A Simplified Coculture System Using Homologous, Attached Cumulus Tissue Results in Improved Human Embryo Morphology and Pregnancy Rates During In Vitro Fertilization

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Abstract
Purpose: This study was undertaken to evaluate simplified methods of human embryo coculture using either attached or nonattached autologous cumulus tissue. Methods: Eight hundred one zygotes were cultured for 48 hr in a prospective, randomized trial comparing culture of embryos either with intact cumulus tissue, with cumulus tissue added to the droplet of culture medium, or without any cumulus tissue. In a follow-up study, embryo quality, pregnancy rates, and implantation rates were compared in 120 consecutive patients undergoing in vitro fertilization with a coculture system using cumulus tissue compared to a cohort of 127 patients undergoing IVF immediately preceding the institution of the coculture protocol. Results: Embryo morphology was significantly improved (P < 0.05) following culture with attached cumulus tissue (5.61 ± 0.29) and culture with added cumulus tissue (4.72 ± 0.31) compared to that of embryos grown in culture medium without cumulus tissue (3.95 ± 0.26). The clinical pregnancy rate improved from 39.4% (50/127) to 49.2% (59/120) following institution of a system of coculture with attached cumulus tissue. Conclusions: These data indicate that a simple coculture system using autologous cumulus tissue can result in improved embryo morphology, implantation rates, and clinical pregnancy rates during in vitro fertilization. This coculture system is simple, is non-labor intensive, and eliminates many of the risks which may be present in other embryo coculture systems.

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