Transvaginal ovarian trauma, poor responders and improvement of success rates in IVF: anecdotal data and a hypothesis.
In this report, we propose an intervention capable of improving IVF outcomes in subfertile women with poor ovarian response. This intervention derives from anecdotal data and observations in our daily practice, but most importantly from trials on experimental models and subfertile women with Polycystic Ovarian Syndrome (PCOS). Our hypothesis suggests that transvaginal induction of trauma to the ovary in the cycle preceding IVF should benefit poor ovarian responders and their lowered pregnancy rates by increasing - at least - the number of retrieved oocytes during oocyte retrieval. Up-to-the minute data show that, via this means, there is a unique response of the ovarian surface epithelium and stroma to the induced trauma. The potential pathways of this beneficial response involve an improvement of the raised gonadotrophins to act either through the mechanical reduction of the size of the ovary or through alterations of the hormonal profile by lowering LH, inhibin and local androgen concentrations through hypothalamic-pituitary axis feedbacks, the induction of increased blood flow to the ovaries, a differentiated local immune reaction and a non-elucidated as yet role of reactive oxygen species. In this report, we also describe the technique and the associated possible negative points while we try to point out the needed research steps to ensure its efficiency before it enters daily clinical practice.
Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece. Electronic address: harrysiri@yahoo.gr.
Charalampos
C
Siristatidis
Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece. Electronic address: evivogiatzi@gmail.com.
Paraskevi
P
Vogiatzi
1st Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University "Aldo Moro", Bari, Italy. Electronic address: stefanoendo@tin.it.
Stefano
S
Bettocchi
Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece. Electronic address: georgebas44@yahoo.com.
George
G
Basios
2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Electronic address: mastorakg@ath.forthnet.gr.
George
G
Mastorakos
2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Electronic address: nvrachnis@hotmail.com.
Nikos
N
Vrachnis
D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D008954:Models, Biological; D054315:Oocyte Retrieval / Q000706:statistics & numerical data; D010053:Ovary / Q000293:injuries*; D010812:Physical Stimulation / Q000379:methods; D011085:Polycystic Ovary Syndrome / Q000473:pathology*; D011247:Pregnancy; D018084:Ultrasonography, Interventional / Q000379:methods*