Follicular fluid and supernatant from cultured cumulus-granulosa cells improve in vitro maturation in patients with polycystic ovarian syndrome
Human in vitro maturation (IVM) is an approach that
was developed about 50 years ago, although its use
in IVF methods is still limited mainly to oncofertility
treatments and female factor infertility, especially in the case
of polycystic ovary syndrome (PCOS). IVM can be considered
as an additional tool in IVF to mimic physiological oocyte
maturation, which corresponds to resumption of the first
meiotic division and progression from diplotene to metaphase
II (MII). Oocyte maturation is characterized by the disappearance
of the germinal vesicle (GV), chromosome condensation,
spindle formation and separation of homologous chromosomes,
extrusion of the first polar body, and arrest of the
meiotic process at MII until fertilization (1). Successful oocyte
maturation requires the completion of nuclear maturation
through meiosis I and II and the maintenance of a good synchronization
with cytoplasmic maturation (2, 3).
The key to IVM success goes beyond the identification of
the best IVM medium and technical conditions. Therefore, the
oocyte, its source, and its follicular environment should be
considered as the crucial points. This could offer an acceptable
explanation for the currently poor implantation rate
and delivery rate per transferred embryos after IVM (about
half of the rates obtained after routine IVF) (4), particularly
in the case of women with PCOS (5, 6). However, other
studies did not find any difference