Capacitation culture of human oocytes from small antral follicles improves in vitro maturation outcome
Francesca Lolicato (BE), Flor Sanchez (BE), Heidi Van Ranst (BE), Greta Verheyen (BE), Ellen Anckaert (BE), Michel De Vos (BE), Sergio Romero (BE), Johan Smitz (BE)
[Lolicato] Free University Brussels and University Hospital UZBrussel, [Sanchez] Free University Brussels and University Hospital UZBrussel, [Van Ranst] University Hospital UZBrussel, [Verheyen] Center for Reproductive Medicine-University Hospital UZBrussel, [Anckaert] University Hospital UZBrussel, [De Vos] Center for Reproductive Medicine-University Hospital UZBrussel, [Romero] Free University Brussels and University Hospital UZBrussel, [Smitz] Free University Brussels and University Hospital UZBrussel
Context: In vitro maturation (IVM) could reduce Assisted Reproductive Technique (ART)-related burden, risks and costs in selected patients. However, reduced efficiency compared to conventional ART precludes a more widespread uptake of the technique. Heterogeneity in IVM cycles protocols across clinics and a lack of knowledge of the physiology of oocyte maturation can be responsible for the low performance of IVM. Objective: The establishment of a pre-maturation system for IVM (CAPA-IVM) which may improve developmental competence of human immature oocytes from small antral follicles. Methods: Prospective pilot study in sibling cumulus-oocytes-complexes (COCs) donated by PCOS patients enrolled in a standard IVM program. Patient(s): 30 PCOS women (AFC>30, follicles between 2 and 6 mm) Intervention(s): Oocyte retrieval after 3 days stimulation with HP-hMG and without hGC ovulation trigger. Incubation of COCs in a pre-IVM culture step followed by IVM. Main Outcome: CAPA-IVM increases meiotic maturation rate (70% vs 48%, p=0.0001) of COCs by 46% over standard IVM and doubled the amount of transferable day 3 embryos (43% vs 23%, p=0.0006) and good quality blastocysts (18% vs 8%, p=0.0116) per oocyte. Measure(s): Maturation and fertilization rates, yield of Good Quality Embryos on Day 3 and Good Quality Blastocysts per COC, blastocysts aneuploidy rate; effect of CAPA-IVM on cumulus–oocyte connections, cumulus cell apoptosis, oocyte chromatin configuration. Result(s): CAPA-IVM preserved the maintenance of trans-zonal projections and significantly improved maturation rate and blastocyst yield. NGS analysis of 20 good quality CAPA-IVM blastocysts did not reveal increased aneuploidy compared to age matched routine ICSI patients. Conclusions: CAPA-IVM is more efficient than standard IVM and opens new horizons for developing safer, more patient friendly and cost-saving ART.