Diving into the oocyte pool

The ovarian reserve comprises an enormous surplus of follicles. Despite this, some women produce insufficient numbers of oocytes by conventional fertility treatments. However, recent technical accomplishments may transform assisted reproductive technology (ART) in such a way that oocytes are not necessarily the limiting factor. In this review, we present possible new strategies for enhancing the quantity of mature oocytes, and current views on autologous oocytes as potential sources of mitochondria to lift performance of compromised oocytes. New discoveries of the signaling pathways activating dormant follicles and breakthroughs in techniques for autologous transfer of mitochondria have opened new doors to unexploited sources of oocytes and attractive ways of revitalizing oocytes. Extended numbers of mature oocytes may be obtained by in-vitro activation of dormant follicles in cortical biopsies or in-vitro maturation of immature oocytes during the natural or stimulated cycle, and used directly for fertility treatment or as a source of autologous mitochondria. New approaches utilizing the abundant resources of immature oocytes combined with techniques for revitalizing deficient oocytes may transform ART, and potentially enhance both quantity and quality of fertilizable oocytes; hereby augmenting the pregnancy potential of women with poor reproductive performance.