Abstract
PurposeStandard oocyte in vitro maturation (IVM) usually results in lower pregnancy rates than in vitro fertilization (IVF). IVM preceded by a prematuration step improves the acquisition of oocyte developmental competence and can enhance embryo quality (EQ). This study evaluated the effectiveness of a biphasic culture system incorporating prematuration and IVM steps (CAPA-IVM) versus standard IVM in women with polycystic ovarian morphology (PCOM).MethodsEighty women (age < 38 years, ≥ 25 follicles of 2–9 mm in both ovaries, no major uterine abnormalities) were randomized to undergo CAPA-IVM (n = 40) or standard IVM (n = 40). CAPA-IVM uses two steps: a 24-h prematuration step with C-type natriuretic peptide-supplemented medium, then 30 h of culture in IVM media supplemented with follicle-stimulating hormone and amphiregulin. Standard IVM was performed using routine protocols.ResultsA significantly higher proportion of oocytes reached metaphase II at 30 h after CAPA-IVM versus standard IVM (63.6 vs 49.0; p < 0.001) and the number of good quality embryos per cumulus-oocyte complex tended to be higher (18.9 vs 12.7; p = 0.11). Clinical pregnancy rate per embryo transfer was 63.2% in the CAPA-IVM versus 38.5% in the standard IVM group (p = 0.04). Live birth rate per embryo transfer was not statistically different between the CAPA-IVM and standard IVM groups (50.0 vs 33.3% [p = 0.17]). No malformations were reported and birth weight was similar in the two treatment groups.ConclusionsUse of the CAPA-IVM system significantly improved maturation and clinical pregnancy rates versus standard IVM in patients with PCOM. Furthermore, live births after CAPA-IVM are reported for the first time.
Highlights
Safety was monitored at each clinic visit or, if any side effects occurred, by questioning and examining the patient, with adverse events and serious adverse events recorded on case report forms
Serious adverse events were defined as any unexpected medical occurrence that resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, or
We report a clinical pregnancy rate of 60% using CAPA-in vitro maturation (IVM) compared with 37.5% using standard IVM, and the latter is comparable to rates reported in previous IVM studies [7, 8, 27,28,29,30], an array of different IVM protocols was used in these studies, including some with hCG priming, which was not used in the current study
Summary
Laarbeeklaan 101, 1090 Brussel, Belgium 5 Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru 6 Fertility and Research Centre, School of Women’s and Children’sHealth, University of New South Wales Sydney, Sydney, NSW, AustraliaIn vitro maturation (IVM) of oocytes is an assisted reproductive technology that obviates the use of controlled ovarian stimulation (COS) for in vitro fertilization (IVF) through collection of immature cumulus-oocyte complexes at the prophase I stage, which are matured in vitro until they reach metaphase II stage [1,2,3].The omission of COS means that IVM is suited to patients with polycystic ovary syndrome (PCOS), who have highly variable responses to stimulation with gonadotropins and are at increased risk of exaggerated ovarian response, potentially resulting in significant morbidity, including ovarian hyperstimulation syndrome (OHSS) [4] and ovarian torsion. In vitro maturation (IVM) of oocytes is an assisted reproductive technology that obviates the use of controlled ovarian stimulation (COS) for in vitro fertilization (IVF) through collection of immature cumulus-oocyte complexes at the prophase I stage, which are matured in vitro until they reach metaphase II stage [1,2,3]. In order for a mature oocyte to successfully support fertilization and embryo development, oocyte competence must be achieved, which is normally only acquired in follicles of pre-ovulatory size [9]. This presents a challenge in the case of IVM because cumulus-oocyte complexes (COCs) are typically collected from small antral follicles. The maturation rate with non-hCG IVM is lower than that with hCG IVM [10]
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