Amphiregulin Versus Non-Amphiregulin Supplementation to Maturation Culturing Medium in IVM.
Status:
Completed
Trial end date:
2020-01-31
Target enrollment:
Participant gender:
Summary
Clinical use of IVM was pioneered in the nineties, but has not yet become a realistic option
for wide-scale practice, for several reasons. Fundamentally, despite recent progress in
improving the implantation and the pregnancy rates using in-vitro matured oocytes, results of
IVM remain lower than treatment cycles utilizing conventional ART. To improve the outcome of
IVM cycles, this study focuses on improving in-vitro culture conditions.
In-vitro maturation (IVM) of human oocytes obtained from minimally stimulated or unstimulated
ovaries offers a more "patient friendly" treatment option than the conventional Assisted
Reproductive Technology (ART) treatment with controlled ovarian hyperstimulation (COH).
Typically, IVM will be offered to women with polycystic ovaries (PCO/PCOS), or to patients
with an excellent ovarian reserve, i.e. a high antral follicle count. IVM treatment is
characterized by minimal administration of FSH or hMG and NO hCG trigger. The IVM approach is
less disruptive to patients' daily life through the reduced need for hormonal and ultrasound
monitoring, avoids a range of minor and major complications, such as ovarian hyperstimulation
syndrome, and aims to reduce the total cost of infertility treatment for the patient and for
the health care budget.
Human oocytes retrieved from small antral follicles are able to resume meiosis by undergoing
germinal vesicle breakdown and extrusion of the first polar body, if oocytes have reached
meiotic competence. These oocytes can be fertilized although only a proportion (less than
50%) of them can develop further into viable embryos. It has been hypothesized that failure
of embryonic development may, at least in part, be due to an immature oocyte cytoplasm. A
novel human in vitro maturation (IVM) culture system (named CAPACITATION-IVM is being
investigated, hereafter named "CAPA") using 1°) natural compounds known to influence cAMP
levels within the cumulus-oocyte-complex and 2°) compounds that are crucial for the
oocyte-cumulus cross-talk. Keeping cyclic AMP high after retrieval in the GV oocyte prevents
the occurrence of nuclear maturation, enabling increased communication between the oocyte and
the cumulus cells. This allows for the improvement in the synchronization of nuclear and
cytoplasmic maturation processes in the oocyte, to the benefit of embryo quality.