The suitability and efficiency of human follicular fluid as a protein supplement in human in vitro fertilization programs

Objective: To evaluate the suitability and efficiency of human follicular fluid (HFF) as a protein supplement in human IVF programs. Design: Comparative study of the effects of HFF and other protein supplements on the in vitro development of mouse oocytes and on the pregnancy rate in human IVF programs. Setting: In Vitro Fertilization Center, Hanna Women’s Clinic, Seoul, Korea. Patient(s): Three hundred twenty-seven patients (388 cycles) who were down-regulated with GnRH agonist and stimulated with hMG. Intervention(s): The suitability was evaluated with the results of animal studies and the efficiency of HFF was investigated with the results of human IVF programs. Main Outcome Measure(s): Meiotic maturation of mouse oocytes, development of mouse embryos, morphological grades of human embryos, pregnancy rate in human IVF programs, and electrophoresis. Result(s): Human follicular fluid significantly stimulated meiotic resumption in mouse oocytes, even in the presence of meiotic inhibitors, and enhanced the developmental potential of mouse embryos in vitro. Compared with human fetal cord serum, human follicular fluid also improved the morphological grade of human embryos by reducing cytoplasmic fragmentation. In conventional IVF cycles of human IVF programs, use of HFF significantly increased the clinical PR (109/234 cycles, 46.5%; P < .05), compared with use of human fetal cord serum (14/52 cycles, 26.9%). However, in intracytoplasmic sperm injection cycles, there was no difference in PRs between use of HFF (38/85 cycles, 44.7%) and use of human fetal cord serum (7/17 cycles, 41.1%). When the protein compositions of human fetal cord serum and HFF were investigated by electrophoresis, a protein of 21 kD was detected specifically in HFF. Conclusion(s): Human follicular fluid is suitable for use as a protein supplement and is effective in increasing the pregnancy rate in human IVF programs.