The effects of co-culture with autologous cumulus cell on pregnancy outcomes by maternal age

It is known that the incidence of apoptosis in cumulus cells is associated with women age. In this study, we aimed to evaluate the influence of autologous cumulus cell co-culture on pregnancy outcomes by maternal age. A retrospective study was performed from January 2014 to December 2018. A total of 588 cycles which underwent GnRH long or antagonist protocol with fresh embryo transfer were analyzed. The cycles with severe male factor and single embryo transfer were excluded. The cycles were divided into two groups according to maternal age; 32–36 years (Group 1), ≥37 years (Group 2). Each group had embryos cultured in defined medium with autologous cumulus cell (ACC) or without autologous cumulus cell (No ACC). The ACC was dissected from the patient’s oocyte-cumulus complexes using two 29-gauge needles and washed twice. The collected ACC was directly put into the culture medium without hyaluronidase treatment. We compared the rates of clinical pregnancy, ongoing pregnancy, and implantation between ACC and No ACC by maternal age. The woman age, man age, and Day 3 good quality embryo rate were similar in the two groups. In the Group 1 cultured with ACC, the pregnancy rates were significantly increased than No ACC (Clinical Pregnancy: 49.4 % vs. 37.2 %, P < 0.05; Ongoing Pregnancy: 45.6 % vs. 31.0 %, P < 0.05; Implantation: 32.1 % vs. 22.1 %, P < 0.05). The clinical pregnancy and ongoing pregnancy rates were not statistically different between ACC and No ACC in Group 2 (Clinical Pregnancy: 16.5 % vs. 26.3 %, P = 0.06; Ongoing Pregnancy: 13.4 % vs. 19.4 %, P = 0.21). However, implantation rate was significantly decreased in ACC (9.0 % vs. 15.8 %, P < 0.05).Table 1Comparison of pregnancy outcomes between ACC and No ACC according to the age of patient.Group (Age)ACCNo ACCCycle (n)Clinical Pregnancies (%)Ongoing Pregnancies (%)Implantation (%)Cycle (n)Clinical Pregnancies (%)Ongoing Pregnancies (%)Implantation (%)Group 1 (32-36)7939 (49.4)36 (45.6)54/168 (32.1)22684 (37.2)*70 (31.0)*104/471 (22.1)*Group 2 (≥37)9716 (16.5)13 (13.4)20/223 (9.0)*18649 (26.3)36 (19.4)63/399 (15.8)* P < 0.05 Open table in a new tab * P < 0.05 The age of women might influence the pregnancy outcomes. These results suggested that co-culture with autologous cumulus cell, for patients under 37 years old, could improve the rates of clinical pregnancy, ongoing pregnancy, and implantation. However, it is considered that co-culture with autologous cumulus cell is not recommended to patients over 37 years old for the improvement of pregnancy rate. Further studies are needed to measure the incidence of apoptosis in autologous cumulus cells to compare the correlation between woman age and the incidence of apoptosis.