J Assist Reprod Genet 37: 347–357 (2020) – 2020-01-04
Lan N. Vuong1,2,3 & Anh H. Le2,3 & Vu N. A. Ho2,3 & Toan D. Pham2,3 & Flor Sanchez4,5 & Sergio Romero4,5 & Michel De Vos4 & Tuong M. Ho2,3 & Robert B. Gilchrist6 & Johan Smitz4
Published: 4 January, 2020
Author information
1. Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam
2. IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
3. HOPE Research Center, Ho Chi Minh City, Vietnam
4. Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, 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’s Health, University of New South Wales Sydney, Sydney, NSW, Australia
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 (CAPAIVM) 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.
Result
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:
In vitro fertilization . In vitro maturation . Polycystic ovary syndrome . Oocyte prematuration . C-type natriuretic peptide