There have been developments in the field of hormone-assisted ovulation. Conventional controlled ovarian stimulation (COS) involves assisted reproduction by way of fertilizing ovarian follicles to stimulate a more successful implantation. Following fertilization, these follicles (eggs) can then be used for IVF or IVM. Now, with second wave COS, two waves of egg pickups can take place during one ovarian cycle.
Second wave COS and IVM are used for those who are poor responders to hormone stimulation. It is important to understand that not all women respond to hormone treatments, whether they have a blockage or antibodies fighting the hormones necessary for fertilization. More specific issues, such as breast cancer or deep vein thrombosis, also require that hormone injections not be used. Second wave COS is not used for women who respond well to hormone treatments, or have the standard number of eggs.
Patients seeking out second wave COS usually have three or less eggs, with two eggs being mature and one being immature. Using IVM, the one immature egg can be made mature. This gives the patient a 30% chance of becoming pregnant. Second wave pick up functions to make as many eggs mature as possible. Now, one month after ovum pick up, we can follow with two courses of ovum stimulation. These two courses lead to the production of 70 to 80% more eggs than with traditional COS. There is less time spent anxiously awaiting result, and the stimulation is constant.
Because a small number of eggs are already primed from the first stimulation, the second stimulation may yield more results. A third and fourth stimulation can take place; there is no limitation to the number of ovarian stimulations that one can receive, meaning more and more viable eggs can be produced. This method is preferred for older women or poor responders who want to collect as many eggs as possible as quickly as possible. Maximizing the eggs collected for storage and use in the future is also a large benefit of second wave COS. Whether a woman wants to use those eggs for a current pregnancy or in the future, second wave COS is a very real option for poor responders.
Calcium ionophore (ICSI injections) are often paired with second wave COS. If a couple is experiencing difficulties getting pregnant, both the man and the woman will be tested. If the man’s sperm is found to be large, slow moving or completely immotile, they will be tested for signs of life. A laser is used to stimulate the tail; if the tail curves, the sperm is alive. The best sperm will be primed and injected into the woman’s egg. It should be noted that calcium ionophore is only recommended in the case where a man’s sperm is not functioning within the normal motility or size parameters.
The world of fertility treatments is continuing to grow and develop in incredible ways. Now, women who would have run out of options in the past have ways to get pregnant. Revolutionary treatments such as second wave COS are giving women the chance to experience the joy of motherhood.
M.D., Faculty of Medicine, Prince of Songkla University Faculty of Medicine Prince of Songkla University , 1979