Abstract
Objective : To study the effectiveness of a new in vitro maturation (IVM) approach based on heterologous follicularfluid (HFF) andsupernatant of cumulus-granulosa cells (CGCs) mimicking the intact follicular microenvironment to rescue immature denudedoocytes (IDOs) of patients with polycystic ovary syndrome (PCOS) whose IVM or IVF outcomes remain poor.Design : Randomized controlled trial. Setting : University-affiliated private center.Patient(s) :One hundred fifty-nine IDOs were obtained from 47 patients with PCOS. First, a simple IVM system (S-IVM; 40 IDOs;control group) was compared with different protocols based on the addition of autologous follicularfluid (AFF-IVM; 44 IDOs), HFF(HFF-IVM; 42 IDO), or HFF with CGC isolated from seven women without PCOS and presenting 100% in vivo oocyte maturation(HFF/CGC-IVM; 33 IDOs).Intervention(s) : None.Main Outcome Measure(s) : IVM outcomes were compared among the four groups (S-IVM, AFF-IVM, HFF-IVM, HFF/CGC-IVM); then the vitro and in vivo maturation results (from controlled ovarian stimulation of PCOS patients) were compared for each group.Result(s) : The HFF/CGC-IVM method gave the best yield of developed blastocysts per IDO compared with S-IVM, AFF-IVM, and HFF-IVM (27% vs. 2%, 2%, and 12%, respectively). The IVM rate with the HFF/CGC-IVM method was even higher than that compared with the in vivo maturation rate (79% vs. 42%), with significant improvement in the cleavage rate (71% vs. 61%).Conclusion(s) : This adapted IVM system could be used to reach an acceptable result in meiotic competence and competent metaphaseII oocytes capable of developing into intact embryos after fertilization and before transfer.