Effect of Super-GDF9 on CAPA-IVM of COCs From Small Antral Follicles

Not Applicable

Recruiting

• Conditions: In Vitro Fertilization

• Registration Number: NCT06766604
• Lead Sponsor: Mỹ Đức Hospital

Brief Summary

CAPA-IVM (In Vitro Maturation) technology is an assisted reproductive method offering significant benefits in terms of safety and treatment costs, particularly for high-risk patients. These include individuals with ovarian hyperstimulation syndrome (OHSS), venous thrombosis, ovarian torsion, or polycystic ovary syndrome (PCOS). However, while the live birth rate in the CAPA-IVM group (35.2%) is comparable to conventional IVF (43.2%), the number of good-quality embryos and cumulative clinical pregnancy rates remain lower. Improving the CAPA-IVM culture process, particularly through the addition of growth factors found in follicular fluid, has shown promise in enhancing oocyte quality.

Growth differentiation factor 9 (GDF9) and Bone morphogenetic protein 15 (BMP15) play critical roles in follicular development, with their heterodimer structure demonstrating the most positive effects on cumulus-oocyte complexes (COCs). Recent studies have identified a potent variant, super GDF9, which is \>1000 times more effective than GDF9 and surpasses cumulin, a heterodimeric growth factor. Super GDF9 enhances cumulus cell expansion and oocyte developmental competence, closely mimicking in vivo maturation.

This study investigates the impact of supplementing super GDF9 during CAPA-IVM culture, aiming to improve outcomes of cumulus-oocyte complexes (COCs) from small follicles and ultimately enhance treatment success.

Detailed Description

CAPA-IVM (In Vitro Maturation) technology is an assisted reproductive method offering significant benefits in terms of safety and treatment costs, particularly for high-risk patients. These include individuals with ovarian hyperstimulation syndrome (OHSS), venous thrombosis, ovarian torsion, or polycystic ovary syndrome (PCOS) - who typically present with a high number of antral follicles (constituting nearly 15% of all patients). Although the live birth rate following the first transfer in the CAPA-IVM group is 35.2%, which is not statistically different from the conventional IVF group at 43.2% (risk difference: -8.1%; 95% confidence interval: -16.6% to 0.5%), the number of good-quality embryos per cycle and the cumulative clinical pregnancy rate remain lower than in conventional IVF. Therefore, improving the CAPA-IVM culture process to achieve the optimal number and quality of oocytes is essential.

Concurrently, adding growth factors commonly found in follicular fluid to the culture medium represents a remarkable advancement in improving oocyte quality in CAPA-IVM. Some somatic compartments, such as expansion, metabolism, and apoptosis, are regulated by soluble growth factors, known as oocyte secretion factors (OSFs). Two OSFs, Growth differentiation factor 9 (GDF9) and Bone morphogenetic protein 15 (BMP15), have been identified as critical for follicular development and fertility in various species such as mice, sheep, and humans. During IVM culture, both the immature and mature forms of these factors as well as their homo- and heterodimer structures have been tested. Notably, the heterodimer structure has shown the most positive effects on cumulus-oocyte complexes (COCs) during IVM culture.

Although both growth factors exist in homodimeric forms, recent studies have found that the GDF9 and BMP15 heterodimer can also form a more potent growth factor called cumulin. BMP15 activates latent GDF9 in cumulin, leading to strong signaling in granulosa cells via type I receptors (ALK4/5) and SMAD2/3 transcription factors. Biomedically engineered cumulin has been proposed to noticeably improve embryo outcomes in mouse and porcine models. Recently, a modified version of wild-type GDF9, called super GDF9, has been demonstrated to be \>1000 times more potent than GDF9 and 4 times more activity than cumulin in SMAD2/3-responsive transcriptional assays in granulosa cells. Previous research has illustrated that adding super GDF9 to CAPA-IVM media in mice induces gene expression in the ovulatory cascade during CAPA-IVM maturation that closely resembles in vivo maturation. Super GDF9 effectively promotes cumulus cell expansion and enhances oocyte developmental competence in vitro. Hence, super GDF9 can potentially replace cumulin, which faces challenges in production and purification.

This study investigates the impact of supplementing super GDF9 during CAPA-IVM culture, aiming to improve outcomes of cumulus-oocyte complexes (COCs) from small follicles and ultimately enhance treatment success.

This study will recruit 300 COCs (an estimated 10 needed patients). 100 COCs will be allocated to the research arm (sGDF-9), while 200 COCs will be allocated to the control arm.

* Screening for eligibility

* This study will be conducted at My Duc Hospital, Ho Chi Minh City, Vietnam.

* Women who are potentially eligible will be provided information about the study at the time of IVM treatment indication.

* Screening for eligibility will be performed on the day of the first visit when the IVM treatment is indicated.

* Patients will be provided information about the study and informed consent documents. The investigators will obtain signed informed consent forms from all women before enrollment.

* Eligible women will be scheduled to undergo oocyte pick-up procedures within 1-7 days from informed consent.

* Oocytes retrieval The oocyte pick-up procedure will be conducted according to the center's standard practices for CAPA-IVM cycles.

Cumulus-oocyte complexes (COCs) from small follicles after OPU will be divided into 2 groups:

* Group 1 (sGDF-9): donated COCs will be cultured in the CAPA and IVM steps, adding 50ng/ml Super-GDF9 during both steps in CAPA-IVM

* Group 2 (Control): The subject's remaining COCs will be cultured in the CAPA and IVM steps without adding Super-GDF9 during CAPA-IVM.

Groups 1 and 2: Collecting after the capacitation step: spent media and blank wells. Collecting after the maturation step: spent media, cumulus cell, and blank wells.

+ CAPA and Maturation culture: CAPA and Maturation culture will be performed routinely following current laboratory protocols. ICSI will be used to fertilize mature oocytes.

Study Timeline

• Status Verified: 2024-12
• Study First Submitted: 2024-12-24
• Study First Submitted QC: 2025-01-08
• Study First Posted: 2025-01-09
• Study Start: 2025-01-10
• Primary Completion: 2025-02-17
• Last Update Submitted: 2025-02-25
• Last Update Posted: 2025-02-28
• Study Completion: 2026-04-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: Female
• Target Recruitment: 9

Inclusion Criteria

1. Women between the ages of 18 and 38 years (both inclusive)
2. BMI ≤ 32 kg/m2
3. PCOS women according to the Rotterdam criteria (2003)
4. Indicating CAPA-IVM treatment.
5. Serum AMH ≥ 4 ng/mL (28.57 pmol/L) at screening and having at least 24 antral follicles in two ovaries by transvaginal ultrasound at the time of CAPA-IVM indication
6. Willing to donate COCs for research purposes
7. Agreeing for frozen embryo
8. Signed informed consent before any study-related procedures

Exclusion Criteria

1. Known endometrioma or grade 3-4 endometriosis according to ASRM classification
2. Uterine abnormalities
3. Couples with severe male factor (sperm concentration <5 million/ml, motility < 10%), surgical sperm retrieval.
4. Previous history of unexplained immature oocytes after IVF treatment
5. Cycles using donor oocytes

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Maturation rate per COC	Two days after oocyte retrieval	Number of MII / COCs

Secondary Outcome Measures

Name	Time	Method
tB	During day 4 after Intra-cytoplasmic sperm injection (before zona starts to thin)	Full blastocyst
Blastocyst rate per COC (day 5 or 6 embryo)	Five or six days after Intra-cytoplasmic sperm injection	Counting the number of patients with Day-5 or Day-6 embryo/COCs
Blastocyst rate per MII	Five or six days after Intra-cytoplasmic sperm injection	Counting the number of patients with Day-5 or Day-6 embryo/MII
Maturation rate per patient	Two days after oocyte retrieval	Number of MII / patient
Degeneration rate per COC	16-18 hours after Intra-cytoplasmic sperm injection	Number of degenerated oocytes after IVM / COCs
Degeneration rate per MII	16-18 hours after Intra-cytoplasmic sperm injection	Number of degenerated oocytes after IVM / MII
Degeneration rate per patient	16-18 hours after Intra-cytoplasmic sperm injection	Number of degenerated oocytes after IVM / patients
t2PN	16-18 hours after Intra-cytoplasmic sperm injection	Time of two pronuclei appearance
Fertilization rate per COC	16-18 hours after Intra-cytoplasmic sperm injection	Number of fertilized oocytes / COCs
Fertilization rate per MII	16-18 hours after Intra-cytoplasmic sperm injection	Number of fertilized oocytes / MII
Fertilization rate per patient	16-18 hours after Intra-cytoplasmic sperm injection	Number of fertilized oocytes / patients
Abnormal fertilization rate per COC	16-18 hours after Intra-cytoplasmic sperm injection	The percentage of zygotes with 1,3, or more than 3 pronuclei after Intra-cytoplasmic sperm injection / COCs
Abnormal fertilization rate per MII	16-18 hours after Intra-cytoplasmic sperm injection	The percentage of zygotes with 1,3, or more than 3 pronuclei after Intra-cytoplasmic sperm injection / MII
Abnormal fertilization rate per patient	16-18 hours after Intra-cytoplasmic sperm injection	The percentage of zygotes with 1,3, or more than 3 pronuclei after Intra-cytoplasmic sperm injection / patients
tPNf	23-25 hours after Intra-cytoplasmic sperm injection	Time of pronuclei fading
t2	25-27 hours after Intra-cytoplasmic sperm injection	First time frame at which an embryo reaches 2-cell stage blastomeres
t3	25-42 hours after Intra-cytoplasmic sperm injection	First time frame at which an embryo reaches 3-cell stage blastomeres
t4	42-44 hours after Intra-cytoplasmic sperm injection	First time frame at which an embryo reaches 4-cell stage blastomeres
t5	44-67 hours after Intra-cytoplasmic sperm injection	First time frame at which an embryo reaches 5-cell stage blastomeres
t8	67-69 hours after Intra-cytoplasmic sperm injection	First time frame at which an embryo reaches 8-cell stage blastomeres
tSC	During day 3 after intracytoplasmic sperm injection (beginning of the compaction of blastomeres)	First evidence of compaction
Day-3 embryo rate per COC	Five days after oocyte retrieval	Counting the number of patients with Day-3 embryo/COCs
Day-3 embryo rate per MII	Three days after Intra-cytoplasmic sperm injection	Counting the number of patients with Day-3 embryo/ MII
Day-3 embryo rate per patient	Three days after Intra-cytoplasmic sperm injection	Counting the number of patients with Day-3 embryo / patients
Good quality Day-3 embryos per COC	Three days after Intra-cytoplasmic sperm injection	Number of grade 1 and grade 2 Day-3 embryos / COCs
Good quality Day-3 embryos per MII	Three days after Intra-cytoplasmic sperm injection	Number of grade 1 and grade 2 Day-3 embryos / MII
Good quality Day-3 embryos per patient	Three days after Intra-cytoplasmic sperm injection	Number of grade 1 and grade 2 Day-3 embryos / patients
tM	During day 4 after Intra-cytoplasmic sperm injection	Time of completion of compaction process
tSB	During day 4 after Intra-cytoplasmic sperm injection (in which the blastocoel is visible)	Initiation of blastulation
Blastocyst rate per patient	Five or six days after Intra-cytoplasmic sperm injection	Counting the number of patients with Day-5 or Day-6 embryo/patient
Good quality blastocysts per COC	Five or six days after Intra-cytoplasmic sperm injection	Number of grade 1 and grade 2 blastocysts / COCs
Good quality blastocysts per MII	Five or six days after Intra-cytoplasmic sperm injection	Number of grade 1 and grade 2 blastocysts / MII
Good quality blastocysts per patient	Five or six days after Intra-cytoplasmic sperm injection	Number of grade 1 and grade 2 blastocysts / patients
Frozen blastocysts rate per COC	Five or six days after Intra-cytoplasmic sperm injection	Counting the number of frozen blastocysts/ COCs
Frozen blastocysts rate per MII	Five or six days after Intra-cytoplasmic sperm injection	Counting the number of frozen blastocysts/ MII
Frozen blastocysts rate per patient	Five or six days after Intra-cytoplasmic sperm injection	Counting the number of frozen blastocysts/ patient
The relative expression ratio (R) of human cumulus cell genes	Cumulus cells will be collected and frozen within 30-50 minutes after oocyte denudation, stored at -80oC until RNA purification	Cumulus cells will be collected, cDNA synthesis after mRNA purification, relative quantification PCR for detecting gene expression (results potentially reported separately)
Rates of Blastocysts by Chromosomal Status in PGT	After study completion, an average of 1 year.	PGT will be performed to classify blastocysts as euploid, aneuploid or mosaic (results potentially reported separately)
Epigenetic Evaluation	After study completion, an average of 1 year.	Epigenetic evaluation of blastocysts will be performed by post-bisulfite adaptor tagging (PBAT), and the average DNA-methylation (%) at imprinted germline differentially methylated regions (gDMRs) will be calculated (results potentially reported separately)

Trial Locations

Locations (1)

My Duc Hospital; 🇻🇳 Ho Chi Minh City, Vietnam