This paper details methodology for using a novel tyramine linked hyaluronan gel for in vitro culture of mouse preantral follicles36,37. Figure 6 illustrates the differences between preantral follicle growth when placed in a conventional 2-D culture system versus a single follicle encapsulated in HA gel for 3-D culture. The native follicle architecture is maintained during the 12 days of culture with an antrum clearly visible on the last day of growth.
The HA gel is very versatile, allowing the growth of isolated follicles singly or in groups and also ovarian tissue is mechanically broken into small clusters of follicles. The gel is transparent making it possible to visualize follicles even if at different depths. Encapsulated follicles and FL-C exhibit radial expansion from continued granulosa cell proliferation (Figure 7). Initial follicle diameters average 139.8 ± 28 µm with the GV oocyte diameter measuring 63.5 ± 4.6 µm. In singly cultured follicles, final diameters measure at about 385.6 ± 36.7 µm, a roughly 3-fold increase in size. Ovulated metaphase II oocytes measure around 84.8 ± 3.8 µm. Within cultured FL-clusters, follicle size is fairly diverse (Figure 5, Figure 7). Ovulated oocytes after hCG trigger are found near the follicle (Figure 8). The majority of metaphase II oocytes will be retrieved from the ovulated COCs. Follicles still embedded after trigger usually contain GV and metaphase I oocytes.
Table 1 contrasts maturation rates between isolated follicles and FL-clusters from fresh or frozen ovaries. FL-C from cryopreserved ovaries had significantly lower maturation rates. Microscopic observations showed them to frequently have broken basal lamina, making them quite susceptible to premature oocyte extrusion. The fragile nature of follicle clusters was somewhat countered by encapsulation. Collagenase treatment of cryopreserved ovaries was avoided as it was especially damaging with low survival and low yield of intact follicles.
Cryopreservation of isolated follicles is much more effective than whole ovary preservation. High maturation rates can be achieved with both vitrification methods examined (Table 2). Despite large differences in cooling rates, oocyte maturation after IVC did not differ. The CL open carrier does allow for more efficiency as up to ten follicles can be loaded on a single CL open carrier. This also shortens the overall time for recovering multiple cryopreserved follicles. However, for any eventual clinical application of vitrification for human follicles the closed sealed system may be preferable.
Chromatin arrangement around the nucleolus of the GV oocyte can be used to identify oocytes most likely to fertilize after ovulation and develop to blastocysts38. Figure 9 illustrates live staining of oocytes to visualize the chromatin distribution pattern.

Figure 1: Schematic of follicle growth. This diagram illustrates the different stages of follicle development from a primary follicle to the secondary preantral stage and finally to a fully mature tertiary follicle ready for ovulation. A microscopic image of a typical preantral follicle is also shown with its different morphologic features. Please click here to view a larger version of this figure.

Figure 2: Schematic of HA encapsulation method. Structure of the hyaluronan gel and the different steps for follicle embedding are illustrated in this diagram. Please click here to view a larger version of this figure.

Figure 3: Follicle isolation and encapsulation. (A, B) Preantral follicle selected for embedding at magnification 40x and 200x. (C) Apoptotic follicle is shown with healthy preantral follicle with oocyte not quite central. (D) Image of HA gel bead seeded with follicles and (E) with two FL-C. Images taken with a stereomicroscope to show the entire gel bead. Please click here to view a larger version of this figure.

Figure 4: Vitrification devices for cryopreservation of isolated follicles. With the CL open carrier device, the vitrification step is conducted by direct immersion of follicles into liquid nitrogen. The rate of cooling is, therefore, extremely high, over -20,000 °C/min. In contrast, with the RI closed carrier, follicles are loaded on the inner plastic stick and dropped into an outer straw immersed in liquid nitrogen. This closed vitrification method avoids direct contact with liquid nitrogen. However, the cooling rate is significantly lower at -1220 °C/min. Loading and recovery of follicles from either carrier is easy. The CL open carrier accommodated loading up to ten follicles per device as compared to just two with the RI closed carrier. This figure has been modified from35. Please click here to view a larger version of this figure.

Figure 5: Representative images of problems encountered. (A) Follicle cluster with oocyte being extruded. (B) Isolated follicles with broken basal lamina membrane and one with an extruded oocyte. (C) Embedded follicle under a bubble in the gel. (D) Follicle cluster that remained in gel (left) compared to cluster embedded too deep that eventually attached to the dish. The wide range of follicle sizes in FL-C is clearly visible. Please click here to view a larger version of this figure.

Figure 6: Comparison of follicle growth in conventions 2-D versus 3-D culture in HA. With 2-D growth, flattening of the follicle and attachment of granulosa cells to the tissue culture dish was observed by Day 4, leaving the oocyte vulnerable to granulosa cell migration, disruption of gap junctions, and premature oocyte extrusion. The HA-encapsulated follicle remained unattached throughout the culture interval. Granulosa cell expansion occurred in all directions, encasing the oocyte and maintaining 3-D architecture. This figure has been modified from36. Please click here to view a larger version of this figure.

Figure 7: Representative images of follicles encapsulated in tyramine-linked hyaluronan gel. (A) Preantral follicle collected after collagenase digestion of fresh ovary on Day 1. (B) Gel drop seeded with four preantral follicles imaged on Day 1 and (C) Day 4 of culture (D) Follicle cluster from fresh ovary on day 2 (E) on Day 6 and (F) on Day 9 of culture. (G) Follicle cluster mechanically dissected from vitrified whole ovary shown on Day 2 and (H) on Day 6 of culture. (I) Follicle with antrum formation is clearly visible on Day 9 of culture. Please click here to view a larger version of this figure.

Figure 8: Oocyte ovulation. (A, B) Ovulated cumulus-oocyte complex (COC) shown next HA-gel bead. (C) Oocytes were imaged after enzymatic treatment of COCs with hyaluronidase to remove surrounding cumulus cells. Numerous metaphase II oocytes. (D) Metaphase II oocyte with prominent polar body. Magnification 400x. (E) Live imaging of metaphase II oocyte using polarized light and an imaging system to visualize meiotic spindle and assess organization, done as described in37. Magnification 400x. Normal birefringent spindle visible. (F) Metaphase II oocyte fixed and stained with anti-alpha/beta-tubulin and propidium iodide to visualize meiotic spindle organization. Please click here to view a larger version of this figure.

Figure 9: Chromatin reorganization in GV oocytes. Chromatin arrangement in GV oocytes after antrum formation was examined by staining of DNA with Hoechst 33342 (50 ng/mL). Representative follicles were harvested from HA beads by gentle pipetting. Granulosa cells were removed using hyaluronidase. GV oocytes were then stained for 15 min. (See protocol by Monti et al.38). Images were taken at 40x magnification. (A) GV oocyte shown on Day 1 at culture initiation exhibiting the non-surrounded chromatin (NSN) staining pattern. (B) GV oocyte from growing follicle with antrum shown on the day of hCG trigger. Chromatin condensed and formed a perinuclear ring around the nucleolus. Please click here to view a larger version of this figure.
| Parameter | Fresh Ovary | Frozen Ovary |
| FL-Isolated | FL-Cluster | FL-Cluster |
| Follicles Observed During IVC | 130 | 154 | 69 |
| Ovulation after HCG (%) | 71% | 66% | 93% |
| (92/130) | (101/154) | (64/69) |
| GVBD (%) | 30% | 28% | 52% |
| (28/92) | (28/101) | (33/64) |
| MII oocyte formation (%) | 59% | 55% | *34% |
| (54//92) | (56/101) | (22/64) |
Table 1: Outcomes with HA-embedded follicles from fresh and vitrified ovaries. Follicles and FL-C from fresh ovaries were matured in vitro after encapsulation in HA gel. HA gel was also tested on follicles from ovaries vitrified using an EG/DMSO protocol39. With fresh ovaries, both individual follicles (FL) and follicle clusters (FL-C) were collected after collagenase digestion. For vitrified ovaries, exposure to collagenase was, in fact, damaging to follicles. The best approach with cryopreserved ovaries was to isolate FL-clusters rather than individual follicles and to only use mechanical dissection with needles. The table contrasts outcomes between HA beads seeded with follicles in groups of 4-6 versus beads with a single FL-C containing 6-10 follicles. *The maturation rate with FL-C from cryopreserved ovaries was significantly lower (p = 0.008; Chi-Square analysis to test for significance).
| Carrier | RI | CL |
| (Closed) | (Open) |
| Survival (%) | 100% (24/24) | 100% (41/41) |
| Antrum formation* (%) | 25.0% (6/24) | 75.6% (31/41)* |
| Ovulation rate (%) | 66.7% (16/24) | 87.8% (36/41) |
| Maturation rate (% MIIs) | 81.3% (13/16) | 69.4% (25/36) |
Table 2: Outcomes after cryopreservation of isolated follicles on two different vitrification devices. High maturation rates were achieved with both the open CL device as well as the closed RI carrier, with its lower cooling rate. Antrum formation was the only outcome measure observed to be significant but did not impact the overall maturation rate (p < 0.05; Chi-square analysis to test for significance).