Single vs. Group CAPA-IVM Culture of Cumulus-oocyte Complexes

Study Overview
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Brief Summary
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Oocyte in vitro maturation (IVM) is a minimal-stimulation ART with reduced hormone-related side effects and risks for the patients. However, the approach is not widely used because of an efficiency gap compared to conventional ART. In order to further optimize and adapt the CAPA-IVM system in the IVM clinic, this pilot study aims to check the feasibility of applying a single COC CAPA-IVM strategy versus the group COC culture CAPA-IVM

Detailed Description
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Oocyte in vitro maturation (IVM) is a minimal-stimulation ART with reduced hormone-related side effects and risks for the patients. However, the approach is not widely used because of an efficiency gap compared to conventional ART. Oocytes retrieved for IVM procedures derive from a heterogeneous pool with variable cellular and molecular characteristics that indicate its immature status. Thus, in vitro systems that permit and enhance acquisition and synchronization of meiotic competence (ability to resume meiosis in response to an ovulatory stimulus) and developmental competence (ability to be fertilized and support early embryo development) before the meiotic trigger are crucial for the optimization of human IVM systems. A novel two-step IVM culture system (named CAPA-IVM) involving a pre-maturation culture with C-type natriuretic peptide (CNP) and a maturation step in presence of Amphiregulin (AREG), both more physiological compounds improving oocyte competence, have been introduced in previous clinical studies. So far these pilot studies proved to increase the rates of oocyte maturation, good quality embryos on day 3, good quality blastocyst, and as a result a higher embryo yield. CAPA-IVM blastocysts have shown similar rates of methylation and gene expression at gDMRs compared to COS embryos; and the expression of ma-jor epigenetic regulators was similar between both groups. Furthermore, an improvement in pregnancy rates strengthens the clinical relevance of the use of CAPA-IVM strategy. In order to further optimize and adapt the CAPA-IVM system in the IVM clinic, this pilot study aims to check the feasibility of applying a single COC CAPA-IVM strategy versus the group COC culture CAPA-IVM. A single COC culture would permit to perform a non-invasive molecular analysis per matured oocyte, in order to identify quality genes ex-pressed in cumulus cells post-IVM (cumulus biomarkers), which could be subsequently used to identify the embryo(s) with highest potential of implantation.

Official Title
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Effect of Single vs. Group CAPA-IVM Culture of Human Cumulus-oocyte Complexes From Small Antral Follicles in a SIBLING Oocyte Study Design

Conditions
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IVF, PCOS, IVM

Intervention / Treatment
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* Other: The way of Cumulus-oocyte complexes (COC) culture


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Having polycystic ovarian morphology: at least 25 follicles (2-9 mm) throughout the whole ovary and/or increased ovarian volume (>10ml) (it is sufficient that 1 ovary fits these criteria) No major uterine or ovarian abnormalities Having at least 15 follicles on the OPU day Patients consent to participate in the study Exclusion Criteria: High (>grade 2) grade endometriosis Cases with extremely poor sperm (serve OAT: density <1 million, mobility <10% and sperm from testicular surgery)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 37 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Single Culture<br>Transfer the COCs cultured individually in Capacitation medium to the individual washing droplets from the washing dish containing Maturation Medium and wash them thoroughly. Then transfer COCs one by one to the Culture dish with Maturation Medium. | Other: The way of Cumulus-oocyte complexes (COC) culture<br>* Cumulus-oocyte complexes (COC) will be cultured in CAPA-IVM standard conditions: 24 hrs capacitation followed by 30h maturation. The first group will be culture in pools (group culture). The second group will be culture individually in 20µl droplets.<br>|
| Experimental: Group Culture<br>Transfer half of the COCs (5-10 at a time) from the Capacitation culture dish to the washing dish containing Maturation Medium (Group Culture) by using an Eppendorf micropipette and wash them thoroughly (load pipette tips with 5µl, max. 10µl). Then transfer COCs to the IVM dish with Maturation Medium (Group Culture). | Other: The way of Cumulus-oocyte complexes (COC) culture<br>* Cumulus-oocyte complexes (COC) will be cultured in CAPA-IVM standard conditions: 24 hrs capacitation followed by 30h maturation. The first group will be culture in pools (group culture). The second group will be culture individually in 20µl droplets.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of good quality embryos | Number of good quality Day 3 embryos obtained | At least 3 days after intra-cytoplasmic sperm injection | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maturation rate | Percentage of mature oocytes by 2 types of COC culture | Two days after oocytes pick-up | 
| Fertilization rate | Percentage of fertilized oocytes by 2 types of COC culture | 16-18 hours after intra-cytoplasmic sperm injection | 
| Cleavage rate | Percentage of day-3 embryos over fertilized oocytes by 2 types of COC culture | At least 3 days after intra-cytoplasmic sperm injection | 
| Expansion rate | Percentage of cumulus-oocyte complexes expanded after culture by 2 types of COC culture | After at least 30 hours of maturation culture | 
| The relative expression ratio ( R ) of human cumulus cell genes | Cumulus cells will be collected, cDNA synthesis after mRNA purification, relative quantification PCR for detecting gene expression | cumulus cells will be collected after at least 30 hours of maturation culture, storaged at -80oC until RNA purification | 
| Positive pregnancy test | Serum human chorionic gonadotropin level greater than 25 mIU/mL | at 2 weeks after the embryo placement after the completion of the first transfer | 
| Clinical pregnancy | at least one gestational sac on ultrasound at 7 weeks' gestation with the detection of heart beat activity | 5 weeks after embryo placement after the completion of the first transfer | 
| Ongoing pregnancy | Ongoing pregnancy is defined as pregnancy with detectable heart rate at 12 weeks' gestation or beyond, after the completion of the first transfer | At 12 weeks' gestation | 
| Implantation rate | as the number of gestational sacs per number of embryos transferred | 3 weeks after embryo transferred after the completion of the first transfer | 
| Multiple pregnancy | Defined as presence of more than one sac at early pregnancy ultrasound (6-8 weeks gestation) | 5 weeks after embryo placement after the completion of the first transfer | 
| Multiple delivery | Birth of more than one baby beyond 24 weeks | At 24 weeks' gestation | 
| Miscarriage | pregnancy loss at < 24 weeks | at 24 weeks of gestation after the completion of the first transfer | 
| Live birth | defined as at least one newborn after 24 weeks of gestation and exhibiting any sign of life; twins were counted as a single birth | At 24 weeks of gestation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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CAPA-IVM, Single culture, Group culture