Follicular fluid and supernatant from cultured cumulus-granulosa cells improve in？vitro maturation in patients with polycystic ovarian syndrome - Fertility and Sterility

To study the effectiveness of a new in vitro maturation (IVM) approach based on heterologous follicular fluid (HFF) and supernatant of cumulus-granulosa cells (CGCs) mimicking the intact follicular microenvironment to rescue immature denuded oocytes (IDOs) of patients with polycystic ovary syndrome (PCOS) whose IVM or IVF outcomes remain poor. Randomized controlled trial. University-affiliated private center. One hundred fifty-nine IDOs were obtained from 47 patients with PCOS. First, a simple IVM system (S-IVM; 40 IDOs; control group) was compared with different protocols based on the addition of autologous follicular fluid (AFF-IVM; 44 IDOs), HFF (HFF-IVM; 42 IDO), or HFF with CGC isolated from seven women without PCOS and presenting 100% in vivo oocyte maturation (HFF/CGC-IVM; 33 IDOs). None. IVM outcomes were compared among the four groups (S-IVM, AFF-IVM, HFF-IVM, HFF/CGC-IVM); then the vitro and in vivo maturation results (from controlled ovarian stimulation of PCOS patients) were compared for each group. The HFF/CGC-IVM method gave the best yield of developed blastocysts per IDO compared with S-IVM, AFF-IVM, and HFF-IVM (27% vs. 2%, 2%, and 12%, respectively). The IVM rate with the HFF/CGC-IVM method was even higher than that compared with the in vivo maturation rate (79% vs. 42%), with significant improvement in the cleavage rate (71% vs. 61%). This adapted IVM system could be used to reach an acceptable result in meiotic competence and competent metaphase II oocytes capable of developing into intact embryos after fertilization and before transfer. El líquido folicular y el sobrenadante de cultivos de células del cúmulo-granulosa mejoran la maduración in vitro en pacientes con síndrome de ovario poliquístico. Estudiar la efectividad de un nuevo abordaje de maduración in vitro (IVM) basado en líquido folicular heterólogo (HFF) y sobrenandante de cultivo de cumulus-células de la granulosa (CGCs) imitando el microambiente folicular intacto para rescatar ovocitos inmaduros denudados (IDOs) de pacientes con síndrome de ovario poliquístico (PCOS) cuyos resultados en IVM o IVF son pobres. Estudio aleatorizado controlado. Centro privado afiliado universidad. Se obtuvieron 159 IDOs de 47 pacientes con PCOS. Primero, un sistema de IVM simple (grupo control: S-IVM; 40 IDOs) se comparó con diferentes protocolos basados en la adición de líquido folicular autólogo (AFF-IVM; 44 IDOs), HHF (HHF-IVM; 42 IDO), o HFF con CGC aislado de siete mujeres sin PCOS y que presentaron una maduración ovocitaria in vivo del 100% (HFF/CGC-IVM; 33 IDOs). ninguna. Los