Research Study to Evaluate Capacitation Culture (CAPA) Followed by in Vitro Maturation (IVM) of Human Oocytes: A Randomized Pilot Study

Patients preparation

Patients with PCOM are allowed to enroll in the study: (1) women with normal menstrual cycle lengths (≤35 days), and (2) women with oligomenorrhea (menstruation occurring at intervals >35 days with 4-9 periods/year) or total amenorrhea. Patients were followed up until the end of pregnancy.

Patients have their first clinic visit on day 2 of the menstrual cycle. At this visit a blood sample was taken for assessment of FSH (Follicle Stimulating Hormone), LH (Luteinizing Hormone), estradiol and progesterone, and they have their gonadotropin injection 150 IU (international unit) once a day in the afternoon. All patients return in the morning of the next day (cycle day 3) for ultrasound and and the final dose of gonadotropin was given in the afternoon (2pm). When all follicles were <8 mm in diameter, another dose of gonadotropin was given, and patients returned the next day for ultrasound, blood tests and have their final dose of gonadotropin that afternoon (2pm). The maximum number of gonadotropin injections are three, and oocyte retrieval is scheduled at 42-46 hours after the last gonadotropin injection in all patients. Ultrasound and blood tests to determine FSH, LH, estradiol and progesterone levels are performed on the day of OPU (Oocyte Pick-up). During OPU, follicle size is measured before puncture. Larger follicles (≥6 mm) are punctured first, then the needle flushes, then smaller follicles (<6 mm) are punctured. Therefore, each tube contains COCs (Cumulus-Oocyte Complex) of a specific size (<6 or ≥6 mm).

Oocyte culture

Oocytes from patients in the CAPA-IVM group are collected and processed in the presence of CNP (C-type Natriuretic Peptide) as meiotic inhibitor. In the CAPA-IVM group, COCs are plated into a 4-well dish (Nunc, Denmark) at 10 COCs/well using CAPA medium (Medicult IVM medium; Origio, Denmark) supplemented with 1 mIU/mL rFSH, 5 ng/mL insulin, 10 nM estradiol, 10 mg/mL human serum albumin [SAGE, Denmark] and 25 nM (nanoMol) CNP under oil for 24 hours at 37°C, 6% carbon dioxide in air). After 24 hours, COCs are washed and transferred into IVM medium (Origio, Denmark) containing 5 ng/mL insulin, 10 nM estradiol, 100 ng/mL human recombinant amphiregulin and 100 mIU/mL rFSH (recombinant Follicle Stimulating Hormone), and incubated under oil for 30 h at 37°C, 6% carbon dioxide in air.