)
Proposed advantages of IVM: Simplify treatment and reduces cost Avoids potential side effects-weight gain,
bloating, breast tenderness, nausea, mood swings, and OHSS
Fear of potential risk of malignancy associated with repeated cycles of ovarian stimulation.
Mar 20,06 OMNI 4
Overall Objective
To assess biological, clinical, psychological and economical impact of in vitro maturation (IVM) of eggs
Mar 20,06 OMNI 5
3 Pillars
IVM
Pillar 1:
Biology
Pillar 2:
Clinical, psychological, economical
Pillar 3:
Population
Pillar I: Biological assessment of
IVM
Mar 20,06 OMNI 7
Biological approach for IVM group
Objectives To compare life cycles and occurrences of
disease from IVF and IVM treated offspring To compare gene profile in maternal placenta of
IVM and IVF derived embryos
Mar 20,06 OMNI 8
Hypotheses
IVM or IVF offspring have no difference in life cycles and occurrences of diseases.
Maternal placentas from IVM or IVF embryos do not have different gene profile.
Mar 20,06 OMNI 9
Research design
Using animal models (mouse or rat), we will compare life cycles and occurrences of diseases after IVF or IVM
We will analyze gene profile in the maternal placenta using microarray after IVF or IVM embryo injection, and confirm this by real time PCR and western blot in the different gestational stages
Pillar II: Clinical, psychological,
economical impact of IVM
Mar 20,06 OMNI 11
Objectives
To evaluate:Efficacy of IVM-pregnancy and live birth
rates.Safety of IVM-complication ratesCost of health servicePsychological impact on infertile couples
Mar 20,06 OMNI 12
Hypotheses
IVM treatment will result in comparable clinical efficacy as standard IVF (i.e. pregnancy and live birth).
IVM decreases the risk of maternal complications and does not increase the risk of fetal, neonatal and long term complications.
IVM is more cost effective than IVF IVM reduces psychological stress of infertile
couples
Mar 20,06 OMNI 13
Research Design
Multicenter prospective randomized control trial comparing IVM to IVF
Cohort study-follow up babies from IVM vs. IVF and spontaneous pregnancy -1 year
Health economic analysis Psychological assessment using validated
structured questionnaire Focus group discussion-clinicians, nurses,
clients
Mar 20,06 OMNI 14
Outcomes Efficacy of IVM vs. IVF:
Fertilization Implantation Pregnancy Live birth
Safety of IVM vs. IVF: Maternal complications (i.e. OHSS, miscarriage) Fetal complications (i.e. congenital anomalies) Newborn (Gestational age, birth weight, APGAR) Follow up of IVM vs. IVF vs. spontaneous pregnancy babies as
a cohort Cost-effectiveness of IVM vs. IVF Impact of IVM and IVF treatment on psychological well
being of infertile couples.
Pillar III: IVF and pregnancy complication
and birth outcomes: a population based study
Mar 20,06 OMNI 16
Objective
To assess the effects of IVF and IVM on pregnancy complications and perinatal outcomes
Mar 20,06 OMNI 17
Methods-subjects
A population-based retrospective cohort
2004-2008 Niday Perinatal Database, Ontario
120 000 births in Ontario every year
900-1000 births with assistant reproduction technology
Mar 20,06 OMNI 18
Methods-exposure and control
Exposure: IVF and IVM
Control: spontaneous pregnancy
Frequency matched by: Year of birth Postal code of residence Plurality Parity Maternal age
Mar 20,06 OMNI 19
Outcome
Pregnancy complications: Gestational hypertension Preeclampsia Eclampsia Gestational diabetes
Obstetric complications Placenta previa Placenta abruption
Mar 20,06 OMNI 20
Methods-outcomes
Birth outcomes: Birth defects Apgar score Gestational age: Preterm birth Birth weight: LBW, SGA
Mortality Fetal death (≥20 gestational weeks) Early neonatal death Late neonatal death
Mar 20,06 OMNI 21
Methods-confounders
Aboriginal statusFirst language of motherMaternal ageParity Initiation time of prenatal careMaternal smokingReproductive history Induction during laborC-section
Mar 20,06 OMNI 22
Timetable and Budget
Timetable Preparation and coordination (6 months) Implementation (4 years) Report writing (6 months)
Budget
Mar 20,06 OMNI 23
Research Team
BiologistsCliniciansPsychologistsEthicistsEpidemiologistsLawyers
Mar 20,06 OMNI 24
Interaction and integration
IVM
Pillar 1:
Biology
Pillar 2:
Clinical, psychological, economical
Pillar 3:
Population
Health Policy makers
Mar 20,06 OMNI 25
STIRRHS Mentors
Dr. Raymond Lambert Dr. Marcel Melancon Dr. Roger Pierson
Dr. Peter Leung (UBC) Dr. Seang Lin Tan (McGill) Dr. Mark Walker (U Ottawa) Dr. Shi Wu Wen (U Ottawa)
Acknowledgement