Hyaluronidase removal of the cumulus oophorus increases in vitro fertilization

The effect of hyaluronidase removal of the cumulus oophorus on the in vitro fertilization rate of oocytes obtained from patients with poor oocyte fertilizability has been evaluated. Eighty-eight oocytes were obtained from 13 patients undergoing in vitro fertilization and embryo transfer (IVF-ET) for indications of male-factor, immunological, and idiopathic infertility. In addition, patients in whom fertilization did not occur on previous IVF cycles were evaluated in the study. The oocytes of each individual patient were randomly assigned into a treatment (removal of the cumulus; N = 40 oocytes) or nontreatment group (control; N = 48 oocytes). Hyaluronidase was used to remove the cumulus immediately following oocyte retrieval, and insemination was performed 6-8 hr later. The overall oocyte fertilization rate (both treated and untreated) was 42%. The treatment group demonstrated a higher rate of fertilization compared to the nontreatment group (55% vs 31%; P less than 0.05). Examination of various patient groups revealed a statistically significant difference in fertilization rates between the treated and the untreated oocytes only in the "no previous fertilization" group (60% vs 28%; P less than 0.05). A higher rate of fertilization of the treated oocytes was also seen in the immunologic infertility group, however, statistical significance was not achieved (50% vs 25%; P = 0.07). Only one clinical pregnancy was achieved in this group of 13 patients. We conclude that in this group of patients, removal of the cumulus prior to insemination may, in some cases, increase the fertilization potential of the oocyte.