Live births after oocyte in vitro maturation with a prematuration step in women with polycystic ovary syndrome

Lan N Vuong, Anh H Le, Vu N A Ho, Toan D Pham, Flor Sanchez, Sergio Romero, Michel De Vos, Tuong M Ho, Robert B Gilchrist, Johan Smitz, Lan N Vuong, Anh H Le, Vu N A Ho, Toan D Pham, Flor Sanchez, Sergio Romero, Michel De Vos, Tuong M Ho, Robert B Gilchrist, Johan Smitz

Abstract

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.

Keywords: C-type natriuretic peptide; In vitro fertilization; In vitro maturation; Oocyte prematuration; Polycystic ovary syndrome.

Conflict of interest statement

All authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
CONSORT diagram. AFC, antral follicle count; CAPA-IVM, capacitation in vitro maturation; FET, frozen embryo transfer; IUI, intrauterine insemination; IVF, in vitro fertilization; IVM, in vitro maturation; OPU, oocyte pick-up; PGS, preimplantation genetic screening
Fig. 2
Fig. 2
Study schedule for CAPA-IVM and standard IVM (control). Patients were randomized to CAPA-IVM or standard IVM. The stimulation protocols are identical in the two arms. Patients received approximately 2.5 days of gonadotropin priming and no human chorionic gonadotropin (hCG) priming. CAPA-IVM group allocated patients had their oocytes 24-h longer in a prematuration culture (orange bar). All embryos were vitrified and transferred in subsequent cycles. CAPA, capacitation prematuration; D3, day 3; Gn, gonadotrophin; IVM, in vitro maturation; OCP, oral contraceptive pill; VIT, vitrification
Fig. 3
Fig. 3
Hormonal profiles during CAPA-IVM (n = 40) compared with standard IVM (n = 40). Serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and progesterone were measured from the day of first visit until the day of immature cumulus-oocyte complex retrieval for both IVM treatments. Values are mean ± standard deviation
Fig. 4
Fig. 4
Comparison of maturation rate between standard and CAPA-IVM in follicles of p value

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