In Vitro Oocyte Maturation With Autologous Exosomes in Women With Low Ovarian Reserve: Preliminary Phase of a Prospective Randomized Clinical Study

Women with diminished ovarian reserve frequently present a high proportion of immature oocytes after controlled ovarian stimulation. These immature oocytes cannot be fertilized and limit the number of mature oocytes available for assisted reproductive procedures. Oocyte maturation is regulated by a coordinated set of intracellular signaling pathways, intercellular communication with granulosa cells, and molecular mechanisms that maintain meiotic arrest and trigger meiotic resumption. Emerging scientific evidence indicates that extracellular vesicles, including autologous exosomes, may play a role in supporting oocyte maturation through the transfer of bioactive molecules.

This preliminary clinical study was designed to evaluate the safety and feasibility of using autologous exosomes as a supplement to conventional in vitro maturation (IVM) media. The study population includes women aged 38-46 years with documented diminished ovarian reserve who declined oocyte donation and who met predefined clinical, endocrine, and reproductive criteria. All participants provided written informed consent. The study was conducted in accordance with national regulations and international ethical principles for research involving human subjects.

Eligible participants undergo controlled ovarian stimulation using recombinant follicle-stimulating hormone, human menopausal gonadotropin, and an antagonist protocol, followed by human chorionic gonadotropin triggering and oocyte retrieval. Only metaphase I oocytes are included in the intervention portion of the study. After identification, metaphase I oocytes are randomly assigned to one of two groups using a simple computer-generated randomization method.

In the control group, oocytes are cultured in conventional in vitro maturation medium. In the experimental group, oocytes are cultured in the same medium supplemented with a standardized quantity of autologous exosomes isolated from each participant according to the study protocol. Culture duration ranges from 24 to 36 hours. After the culture period, oocytes reaching metaphase II are fertilized via intracytoplasmic sperm injection to standardize the fertilization procedure. Embryos developing after fertilization are cultured under standardized laboratory conditions, evaluated according to established morphological criteria, and cryopreserved for use in a future phase of the research. Embryo transfer is not performed during this preliminary phase.

The primary objective of the study is to assess whether autologous exosome supplementation is feasible and safe for use in IVM culture systems. Secondary objectives include documenting the procedures involved in oocyte handling, fertilization, and embryo cryopreservation to support future phases of the study. The study does not include analysis of results or clinical outcomes, as no outcomes are permitted to be reported in the Protocol Section of the ClinicalTrials.gov record. A subsequent phase of the research will evaluate implantation, clinical pregnancy, and live birth after transfer of cryopreserved embryos generated in this protocol.