{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:19:13Z","timestamp":1760660353922,"version":"build-2065373602"},"reference-count":56,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fundamental Research Grant Scheme (FRGS), awarded by the Ministry of Higher Education of Malaysia","award":["FRGS\/1\/2021\/SKK01\/UKM\/02\/1"],"award-info":[{"award-number":["FRGS\/1\/2021\/SKK01\/UKM\/02\/1"]}]},{"name":"Innovation and Research Secretariat [56] of the Faculty of Medicine, National University of Malaysia"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Managing women with diminished ovarian reserve for in vitro fertilization (IVF) is challenging, often resulting in low oocyte yield and cycle failures. We hypothesize that coupling in vitro fertilization (IVF) with rescue in vitro maturation (r-IVM) can improve overall maturation rates without compromising the overall IVF outcome. Our study compared DOR and normal ovarian reserve (NOR) cohorts by evaluating 15 immature oocyte progressions following r-IVM. We analyzed the gene expression of cumulus cells related to GREM1, PTGS2, and HAS2 to correlate with OQ, EQ, and overall IVF outcome. Significant differences were noted in AMH levels, AFCs, and oocyte numbers (p &lt; 0.05). Following r-IVM, the DOR cohort achieved a 50% maturation rate with improved overall quality; however, the difference was not statistically significant (p &gt; 0.05). Fertilization rates were comparable, but EQ was better in DOR. All genes in DOR were upregulated post-r-IVM, whereas NOR showed downregulation of PTGS2 and GREM1 (p &lt; 0.05). Otherwise, DOR exhibited higher pregnancy rates and live birth rates, although the difference was not statistically significant (p &gt; 0.05). Overall, our findings suggest that r-IVM could provide improved fertility outcomes for DOR women in standard IVF cycles.<\/jats:p>","DOI":"10.3390\/life15101609","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T12:17:02Z","timestamp":1760617022000},"page":"1609","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Comparative Analysis of Gremlin-1 (GREM1), Hyaluronic Acid Synthetase-2 (HAS2), and Prostaglandin-Endoperoxide Synthase-2 (PTGS2) Expression in Cumulus Cells Among Women with Diminished Ovarian Reserve Following Rescue In Vitro Maturation (r-IVM)"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2735-3274","authenticated-orcid":false,"given":"Mohd Faizal","family":"Ahmad","sequence":"first","affiliation":[{"name":"Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9343-7954","authenticated-orcid":false,"given":"Marjanu Hikmah","family":"Elias","sequence":"additional","affiliation":[{"name":"Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norazilah Mat","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor Branch, Jalan Hospital, Sungai Buloh 47000, Selangor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0383-572X","authenticated-orcid":false,"given":"Muhammad Azrai","family":"Abu","sequence":"additional","affiliation":[{"name":"Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9960-4888","authenticated-orcid":false,"given":"Saiful Effendi","family":"Syafruddin","sequence":"additional","affiliation":[{"name":"Medical Molecular Biology Institute, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ani Amelia","family":"Zainuddin","sequence":"additional","affiliation":[{"name":"Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0635-1816","authenticated-orcid":false,"given":"Shah Shamsul","family":"Azhar","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7440-8127","authenticated-orcid":false,"given":"Nao","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, St. Marianna School of Medicine, Kawasaki 216-8511, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4796-1613","authenticated-orcid":false,"given":"Abdul Kadir Abdul","family":"Karim","sequence":"additional","affiliation":[{"name":"Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.fertnstert.2023.02.010","article-title":"Oocyte in vitro maturation: Physiological basis and application to clinical practice","volume":"119","author":"Gilchrist","year":"2023","journal-title":"Fertil. 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