Journal
JOURNAL OF ASSISTED REPRODUCTION AND GENETICS
Volume 37, Issue 2, Pages 347-357Publisher
SPRINGER/PLENUM PUBLISHERS
DOI: 10.1007/s10815-019-01677-6
Keywords
In vitro fertilization; In vitro maturation; Polycystic ovary syndrome; Oocyte prematuration; C-type natriuretic peptide
Funding
- Vrije Universiteit Brussel (IOF Project 4R-ART) [2042]
- joint FWO Flanders-NAFOSTED research project [G.0D97.18N]
- Vietnam National Foundation for Science and Technology Development (NAFOSTED) [FWO.106-YS.2017.02]
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Purpose Standard 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). Methods Eighty 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. Results A 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. Conclusions Use 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.
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