In vitro maturation of oocytes (IVM) describes a process whereby immature oocytes that have been collected as part of an assisted reproductive treatment cycle are matured in a laboratory. After maturation, they are usually fertilized with sperm, via intracytoplasmic sperm injection (ICSI), and the resulting embryos cultured. The perceived benefits of this technology are that it involves a shorter duration of time between the commencement of a treatment cycle and oocyte collection, and it avoids the risk of ovarian hyperstimulation syndrome (OHSS). OHSS is a very serious medical condition that women with polycystic ovary syndrome (PCOS) are particularly susceptible to developing. IVM technology has been used for several decades, but in the last ten years there has been a resurgence of interest in its use with the development of enhanced maturation media to assist the IVM process and the initiation of several randomized trials to compare potential benefits and drawbacks in comparison to the standard in vitro fertilization (IVF) approach.

The significant advances in ultrasound technology have resulted in an increase in the prevalence of PCO morphological ultrasonographic criteria diagnosis. These patients have a live birth rate after undergoing up to three cycles of IVF treatment that is 82% higher than women with normal ovaries, requiring fewer ampules of gonadotrophins, producing more follicles and viable oocytes with similar fertilisation and miscarriage rates. Since these women exhibit an exaggerated response to gonadotrophin therapy regardless of COH protocol, the risk remains the increased prevalence of OHSS. Since no COH protocol is superior to manage these patients, protocols that trigger oocyte maturation with a GnRH agonist, with or without a ‘freeze-all’ approach, should be encouraged. Therefore, it is important that every patient undergoing IVF has a baseline ultrasound scan, antral follicle count and AMH levels as well as an assessment of ovarian morphology prior to ART treatments in order to assess risk and reduce complications.