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<art><ui>1477-7827-9-3</ui><ji>1477-7827</ji><fm>
<dochead>Research</dochead>
<bibl>
<title>
<p>Ultrastructure of isolated mouse ovarian follicles cultured <it>in vitro</it>
</p>
</title>
<aug>
<au id="A1" ce="yes"><snm>Nottola</snm><mi>A</mi><fnm>Stefania</fnm><insr iid="I1"/><email>stefania.nottola@uniroma1.it</email></au>
<au id="A2" ce="yes"><snm>Cecconi</snm><fnm>Sandra</fnm><insr iid="I2"/><email>sandra.cecconi@cc.univaq.it</email></au>
<au id="A3"><snm>Bianchi</snm><fnm>Serena</fnm><insr iid="I2"/><email>serena.bianchi@univaq.it</email></au>
<au id="A4"><snm>Motta</snm><fnm>Cecilia</fnm><insr iid="I1"/><email>cmotta@ospedalesantandrea.it</email></au>
<au id="A5"><snm>Rossi</snm><fnm>Gianna</fnm><insr iid="I2"/><email>gianna.rossi@cc.univaq.it</email></au>
<au id="A6"><snm>Continenza</snm><mi>A</mi><fnm>Maria</fnm><insr iid="I2"/><email>mariaadelaide.continenza@cc.univaq.it</email></au>
<au ca="yes" id="A7"><snm>Macchiarelli</snm><fnm>Guido</fnm><insr iid="I2"/><insr iid="I3"/><email>guido.macchiarelli@cc.univaq.it</email></au>
</aug>
<insg>
<ins id="I1"><p>Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, "La Sapienza" University of Rome, Rome, Italy</p></ins>
<ins id="I2"><p>Department of Health Sciences, University of L'Aquila, L'Aquila, Italy</p></ins>
<ins id="I3"><p>Centre of Microscopy, University of L'Aquila, L'Aquila, Italy</p></ins>
</insg>
<source>Reproductive Biology and Endocrinology</source>
<issn>1477-7827</issn>
<pubdate>2011</pubdate>
<volume>9</volume>
<issue>1</issue>
<fpage>3</fpage>
<url>http://www.rbej.com/content/9/1/3</url>
<xrefbib><pubidlist><pubid idtype="doi">10.1186/1477-7827-9-3</pubid><pubid idtype="pmpid">21232101</pubid></pubidlist></xrefbib>
</bibl>
<history><rec><date><day>4</day><month>10</month><year>2010</year></date></rec><acc><date><day>13</day><month>1</month><year>2011</year></date></acc><pub><date><day>13</day><month>1</month><year>2011</year></date></pub></history>
<cpyrt><year>2011</year><collab>Nottola et al; licensee BioMed Central Ltd.</collab><note>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</note></cpyrt>
<abs>
<sec>
<st>
<p>Abstract</p>
</st>
<sec>
<st>
<p>Background</p>
</st>
<p>
<it>In vitro </it>maturation of ovarian follicles, in combination with cryopreservation, might be a valuable method for preserving and/or restoring fertility in mammals with impaired reproductive function. Several culture systems capable of sustaining mammalian follicle growth <it>in vitro </it>have been developed and many studies exist on factors influencing the development of <it>in vitro </it>grown oocytes. However, a very few reports concern the ultrastructural morphology of <it>in vitro </it>grown follicles.</p>
</sec>
<sec>
<st>
<p>Methods</p>
</st>
<p>The present study was designed to evaluate, by transmission and scanning electron microscopy, the ultrastructural features of isolated mouse preantral follicles cultured <it>in vitro </it>for 6 days in a standard medium containing fetal calf serum (FCS). The culture was supplemented or not with FSH.</p>
</sec>
<sec>
<st>
<p>Results</p>
</st>
<p>The follicles cultured in FCS alone, without FSH supplementation (FCS follicles), did not form the antral cavity. They displayed low differentiation (juxta-nuclear aggregates of organelles in the ooplasm, a variable amount of microvilli on the oolemma, numerous granulosa cell-oolemma contacts, signs of degeneration in granulosa cell compartment). Eighty (80)% of FSH-treated follicles formed the antral cavity (FSH antral follicles). These follicles showed various ultrastructural markers of maturity (spreading of organelles in ooplasm, abundant microvilli on the oolemma, scarce granulosa cell-oolemma contacts, granulosa cell proliferation). Areas of detachment of the innermost granulosa cell layer from the oocyte were also found, along with a diffuse granulosa cell loosening compatible with the antral formation. Theca cells showed an immature morphology for the stage reached. Twenty (20)% of FSH-treated follicles did not develop the antral cavity (FSH non-antral follicles) and displayed morphological differentiation features intermediate between those shown by FCS and FSH antral follicles (spreading of organelles in the ooplasm, variable amount of microvilli, scattered granulosa cell-oolemma contacts, signs of degeneration in granulosa cell compartment).</p>
</sec>
<sec>
<st>
<p>Conclusions</p>
</st>
<p>It is concluded that FSH supports the <it>in vitro </it>growth of follicles, but the presence of a diffuse structural granulosa cell-oocyte uncoupling and the absence of theca development unveil the incomplete efficiency of the system. The present study contributes to explain, from a morphological point of view, the effects of culture conditions on the development of mouse <it>in vitro </it>grown follicles and to highlight the necessity of maintaining efficient intercellular communications to obtain large numbers of fully-grown mature germ cells.</p>
</sec>
</sec>
</abs>
</fm><bdy>
<sec>
<st>
<p>Background</p>
</st>
<p>
<it>In vitro </it>culture and maturation of preantral ovarian follicles currently represents one of the most important tools of investigation in the field of assisted reproduction. This technique, in combination with cryopreservation, might be a valuable method for preserving and/or restoring fertility in mammals with impaired reproductive function, ultimately achieving <it>in vitro </it>growth of viable oocytes competent for fertilization <abbrgrp>
<abbr bid="B1">1</abbr>
</abbrgrp>. The low temperature has been demonstrated useful to store gametes in several mammalian species such as mouse <abbrgrp>
<abbr bid="B2">2</abbr>
<abbr bid="B3">3</abbr>
<abbr bid="B4">4</abbr>
</abbrgrp>, sheep <abbrgrp>
<abbr bid="B5">5</abbr>
<abbr bid="B6">6</abbr>
</abbrgrp> and human [for review, see: 7]. After thawing, one strategy for yielding mature oocytes may be to isolate small (preantral) follicles (that result tolerant to cryodamage) <abbrgrp>
<abbr bid="B1">1</abbr>
</abbrgrp> from the cryopreserved ovarian tissue and to subject them to subsequent <it>in vitro </it>culture <abbrgrp>
<abbr bid="B2">2</abbr>
<abbr bid="B8">8</abbr>
<abbr bid="B9">9</abbr>
<abbr bid="B10">10</abbr>
<abbr bid="B11">11</abbr>
<abbr bid="B12">12</abbr>
<abbr bid="B13">13</abbr>
<abbr bid="B14">14</abbr>
<abbr bid="B15">15</abbr>
<abbr bid="B16">16</abbr>
</abbrgrp>.</p>
<p>In recent years, numerous <it>in vitro </it>culture systems for ovarian mammalian follicles and immature oocytes have been designed to study regulative processes occurring during folliculogenesis and oogenesis. These studies contributed to the development of new reproductive biotechnologies, including clinical application in the treatment of human infertility <abbrgrp>
<abbr bid="B1">1</abbr>
<abbr bid="B15">15</abbr>
<abbr bid="B17">17</abbr>
<abbr bid="B18">18</abbr>
<abbr bid="B19">19</abbr>
<abbr bid="B20">20</abbr>
<abbr bid="B21">21</abbr>
<abbr bid="B22">22</abbr>
</abbrgrp>. At present, follicles at various stages of development collected from both fresh or cryopreserved ovarian tissue have the potentiality to grow <it>in vitro</it>. However, culture procedures have not been yet optimized. This is partially due to the heterogeneity of the follicle population present in the adult ovarian tissue and to the extreme variability of culture systems and media, including considerable variations in length of the culture period in relation to different animal species <abbrgrp>
<abbr bid="B1">1</abbr>
<abbr bid="B18">18</abbr>
<abbr bid="B23">23</abbr>
</abbrgrp>.</p>
<p>Fertilizable oocytes and live offspring following embryo transfer were firstly obtained from mouse preantral follicles, cultured either intact <abbrgrp>
<abbr bid="B24">24</abbr>
</abbrgrp> or devoid of theca cell (TC) layers (oocyte-granulosa cell - GC-complexes) <abbrgrp>
<abbr bid="B25">25</abbr>
<abbr bid="B26">26</abbr>
<abbr bid="B27">27</abbr>
</abbrgrp>. Then, many papers have been published on the culture of small follicles from mouse <abbrgrp>
<abbr bid="B1">1</abbr>
<abbr bid="B28">28</abbr>
</abbrgrp> or large mammals such as pig <abbrgrp>
<abbr bid="B29">29</abbr>
<abbr bid="B30">30</abbr>
<abbr bid="B31">31</abbr>
</abbrgrp>, sheep <abbrgrp>
<abbr bid="B32">32</abbr>
</abbrgrp>, bovine <abbrgrp>
<abbr bid="B17">17</abbr>
<abbr bid="B29">29</abbr>
<abbr bid="B33">33</abbr>
<abbr bid="B34">34</abbr>
</abbrgrp>, primates <abbrgrp>
<abbr bid="B17">17</abbr>
</abbrgrp> and humans <abbrgrp>
<abbr bid="B14">14</abbr>
<abbr bid="B20">20</abbr>
<abbr bid="B35">35</abbr>
<abbr bid="B36">36</abbr>
</abbrgrp>. These studies pointed out that mouse is the most handling source for experimental <it>in vitro </it>model. In fact, mouse oocytes can acquire full developmental competence under very different culture conditions <abbrgrp>
<abbr bid="B24">24</abbr>
<abbr bid="B25">25</abbr>
<abbr bid="B37">37</abbr>
<abbr bid="B38">38</abbr>
<abbr bid="B39">39</abbr>
<abbr bid="B40">40</abbr>
<abbr bid="B41">41</abbr>
<abbr bid="B42">42</abbr>
</abbrgrp>. Thus, setting up an <it>in vitro </it>grown (IVG) mouse follicle model for the morphological studies is fundamental for the validation of IVG technologies and may provide a useful background for the studies in large mammals <abbrgrp>
<abbr bid="B43">43</abbr>
</abbrgrp>. However, up to now only a few and not comprehensive microscopical studies concerned with IVG mouse follicles.</p>
<p>During the last decades, electron microscopy provided significant data on the morphological changes of mammalian ovarian follicle development <it>in vivo </it>
<abbrgrp>
<abbr bid="B44">44</abbr>
<abbr bid="B45">45</abbr>
<abbr bid="B46">46</abbr>
<abbr bid="B47">47</abbr>
<abbr bid="B48">48</abbr>
<abbr bid="B49">49</abbr>
</abbrgrp>. More recently, several studies reported a few ultrastructural data on isolated preantral ovarian follicles of various mammals subjected <it>in vitro </it>to different culture conditions. These observations focused on early maturation of human primordial follicles <abbrgrp>
<abbr bid="B14">14</abbr>
</abbrgrp>, changes of mouse TCs <abbrgrp>
<abbr bid="B50">50</abbr>
</abbrgrp> and rat GC-oolemma contacts <abbrgrp>
<abbr bid="B51">51</abbr>
</abbrgrp> or degenerative aspects of bovine follicles <abbrgrp>
<abbr bid="B52">52</abbr>
</abbrgrp> in culture. The ultrastructure of preantral mouse follicle after cryopreservation was studied in mouse <abbrgrp>
<abbr bid="B2">2</abbr>
<abbr bid="B16">16</abbr>
</abbrgrp>. Other studies concerned follicle ultrastructure in human <abbrgrp>
<abbr bid="B53">53</abbr>
<abbr bid="B54">54</abbr>
</abbrgrp> and goat <abbrgrp>
<abbr bid="B55">55</abbr>
<abbr bid="B56">56</abbr>
</abbrgrp> organ cultures. These papers agree with the fact that transmission electron microscopy (TEM) is an irreplaceable tool for the fine study of the ovarian follicle morphodynamics. However, a comprehensive and systematic ultrastructural survey of IVG isolated preantral follicles grown <it>in vitro </it>in basic conditions is lacking in the literature. In addition, to our knowledge, the fine surface morphology of IVG follicles as revealed by scanning electron microscopy (SEM) has been previously addressed only in a preliminary report of our group <abbrgrp>
<abbr bid="B57">57</abbr>
</abbrgrp>.</p>
<p>Aims of the present study were: 1. to analyze the ultrastructural features of IVG mouse preantral follicles cultured with TC layer, evaluating follicle morphology by a combined TEM/SEM ultrastructural approach, to describe fine intracellular structures and three-dimensional details; 2. to compare the ultrastructural features of the follicles cultured in presence or absence of FSH supplementation.</p>
</sec>
<sec>
<st>
<p>Methods</p>
</st>
<sec>
<st>
<p>Preantral follicle isolation and culture</p>
</st>
<p>Five consecutive experiments were performed. All the experiments were carried out in accordance with the procedure described in the guidelines for the care and use of laboratory animals approved by the Animal Care Committee of the University of L'Aquila. A total of 20 Swiss CD1 female mice (Harlan, Udine, Italy), aged 24-26 days, killed by cervical dislocation, were used in these experiments. Preantral follicles (N = 500) were mechanically isolated from the ovaries (together with a small clump of thecal-stromal tissue attached) under a stereo-microscope using fine needles and collected with a micropipette. Only those showing a centrally located oocyte within an intact basement membrane, with no apparent sign of necrosis were selected for further culture (N = 350). To this end follicles were individually cultured in 25 &#956;l of culture medium in 96-V-well microtitre plates (Greiner Labortechnik, LTD), overlaid with 70 ml of mineral oil (embryo tested, d = 0.84 g/ml). Culture medium was Alpha Minimal Essential Medium (&#945;-MEM) supplemented with 1% ITS (insulin, 5 &#956;g/ml; transferrin, 5 &#956;g/ml; and sodium selenite, 5 ng/ml), antibiotics (penicillin, 100 U/ml; streptomycin, 100 mg/ml), and 5% fetal calf serum (FCS) supplemented or not with highly purified ovine FSH (100 mIU/ml, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)-o-FSH-19-SIAFP, BIO). All the other chemicals used in culture were purchased from Sigma Chemical Company (St. Louis, MO, USA). Both follicles cultured in FCS alone, without FSH supplementation (FCS follicles, N = 150) and FSH-treated follicles (N = 200) were incubated at 37&#176;C in 5% CO<sub>2 </sub>in air and saturated humidity for 6 days. Culture medium was changed every other day.</p>
</sec>
<sec>
<st>
<p>Electron microscopy</p>
</st>
<p>At the end of the culture period, follicles from both groups (N = 60) were destined to electron microscopy analysis.</p>
<p>Thirty (30) follicles were fixed in 1.5% glutaraldehyde in 0.1 M PBS and then processed for light microscopy (LM) and TEM according to the procedures described by Motta et al. <abbrgrp>
<abbr bid="B46">46</abbr>
</abbrgrp>. Semi-thin sections, cut with a glass knife and mounted on glass, were stained with methylene blue and observed by LM. Ultra-thin sections cut with a diamond knife and mounted onto copper grids, were double stained with uranyl acetate and lead citrate. TEM observations were performed by means of Zeiss EM 10 and Philips TEM CM100 Electron Microscopes.</p>
<p>The remaining 30 specimens were fixed in 2.5% glutaraldehyde in 0.1 M PBS and processed for conventional SEM or for digestion of the extracellular matrix <abbrgrp>
<abbr bid="B45">45</abbr>
<abbr bid="B58">58</abbr>
</abbrgrp>. By this method, the cell framework of follicles was preserved whereas extracellular tissue components, including collagen fibrils, were removed. Samples were observed in Philips XL-30-CP and Hitachi S-4000 scanning electron microscopes.</p>
</sec>
<sec>
<st>
<p>Statistical analysis</p>
</st>
<p>Follicular growth was evaluated by phase contrast microscopy (PCM) measuring follicular and oocyte diameters (in &#956;m) from day 1 to day 6 of culture.</p>
<p>For the image analysis study, sections were made at the midpoint of the follicles, in order to minimize bias due to tangential sectioning. The presence and amount of the transzonal processes (TZPs) of the innermost layer of the GCs surrounding the oocytes of FCS follicles and FSH-treated follicles was evaluated by TEM on sections made at several planes (magnification: x6300). Images were further enlarged on the PC screen, in order to easily recognize and count TZPs. Values were expressed in number of visible portions of TZPs per 20 &#956;m<sup>2 </sup>of zona pellucida area.</p>
<p>Statistical data were shown as mean &#177; SD. <it>P</it>-value and statistical significance were evaluated by Student's t test <abbrgrp>
<abbr bid="B59">59</abbr>
</abbrgrp>. Significance was defined as <it>P </it>&lt; 0.05.</p>
</sec>
</sec>
<sec>
<st>
<p>Results</p>
</st>
<sec>
<st>
<p>Follicle culture</p>
</st>
<p>At the end of a 6 day-culture period, all FCS follicles underwent a small increase in size (from 160 &#177; 10 &#956;m to 200 &#177; 10 &#956;m; <it>P </it>&gt; 0.05) and did not develop the antral cavity (AC). By contrast, a high percentage (80%) of FSH-treated follicles increased significantly in diameter (from 160 &#177; 10 &#956;m to 420 &#177; 20 &#956;m; <it>P </it>&lt; 0.05) and formed variable sized ACs. By PCM the AC appeared as a translucent area in the GC mass that could also comprise about half of the follicle. On the basis of the above observations, follicles were sorted into three groups: FCS follicles, FSH-treated follicles with a visible AC (FSH antral follicles), and FSH-treated follicles without a visible AC (FSH non-antral follicles). Growth was also observed in the germinal component, as oocyte diameter increased from 62 &#177; 1 &#956;m up to 73 &#177; 1 &#956;m (<it>P </it>&lt; 0.01) without differences among the various groups <abbrgrp>
<abbr bid="B39">39</abbr>
<abbr bid="B40">40</abbr>
</abbrgrp>.</p>
<p>After culture, 60 intact follicles (20 FCS follicles, 20 FSH antral follicles and 20 FSH non-antral follicles) were chosen and assigned to electron microscopy examination. Specifically, 10 follicles from each group were prepared for LM-TEM analysis whereas the remaining follicles were destined to SEM examination.</p>
</sec>
<sec>
<st>
<p>General appearance of IVG follicles at day 6</p>
</st>
<p>As seen by LM or SEM, all follicles maintained a round shape during culture. All follicular main structural elements were present (TCs, basement membrane, GCs, zona pellucida and oocyte) (Figure <figr fid="F1">1</figr>). All follicles showed round shaped and centrally located intact oocytes with a normally structured zona pellucida (Figure <figr fid="F1">1a, c, e</figr>). FCS follicles showed 4-5 layers of cuboidal GCs (Figure <figr fid="F1">1a, b</figr>); FSH-treated follicles showed more numerous GCs distributed in a higher number of layers (6-8) (Figure <figr fid="F1">1c, d, e, f</figr>). FSH antral follicles presented fluid-filled spaces among somatic cells (Figure <figr fid="F1">1c</figr>), while FCS and FSH non-antral follicles showed a compact granulosa layer (Figure <figr fid="F1">1a, b, e, f</figr>). All follicles showed an intact but thin, immature theca layer (Figure <figr fid="F1">1</figr>).</p>
<fig id="F1"><title><p>Figure 1</p></title><caption><p>General appearance of <it>in vitro </it>grown follicles</p></caption><text>
   <p><b>General appearance of <it>in vitro </it>grown follicles</b>. FCS follicles (panels a, b); FSH antral follicles (panels c, d); FSH non-antral follicles (panels e, f). The general appearance of cultured follicles is shown by LM (panels a, c, e) and SEM (panels b, d, f). Panels a-f, O: oocyte; GC: granulosa cells; TC: theca cells. Panels a, c, e, ZP: zona pellucida; b: basement membrane. Panel c, asterisks: fluid-filled spaces. Bar is: 30 &#956;m (panel a); 100 &#956;m (panels b, d); 50 &#956;m (panels c, f); 45 &#956;m (panel e).</p>
</text><graphic file="1477-7827-9-3-1" hint_layout="double"/></fig>
</sec>
<sec>
<st>
<p>Main ultrastructural features of IVG follicles at day 6</p>
</st>
<sec>
<st>
<p>FCS follicles</p>
</st>
<p>
<it>Oocyte: </it>the nuclear envelope was continuous and irregular in shape because provided with folds and invaginations (Figure <figr fid="F2">2a</figr>). The ooplasm showed accumulation in the juxta-nuclear region of cytoplasmic organelles, especially aggregates of rounded mitochondria and lipid droplets (Figure <figr fid="F2">2a, b</figr>). The ooplasm also showed some vacuolization. The oolemma was continuous and bordered with microvilli, variable in length and amount. GCs were closely adhering to the zona pellucida (Figure <figr fid="F2">2c</figr>), which was always apparently normal and crossed by numerous TZPs originating from the innermost layer of the GCs and reaching the oolemma (GC-oolemma contacts) (Figure <figr fid="F2">2c, d</figr>). The mean number &#177; SD per 20 &#956;m<sup>2 </sup>of TZPs was 29.90 &#177; 7.08 (Table <tblr tid="T1">1</tblr>).</p>
<tbl id="T1"><title><p>Table 1</p></title><caption><p>Morphometric evaluation of the presence of transzonal processes (TZPs) in IVG mouse ovarian follicles cultured with or without FSH for 6 days</p></caption><tblbdy cols="4">
      <r>
         <c>
            <p/>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>FCS</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>FSH ANTRAL</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>FSH NON-ANTRAL</it>
               </b>
            </p>
         </c>
      </r>
      <r>
         <c cspan="4">
            <hr/>
         </c>
      </r>
      <r>
         <c ca="center">
            <p>
               <b>
                  <it>N&#176; of TZPs/20 &#956;m</it>
               </b>
               <sup>
                  <b>
                     <it>2</it>
                  </b>
               </sup>
            </p>
         </c>
         <c ca="center">
            <p>29.90 &#177; 7.08<sup>a</sup></p>
         </c>
         <c ca="center">
            <p>6.80 &#177; 6.20<sup>b</sup></p>
         </c>
         <c ca="center">
            <p>14.20 &#177; 8.05<sup>c</sup></p>
         </c>
      </r>
   </tblbdy><tblfn>
      <p><sup>a,b</sup><it>P </it>&lt; 0.0001; <sup>a,c </sup><it>P </it>= 0.0002; <sup>b,c </sup><it>P </it>= 0.0334</p>
      <p>Values are expressed as mean &#177; SD</p>
   </tblfn></tbl>
<fig id="F2"><title><p>Figure 2</p></title><caption><p>FCS follicles: oocyte and granulosa cells</p></caption><text>
   <p><b>FCS follicles: oocyte and granulosa cells</b>. Note the presence of juxta-nuclear aggregates of mitochondria (M) and lipid droplets (L) in the oocyte (panels a, b). Scarce (panel c) or more abundant (panel d) microvilli (m) are present on the oolemma. Damaged granulosa cells (asterisks, panel e) are seen around the oocyte, sometimes showing chromatin margination in the nucleus (N), vacuoles (V) and lipid droplets (L) in the cytoplasm (panel f). A diffuse blebbing on the granulosa cell (GC) surface is also observable in panel g. Granulosa cells (GC) with normal appearance are clearly recognizable in panels c, h. Panel a, N: oocyte nucleus; panels c, d, arrows: granulosa cell cytoplasmic projections crossing the zona pellucida (ZP) to reach the oocyte (O) surface (transzonal processes). Bar is: 2 &#956;m (panel a); 1.8 &#956;m (panel b); 5 &#956;m (panel c); 52 &#956;m (panel d); 2.8 &#956;m (panel e); 1.5 &#956;m (panel f); 40 &#956;m (panel g); 2.1 &#956;m (panel h). Panels a-c, e, f, h: TEM; panels d, g: SEM.</p>
</text><graphic file="1477-7827-9-3-2" hint_layout="double"/></fig>
<p>
<it>Granulosa layer: </it>GCs formed a compact layer around the oocyte (Figure <figr fid="F2">2c</figr>). In about 40% of samples abundant residual debris of damaged GCs were present (Figure <figr fid="F2">2e</figr>). In these samples a great number of GCs exhibited clear signs of cell damage such as: abnormal distribution of nuclear chromatin, e.g. margination and karyolysis (Figure <figr fid="F2">2f</figr>); presence of cytoplasmic large vacuoles and voluminous lipid droplets (Figure <figr fid="F2">2e, f</figr>); surface alterations mainly characterized by diffuse blebbing of GC membranes revealed by SEM (Figure <figr fid="F2">2g</figr>). The remaining samples (60%) presented a normal appearance of GCs, characterized by a nucleus containing dispersed chromatin and one or more nucleoli. In addition, numerous organelles, mainly represented by mitochondria, were seen in their cytoplasm (Figure <figr fid="F2">2c, h</figr>).</p>
<p>
<it>Theca layer: </it>TCs usually distributed out of the healthy granulosa basement membrane in one (Figure <figr fid="F3">3a, b</figr>) or, more rarely, two (Figure <figr fid="F3">3c</figr>) continuous layers. TCs exhibited a large elongated nucleus with chromatin aggregates and a normal cytoplasm containing occasional lipid droplets and a few mitochondria (Figure <figr fid="F3">3b, c</figr>).</p>
<fig id="F3"><title><p>Figure 3</p></title><caption><p>FCS follicles: theca cells</p></caption><text>
   <p><b>FCS follicles: theca cells</b>. A thin theca cell layer (TL) is observable by SEM around the granulosa layer (GL) in panel a. Theca cells (TC) forming one or two-three layers are seen by TEM in panels b, c. Panels b, c, GC: granulosa cells; b: basement membrane. Panel c, M: theca cell mitochondria; L: theca cell lipid droplets. Bar is: 30 &#956;m (panel a); 1 &#956;m (panel b); 0.5 &#956;m (panel c).</p>
</text><graphic file="1477-7827-9-3-3" hint_layout="double"/></fig>
</sec>
<sec>
<st>
<p>FSH antral follicles</p>
</st>
<p>
<it>Oocyte: </it>the oocytes enclosed in FSH antral follicles showed an ooplasm provided with numerous scattered organelles mainly represented by rounded mitochondria with a few peripheral cristae, lipid droplets, primary and secondary lysosomes, aggregated or isolated vesicles of smooth endoplasmic reticulum and the fibrillar lattices typical of mouse oocytes (Figure <figr fid="F4">4a, b</figr>). The suboolemmal area contained sparse cortical granules and electron-dense particles along with membranes of smooth endoplasmic reticulum. The oolemma showed abundant and uniformly distributed microvilli protruding into the perivitelline space (Figure <figr fid="F4">4b, c</figr>). The innermost GCs showed areas of detachment from the oocyte, thus forming a discontinuous cell layer around a well preserved zona pellucida (Figure <figr fid="F4">4a, d</figr>). In those areas in which GCs were in close contact with the oocyte, long and tortuous TZPs were seen crossing the zona pellucida and reaching the oolemma (Figure <figr fid="F4">4a, d</figr>), where they intermingled with the microvilli covering the oocyte (Figure <figr fid="F4">4e</figr>). The GCs of the outer layer did not show these extensions. From a morphometric analysis the number of TZPs in FSH antral follicles (mean number &#177; SD per 20 &#956;m<sup>2 </sup>= 6.80 &#177; 6.20) appeared reduced in comparison with that found in FCS follicles, and this difference was highly significant (<it>P </it>&lt; 0.0001) (Table <tblr tid="T1">1</tblr>).</p>
<fig id="F4"><title><p>Figure 4</p></title><caption><p>FSH antral follicles: oocyte and granulosa cells</p></caption><text>
   <p><b>FSH antral follicles: oocyte and granulosa cells</b>. The oocytes (O) contain numerous organelles, uniformly distributed in the ooplasm (panels a, b, d). Note the presence of scattered cortical granules (arrows) in the suboolemmal area (panel b). Numerous microvilli (m) can be observed on the oocyte surface (panels b, c). Cytoplasmic projections (arrows) stemming from the inner granulosa cell (GC) layer are seen crossing the zona pellucida (ZP) (panels a, d) and reaching the oocyte (transzonal processes) (panels d, e). Areas of detachment between inner granulosa cells and oocyte are also present (asterisks, panels a, d). Outer granulosa cells (GC) appeared irregularly rounded/polygonal and scarcely adherent each other (panels f, h). Uniformly dispersed chromatin and one or more nucleoli are seen in both inner (panels a, d) and outer (panels f, g) granulosa cells. Panel b, ZP: zona pellucida. Panel e, O: oocyte. Panel f, arrow: loss of contact among granulosa cells; panel g, L: lipid droplets in the granulosa cell cytoplasm. Bar is: 3.5 &#956;m (panel a); 1 &#956;m (panel b); 10 &#956;m (panel c); 2 &#956;m (panel d); 9 &#956;m (panel e); 3 &#956;m (panels f, g); 50 &#956;m (panel h). Panels a, b, d, f, g: TEM; panels c, e, h: SEM.</p>
</text><graphic file="1477-7827-9-3-4" hint_layout="double"/></fig>
<p>
<it>Granulosa layer: </it>the onset of antral formation caused loss of contact between GCs (arrows in Figure <figr fid="F4">4f</figr>). In 90% of the samples GC nucleus usually displayed dispersed chromatin, one or more nucleoli and a regular nuclear envelope (Figure <figr fid="F4">4f</figr>); their cytoplasm showed abundant mitochondria and lipid droplets (Figure <figr fid="F4">4g</figr>). Outer GCs appeared as irregularly rounded or polygonal cells (Figure <figr fid="F4">4h</figr>) arranged in numerous concentric layers, radially situated around the oocyte (Figure <figr fid="F1">1c, d</figr>) and delimited by a continuous basement membrane (Figure <figr fid="F5">5a, b, c</figr>). Only in a small percentage of follicles (10%) the GC population showed obvious ultrastructural features of cell damage.</p>
<fig id="F5"><title><p>Figure 5</p></title><caption><p>FSH antral follicles: theca cells</p></caption><text>
   <p><b>FSH antral follicles: theca cells</b>. Theca cells (TC) forming one or two layers are seen by TEM in panels a, b. Lipid droplets (L) are visible in the theca cell cytoplasm (panel c). By SEM, the cells of the theca layer (TL) are provided with a few surface expansions (panel d). Panels a-c, GC: granulosa cells; b: basement membrane. Bar is: 5 &#956;m (panel a); 0.9 &#956;m (panel b); 1.5 &#956;m (panel c); 30 &#956;m (panel d).</p>
</text><graphic file="1477-7827-9-3-5" hint_layout="double"/></fig>
<p>
<it>Theca layer: </it>in all samples TCs, arranged in one or two layers (Figure <figr fid="F1">1c, d</figr>; Figure <figr fid="F5">5a, b</figr>) showed a flat and elongated shape (Figure <figr fid="F5">5a, d</figr>), a large nucleus with numerous dense chromatin aggregates, a cytoplasm containing scarce lipid droplets (Figure <figr fid="F5">5a, b, c</figr>) and a few surface microvilli and blebs (Figure <figr fid="F5">5d</figr>).</p>
</sec>
<sec>
<st>
<p>FSH non-antral follicles</p>
</st>
<p>
<it>Oocyte: </it>the ooplasm showed scattered organelles (Figure <figr fid="F6">6a</figr>) and a few cortical granules placed in suboolemmal areas (Figure <figr fid="F6">6b</figr>). The oolemma was provided with a variable number of microvilli (Figure <figr fid="F6">6a, b, c</figr>). The zona pellucida was ultrastructurally normal (Figure <figr fid="F6">6a</figr>). TZPs of GCs were found crossing the zona pellucida and reaching the oocyte (Figure <figr fid="F6">6a, b, c</figr>); however, as far as the TZP number is concerned, it displayed an intermediate value in FSH non-antral follicles (mean number &#177; SD per 20 &#956;m<sup>2 </sup>= 14.20 &#177; 8.05) in comparison with the number of TZPs found in FCS and FSH antral follicles, and the difference was statistically significant in both cases (P = 0.0002 and P = 0.0334, respectively) (Table <tblr tid="T1">1</tblr>).</p>
<fig id="F6"><title><p>Figure 6</p></title><caption><p>FSH non-antral follicles: oocyte and granulosa cells</p></caption><text>
   <p><b>FSH non-antral follicles: oocyte and granulosa cells</b>. In panel a the oocyte (O) contains numerous organelles scattered in the ooplasm. A variable amount of microvilli (m, panel b) can be found on the oocyte surface (O, panels b, c). Both altered (panel a) and apparently healthy (panel d) granulosa cells (GC), often provided with surface expansions (panels c, e), are seen in the follicle wall. Panel a, asterisks: granulosa cell debris. Panels a, b, ZP: zona pellucida. Panel b, black arrow: cortical granule. Panels b, c, white arrows: granulosa cell cytoplasmic projections (transzonal processes). Panel d, TC: theca cells. Bar is: 2.5 &#956;m (panel a); 0.6 &#956;m (panel b); 26 &#956;m (panel c); 5 &#956;m (panel d); 36 &#956;m (panel e). Panels a, b, d: TEM; panels c, e: SEM.</p>
</text><graphic file="1477-7827-9-3-6" hint_layout="double"/></fig>
<p>
<it>Granulosa and theca layers: </it>overall ultrastructural morphology of FSH non-antral GCs (Figure <figr fid="F1">1e, f</figr>; Figure <figr fid="F6">6a, d, e</figr>) and TCs (Figure <figr fid="F1">1e, f</figr>; Figure <figr fid="F7">7a, b, c</figr>) was almost superimposable to that seen in FCS samples.</p>
<fig id="F7"><title><p>Figure 7</p></title><caption><p>FSH non-antral follicles: theca cells</p></caption><text>
   <p><b>FSH non-antral follicles: theca cells</b>. Theca cells (TC) forming one or two layers are seen by TEM in panels a, b. Lipid droplets (L) are visible in the theca cell cytoplasm (panel b). By SEM, the cells of the theca layer (TL) show a few surface expansions (panel c). Panel a, GC: granulosa cells; b: basement membrane. Bar is: 1 &#956;m (panel a); 1.2 &#956;m (panel b); 20 &#956;m (panel c).</p>
</text><graphic file="1477-7827-9-3-7" hint_layout="double"/></fig>
<p>Table <tblr tid="T2">2</tblr> shows a summary of Results.</p>
<tbl id="T2"><title><p>Table 2</p></title><caption><p>Ultrastructural changes in IVG mouse ovarian follicles cultured with or without FSH (100 mIU/ml) for 6 days</p></caption><tblbdy cols="10">
      <r>
         <c ca="center">
            <p>
               <b>
                  <it>Group</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>N&#176;</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>Shape</it>
               </b>
            </p>
         </c>
         <c>
            <p/>
         </c>
         <c>
            <p/>
         </c>
         <c>
            <p/>
         </c>
         <c>
            <p/>
         </c>
         <c>
            <p/>
         </c>
         <c>
            <p/>
         </c>
         <c>
            <p/>
         </c>
      </r>
      <r>
         <c>
            <p/>
         </c>
         <c>
            <p/>
         </c>
         <c>
            <p/>
         </c>
         <c cspan="3" ca="center">
            <p>
               <b>
                  <it>Oocyte</it>
               </b>
            </p>
         </c>
         <c cspan="3" ca="center">
            <p>
               <b>
                  <it>Granulosa</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>Theca</it>
               </b>
            </p>
         </c>
      </r>
      <r>
         <c>
            <p/>
         </c>
         <c>
            <p/>
         </c>
         <c>
            <p/>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>Organelle</it>
               </b>
            </p>
            <p>
               <b>
                  <it>distribution</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>Oolemma</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>Zona</it>
               </b>
            </p>
            <p>
               <b>
                  <it>Pellucida</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>N&#176; and</it>
               </b>
            </p>
            <p>
               <b>
                  <it>arrangement of</it>
               </b>
            </p>
            <p>
               <b>
                  <it>layers</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>
Transzonal</it>
               </b>
            </p>
            <p>
               <b>
                  <it>processes*
</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>Signs of</it>
               </b>
            </p>
            <p>
               <b>
                  <it>degeneration</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>
               <b>
                  <it>N&#176; of</it>
               </b>
            </p>
            <p>
               <b>
                  <it>layers</it>
               </b>
            </p>
         </c>
      </r>
      <r>
         <c cspan="10">
            <hr/>
         </c>
      </r>
      <r>
         <c ca="center">
            <p>
               <b>
                  <it>FCS</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>20</p>
         </c>
         <c ca="center">
            <p>Rounded</p>
         </c>
         <c ca="center">
            <p>Juxta-nuclear</p>
         </c>
         <c ca="center">
            <p>Microvilli +/-</p>
         </c>
         <c ca="center">
            <p>Intact</p>
         </c>
         <c ca="center">
            <p>4-5</p>
            <p>Compact</p>
         </c>
         <c ca="center">
            <p>++</p>
         </c>
         <c ca="center">
            <p>Present in</p>
            <p>40% of</p>
            <p>samples</p>
         </c>
         <c ca="center">
            <p>1-2</p>
         </c>
      </r>
      <r>
         <c ca="center">
            <p>
               <b>
                  <it>FSH</it>
               </b>
            </p>
            <p>
               <b>
                  <it>ANTRAL</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>20</p>
         </c>
         <c ca="center">
            <p>Rounded</p>
         </c>
         <c ca="center">
            <p>Scattered</p>
         </c>
         <c ca="center">
            <p>Microvilli +</p>
         </c>
         <c ca="center">
            <p>Intact</p>
         </c>
         <c ca="center">
            <p>6-8</p>
            <p>Cell loosening,</p>
            <p>with fluid-filled</p>
            <p>intercellular spaces</p>
            <p>Innermost layer</p>
            <p>discontinuous</p>
         </c>
         <c ca="center">
            <p>+/-</p>
         </c>
         <c ca="center">
            <p>Present in</p>
            <p>10% of</p>
            <p>samples</p>
         </c>
         <c ca="center">
            <p>1-2</p>
         </c>
      </r>
      <r>
         <c ca="center">
            <p>
               <b>
                  <it>FSH</it>
               </b>
            </p>
            <p>
               <b>
                  <it>NON-</it>
               </b>
            </p>
            <p>
               <b>
                  <it>ANTRAL</it>
               </b>
            </p>
         </c>
         <c ca="center">
            <p>20</p>
         </c>
         <c ca="center">
            <p>Rounded</p>
         </c>
         <c ca="center">
            <p>Scattered</p>
         </c>
         <c ca="center">
            <p>Microvilli +/-</p>
         </c>
         <c ca="center">
            <p>Intact</p>
         </c>
         <c ca="center">
            <p>6-8</p>
            <p>Compact</p>
         </c>
         <c ca="center">
            <p>+</p>
         </c>
         <c ca="center">
            <p>Present in</p>
            <p>40% of</p>
            <p>samples</p>
         </c>
         <c ca="center">
            <p>1-2</p>
         </c>
      </r>
   </tblbdy><tblfn>
      <p>*See Table 1 for details</p>
   </tblfn></tbl>
</sec>
</sec>
</sec>
<sec>
<st>
<p>Discussion</p>
</st>
<p>It is well established that gonadotropins are necessary for antral follicle development <it>in vivo </it>
<abbrgrp>
<abbr bid="B37">37</abbr>
<abbr bid="B38">38</abbr>
<abbr bid="B39">39</abbr>
<abbr bid="B40">40</abbr>
</abbrgrp>. Gonadotropins do not influence initiation of follicle growth, but they are critical to complete follicular development <abbrgrp>
<abbr bid="B1">1</abbr>
</abbrgrp>. Even if preantral follicle growth <it>in vivo </it>is considered to be gonadotropin independent, FSH supplementation <it>in vitro </it>can be useful in driving initial follicle growth by exerting a positive effect on follicle survival and oocyte quality in mouse <abbrgrp>
<abbr bid="B23">23</abbr>
<abbr bid="B60">60</abbr>
<abbr bid="B61">61</abbr>
</abbrgrp> and other mammalian species <abbrgrp>
<abbr bid="B31">31</abbr>
<abbr bid="B34">34</abbr>
<abbr bid="B62">62</abbr>
<abbr bid="B63">63</abbr>
<abbr bid="B64">64</abbr>
<abbr bid="B65">65</abbr>
</abbrgrp>. Some studies, however, report contrasting results <abbrgrp>
<abbr bid="B66">66</abbr>
<abbr bid="B67">67</abbr>
</abbrgrp>. FSH is also essential in inducing the production and/or effect(s) of factors that may positively affect follicle growth <abbrgrp>
<abbr bid="B68">68</abbr>
</abbrgrp>. Also the modulator activity of activin on follicular culture <abbrgrp>
<abbr bid="B20">20</abbr>
<abbr bid="B61">61</abbr>
<abbr bid="B69">69</abbr>
</abbrgrp> may be exerted through up-regulation of FSH receptor expression in GCs at early follicular stages <abbrgrp>
<abbr bid="B70">70</abbr>
</abbrgrp>.</p>
<p>Our study reports the morphological ultrastructural characterization of mouse preantral follicles cultured <it>in vitro </it>with intact theca layers according to the protocol established by Gosden and collaborators <abbrgrp>
<abbr bid="B24">24</abbr>
</abbrgrp>. The results obtained demonstrated that IVG follicles forming AC present several ultrastructural features of maturity if compared with those grown <it>in vivo </it>
<abbrgrp>
<abbr bid="B71">71</abbr>
<abbr bid="B72">72</abbr>
<abbr bid="B73">73</abbr>
</abbrgrp>. Such a positive effect is mediated by the presence of FSH in the culture medium, as follicles cultured with FCS only were characterized by the failure of oocyte development and GC proliferation, and excess of GC degeneration as well.</p>
<p>Concerns from a data presentation perspective could arise from the obvious lack of a control, viable oocyte microscopic analysis from ovarian samples that would be physiologically comparable to the endocrine environment which defined these <it>in vitro </it>studies. Therefore, in order to support the interpretation of the noted structural changes in oocyte ultrastructure, we had to compare our <it>in vitro </it>results to the baseline <it>in vivo </it>data that were found in the literature. However, the changes noted between FCS (<it>in vitro </it>control) and FSH-treated follicles clearly demonstrated the supportive influences of FSH on oocyte viability <it>in vitro</it>.</p>
<p>Following FSH addiction to culture, the most evident characteristic of maturity shown by the FSH-treated group was represented by the rearrangement of oocyte intracytoplasmatic organelles, which appeared uniformly scattered throughout the cytoplasm. In FCS follicles, most of the organelles are instead condensed into a crescent region of the cytoplasm close to the nucleus, probably corresponding to the so-called "paranuclear complex". This feature is the ultrastructural correlate of the Balbiani's vitelline body and is typical of resting oocytes <abbrgrp>
<abbr bid="B47">47</abbr>
<abbr bid="B74">74</abbr>
</abbrgrp>. The persistence of this structure in oocytes of growing follicles may be a sign of ooplasmic immaturity <abbrgrp>
<abbr bid="B75">75</abbr>
</abbrgrp> or may be associated with loss of oocyte viability, at least in the mouse <abbrgrp>
<abbr bid="B76">76</abbr>
</abbrgrp>. Other ultrastructural markers of maturity in the oocytes of the FSH-treated group (and mostly in FSH antral follicles) were the distribution of cortical granules, that were seen throughout the ooplasm and in subplasmalemmal areas <abbrgrp>
<abbr bid="B47">47</abbr>
</abbrgrp> and the numerous microvilli uniformly distributed on the plasmalemma. During follicular growth, the oocyte surface displays a gradual increase of microvilli, as clearly demonstrated by studies on macerated samples in rodents <abbrgrp>
<abbr bid="B44">44</abbr>
<abbr bid="B45">45</abbr>
</abbrgrp>. Microvilli seem to be involved in apposition and fusion of the sperm and oocyte membranes at fertilization <abbrgrp>
<abbr bid="B77">77</abbr>
<abbr bid="B78">78</abbr>
</abbrgrp>. Despite to the evidence of a cytoplasmic maturation in the oocytes of FSH-treated follicles, oocyte diameter does not increase up to the final size, reaching <it>in vitro </it>only 90% of the diameter of the oocytes physiologically grown <it>in vivo </it>
<abbrgrp>
<abbr bid="B41">41</abbr>
<abbr bid="B42">42</abbr>
<abbr bid="B73">73</abbr>
</abbrgrp>.</p>
<p>By SEM and TEM analyses, in FSH-treated follicles, the GCs facing the oocyte appeared frequently detached, forming a discontinuous layer. This feature was particularly evident in FSH antral follicles. Long and tortuous TZPs crossing the zona pellucida and reaching the oolemma were present in the areas where GCs adhered to the oocyte. From a morphometric analysis the number of TZPs in FSH-treated follicles, both antral and non-antral, appeared reduced in comparison with that found in FCS follicles. This reduction was more evident in FSH antral follicles. In <it>in vivo </it>conditions, TZPs are very numerous in preantral follicles, forming both communicating (gap junctional) and adhesive contacts at the oolemma. The formation of gap junctions is fundamental for oocyte growth and maturation <abbrgrp>
<abbr bid="B46">46</abbr>
<abbr bid="B79">79</abbr>
<abbr bid="B80">80</abbr>
</abbrgrp> because it facilitates the transfer of amino acids, glucose metabolites and nucleotides to the growing oocyte <abbrgrp>
<abbr bid="B46">46</abbr>
</abbrgrp>. The TZPs could provide a polarized means that orients the secretory organelles of the somatic cells <abbrgrp>
<abbr bid="B81">81</abbr>
</abbrgrp>. Presence of <it>zonulae adherentes </it>and desmosomes also guarantee the mechanical stability of the follicular unit <abbrgrp>
<abbr bid="B47">47</abbr>
<abbr bid="B82">82</abbr>
</abbrgrp>. During antral follicle development <it>in vivo</it>, TZPs retract and maintain fewer terminal connections with the oocyte than in preantral follicles. This consequently changes the oocyte transcriptional activity and meiotic competence. Such a retraction seems promoted by FSH, through a remodeling of the TZP cytoskeleton <abbrgrp>
<abbr bid="B83">83</abbr>
</abbrgrp>. In our study, the reduction in number of TZPs in FSH-treated follicles, and particularly in those developing the AC (FSH antral follicles), well correlates with the data summarized above. However, in our <it>in vitro </it>model, such a reduction could be related not only to a physiological TZP retraction but also to the presence of areas of detachment, with consequent structural uncoupling, between the innermost GC layer and the oocyte.</p>
<p>The small percentage of morphological damages of GCs of FSH antral follicles can be understood as a physiological event occurring in follicular development in response to specific apoptotic signals or lack of survival signals <abbrgrp>
<abbr bid="B47">47</abbr>
</abbrgrp>. The increased amount of degenerated figures such as changes of chromatin and blebbing of plasma membrane, found in both FCS and FSH non-antral follicles, are likely due to absence or partial inactivity of FSH, respectively <abbrgrp>
<abbr bid="B84">84</abbr>
</abbrgrp>. In agreement with our ultrastructural data, the rate of apoptosis in the GC compartment is higher in FCS follicles than in FSH-treated follicles <abbrgrp>
<abbr bid="B42">42</abbr>
</abbrgrp>.</p>
<p>One or a few layers of TCs were found around the cultured follicles belonging to all groups. Theca layers may be damaged by follicle collection, remaining in a small number after mechanical isolation <abbrgrp>
<abbr bid="B50">50</abbr>
</abbrgrp>. In all groups TCs presented an elongated and/or flattened shape with occasional cytoplasmic lipid droplets; these appearances are typical of immature TCs <abbrgrp>
<abbr bid="B47">47</abbr>
</abbrgrp>.</p>
</sec>
<sec>
<st>
<p>Conclusions</p>
</st>
<p>We have evaluated a standardized culture system in which FSH is allowed to stimulate preantral follicle development <it>in vitro </it>until the antral stage. Our results provide the direct evidence that FSH addiction is essential for the morphological follicle differentiation during <it>in vitro </it>growth of mouse preantral follicles. Our study clearly demonstrates that only FSH-treated follicles show ultrastructural markers of maturity (AC formation, scattered organelles, retraction of TZPs). The different response to FSH and the delicate ultrastructural differences observed between FSH antral and FSH non-antral follicles suggest the existence of a process of commitment of certain follicles acting at the onset of development. Uncommitted follicles maintain granulosa compartment resistant to FSH and unable in forming AC. Other studies are required to confirm this hypothesis.</p>
<p>We also demonstrated that, even when FSH is administered and induces AC formation, not all the components of the cultured follicles undergo the morphological changes occurring <it>in vivo</it>. In fact, in all groups, including FSH antral follicles, oocytes grew but did not reach the full size, as the <it>in vivo </it>counterpart. The presence in FSH antral follicles of an abnormal, diffuse structural GC-oocyte uncoupling (beyond the physiological TZP retraction) may be the ultrastructural sign of an altered cross-talk between the gamete and the surrounding somatic cells. This may be a factor determining the inability of the oocyte to complete its growth <it>in vitro</it>. Thus, our study highlights the necessity of maintaining efficient intercellular communications to obtain <it>in vitro </it>large numbers of fully-grown mature germ cells.</p>
<p>Finally, FSH addiction has a limited effect on TC morphological maturation, which plays a crucial role in driving regular GC proliferation during preantral follicle development <abbrgrp>
<abbr bid="B85">85</abbr>
</abbrgrp>. The absence of a fully mature theca layer around cultured follicles could be mainly related to the lack of blood vessels and stromal cells to be recruited at the periphery of the follicles. Consequently the follicles are isolated from systemic influences and are not exposed to vascular growth factors and to components of extracellular matrix. Perhaps a better development of TCs could be obtained by culturing the follicles within low-stiffness synthetic extracellular matrices <abbrgrp>
<abbr bid="B86">86</abbr>
</abbrgrp> which mimic the <it>in vivo </it>microenvironment. Also GH addiction during culture could be useful in sustaining TC proliferation and differentiation <abbrgrp>
<abbr bid="B50">50</abbr>
</abbrgrp>.</p>
<p>In conclusion, several morphological discrepancies have been evidenced in our study between <it>in vivo </it>and <it>in vitro </it>development of mouse ovarian follicles, even when FSH was administered in culture to reduce the negative influence of the artificial microenvironment on ovarian follicle growth. Electron microscopy, associated with other <it>in vivo </it>and <it>in vitro </it>analytic studies, has a well recognized diagnostic-prognostic role in the assessment of ovarian follicle and oocyte viability during the application of biotechnological protocols in assisted reproduction, including those designed to fertility preservation <abbrgrp>
<abbr bid="B87">87</abbr>
<abbr bid="B88">88</abbr>
</abbrgrp>. The introduction of ultrastructural markers may be useful to evaluate the quality of IVG follicles, and particularly of their oocytes. Our original observations, as well, may ultimately serve as a model in research to improve knowledge in folliculogenesis and oogenesis, and may represent a basic reference for further morphologic studies on follicular somatic cells, oocyte and their interaction in <it>in vitro </it>models.</p>
</sec>
<sec>
<st>
<p>Competing interests</p>
</st>
<p>The authors declare that they have no competing interests.</p>
</sec>
<sec>
<st>
<p>Authors' contributions</p>
</st>
<p>SAN and SC directed the study and wrote the manuscript. SAN also participated to the interpretation of the ultrastructural data and performed the statistical evaluation. SC, SB, CM, GR, MAC have made contribution to acquisition of data. In particular, SC and GR provided the <it>in vitro </it>culture protocol, SB participated in the acquisition and evaluation of SEM data and helped to draft the manuscript, CM was involved in the acquisition of ultrastructural data and MAC participated in the acquisition and analysis of LM data. GM designed and directed the study, participated in the evaluation of data and critically revised the manuscript. Acquisition of funding was performed by SAN, SC and GM. All authors read and approved the final manuscript.</p>
</sec>
</bdy><bm>
<ack>
<sec>
<st>
<p>Acknowledgements</p>
</st>
<p>The authors gratefully acknowledge and thank Dr. Tiziana Stallone for her contribution in the TEM work. The present study was supported by funds from the Italian Ministry of Education, University and Research (grants from "La Sapienza" University, Rome and from the University of L'Aquila).</p>
</sec>
</ack>
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