# Drug-free in vitro activation and autologous transplantation in infertile women with diminished ovarian reserve: An experimental pilot study

## TL;DR

A new drug-free technique to activate ovarian follicles in infertile women with low ovarian reserve shows promise in improving pregnancy outcomes.

## Contribution

This is the first experimental pilot study to evaluate drug-free in vitro activation of ovarian tissue in women with diminished ovarian reserve.

## Key findings

- In vitro activation significantly increased antral follicle count in women with diminished ovarian reserve.
- The technique resulted in a 22.2% pregnancy rate in the two cases observed.
- Estradiol levels decreased significantly after the in vitro activation procedure.

## Abstract

Poor ovarian response and diminished ovarian reserves (DOR) significantly contribute to female infertility. Previous attempts have been made to enhance follicular growth and improve pregnancy outcomes in these participants.

This study aimed to assess the efficacy of the in vitro drug-free activation technique of the ovarian reservation and in vitro fertilization stimulation cycle outcomes in DOR participants.

This pilot phase study investigated the impact of in vitro activation (IVA) on ovarian reservation and in vitro fertilization outcome in 10 infertile women with DOR from May to December 2023 at Taleghani Infertility Center, Tehran, Iran. Participants underwent general surgery and laparoscopy, involving the removal of a portion of one ovary, immediate transfer to the laboratory, dissection into small cubes, and subsequent re-implantation into the cases's ovary. The primary outcomes, include the count of retrieved oocytes, the number of oocytes reaching metaphase, and the secondary outcomes were the quantity and the number of embryos transferred, implantation rate, and occurrence of clinical pregnancy.

The study revealed a significant increase in the antral follicle count before and after IVA (p = 0.033). Before IVA, the median estradiol level was 93.5 (57.0), which reduced to 79.0 (35.0) after IVA, indicating a statistically significant difference. On average, 2.3 (0.8) oocytes were retrieved, among which 1.5 (0.7) were metaphase II oocytes. The observed pregnancy rate among the 2 cases was 22.2%.

The current study suggests that IVA may positively impact follicular growth and pregnancy outcomes among women with DOR.