1 / 16

Improving Ovum Quality

imrpove ovum quality in ART

Zoha6
Télécharger la présentation

Improving Ovum Quality

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Improving Ovum Quality Saminakhalid (sirm)

  2. INTRODUCTION • Oocyte quality is a fundamental determinant of successful in vitro fertilization (IVF) outcomes. Clinically, high-quality oocytes are more likely to: • Fertilize normally • Develop into blastocysts • Implant successfully • Lead to live birth • Poor oocyte quality remains a major challenge in assisted reproductive technology (ART), particularly in women with advanced maternal age, diminished ovarian reserve, or poor response to stimulation. Current practice emphasizes evidence-based optimization of biological, medical, and laboratory factors.

  3. Pathophysiology of Oocyte Quality • Oocyte competence depends on cytoplasmic and nuclear maturation, mitochondrial function, and chromosomal integrity. • Age-related decline in oocyte quality is associated with increased aneuploidy and reduced mitochondrial efficacy. • Oxidative stress and suboptimal follicular microenvironment contribute to damage at the molecular level. • Understanding these mechanisms guides interventions aimed at improving developmental potential before and during ART cycles.

  4. Clinical Assessment of Oocyte Quality Morphological Assessment • Morphology remains the primary clinical tool for oocyte quality scoring in IVF labs. • Scoring includes evaluation of ooplasm, zonapellucida, polar body, and perivitelline space. • Advanced assessments (e.g., spindle imaging or mitochondria metrics) are used primarily in research or specialty centers due to cost/complexity. Emerging Measurement Technologies • Artificial intelligence–guided mechanotyping systems are being developed to non-destructively quantify mechanical properties related to competence.

  5. Evidence-Based Interventions for Improving Oocyte Quality Controlled Ovarian Stimulation (COS) • COS protocols are designed to recruit and mature multiple follicles using individualized gonadotropin dosing. • Optimizing COS according to ovarian reserve and patient characteristics is essential and guided by ESHRE guidelines, although direct evidence on improving intrinsic oocyte quality is limited. Timing of Trigger and Retrieval • The interval between final oocyte maturation trigger and oocyte pick-up can influence maturity and subsequent quality, with computational models proposed to individualize this timing.

  6. Adjunct Nutritional and Lifestyle Interventions • Antioxidants & Nutraceutical Support • Clinical evidence supports the use of certain supplements to optimize the reproductive environment: Berries (blueberries, strawberries, raspberries) – high in polyphenols • Citrus fruits – vitamin C source • Spinach, kale, broccoli – folate and carotenoids • Coenzyme Q10 (CoQ10): Enhances mitochondrial function and may improve oocyte competence, particularly in women of advanced age or diminished reserve~200–600 mg/day. • Myo-inositol: Helps improve ovarian function, especially in PCOS cases. • Vitamin D, Omega-3s, folate:Support hormone balance, reduce oxidative stress, and support cellular processes. Fatty fish: salmon, sardines, mackerel. Walnuts, flaxseeds, chia seeds. Extra-virgin olive oil. Avocado • DHEA: May be beneficial in selected patients with low ovarian reserve when medically monitored, although formal guidelines do not routinely recommend its use due to limited evidence. Note: Supplements should be initiated ≥2–3 months before IVF to align with the oocyte growth cycle and under clinician supervision for dosage and interactions.

  7. Lifestyle Factors • Healthy BMI and diet: A balanced diet rich in antioxidants supports folliculogenesis. • Avoidance of smoking and excess alcohol: Reduces toxin-induced oocyte damage. • Moderate exercise and stress management: Enhance systemic circulation and endocrine balance.

  8. Laboratory and Advanced ART Add-Ons • While some laboratory add-ons aim to enhance oocyte competence, evidence varies: • 6.1 In Vitro Maturation (IVM) and Biphasic Protocols • Pre-IVM strategies modulating cyclic AMP before meiotic induction show potential to enhance maturation rates, although standardization and broad clinical adoption are still under evaluation. • 6.2 Culture Media and Artificial Oocyte Activation • Hyaluronan-rich media and artificial activation techniques may support fertilization and development but lack uniform evidence for improved quality per se. • 6.3 Platelet-Rich Plasma (PRP) and Experimental Therapies • Intra-ovarian PRP and experimental pharmacologic agents (e.g., those targeting chromosomal protection) show preliminary promise but require further clinical validation.

  9. Weight and Oocyte Quality • Obesity is strongly associated with reduced fertility, impaired oocyte competence, lower embryo quality, and decreased live-birth rates in IVF. • Obesity promotes insulin resistance, leading to compensatory hyperinsulinemia. • Elevated insulin: • Increases ovarian androgen production (via theca cells). • Disrupts folliculogenesis and oocyte maturation. • Alters mitochondrial metabolism in oocytes.

  10. Weight and Oocyte Quality • Clinical Evidence • Even 5–10% weight loss in overweight/obese women: • Improves ovulation rates. • Enhances response to ovarian stimulation. • May improve oocyte maturity and embryo quality. • Many reproductive medicine guidelines recommend pre-conception weight optimization before IVF when BMI is elevated.

  11. Weight and Oocyte Quality • Gradual lifestyle-based weight loss is preferred over extreme dieting. • Combination of: • Caloric moderation • Low-glycemic Mediterranean-type diet • Regular physical activity • Rapid or excessive weight loss may impair ovulation, so balance is essential.

  12. Society-Level Guidance and Evidence Limitations Current Guidelines • Major reproductive medicine societies (e.g., ESHRE and ASRM) provide practice guidance on stimulation protocols, monitoring, and add-ons; however, direct evidence for routine interventions solely aimed at enhancing oocyte quality remains limited. • ESHRE advises caution with many adjunct treatments including DHEA or growth hormone, citing insufficient or conflicting data. Research Gaps • High-quality randomized trials demonstrating clear benefits on live birth rates for most add-ons are still needed. • Individualization of treatment, based on patient age, ovarian reserve, and clinical history, remains best practice.

  13. CONCLUSION • Optimizing oocyte quality in IVF requires a multidisciplinary approach combining: • Evidence-based ovarian stimulation and cycle management • Pre-treatment nutritional and lifestyle optimization • Appropriate use of laboratory technologies and supplements • Patient-specific clinical decision-making • Despite ongoing innovation, clinically validated strategies with definitive impact on intrinsic oocyte quality remain limited, highlighting the need for continued research and adherence to evolving guidelines.

  14. REFERENCES • European Society of Human Reproduction and Embryology (ESHRE) published guidelines for ovarian stimulation and add-ons. • American Society for Reproductive Medicine (ASRM) Practice Committee guidance documents. • Peer-reviewed literature on oocyte maturation techniques and supplements.

  15. THANK YOU

More Related