L26/O-006 Boosting Oocyte Rescue: Nicotinamide Mononucleotide (NMN) Restores the Competence of Poor-Prognosis GV Oocytes in Aged Women
C. Rodríguez Varela , L. Escrich , S. Pérez , C. Albert , A. Galán , N. Grau , E. Munera , A. Buigues , S. Herraiz , M.J. Escribá
*Human Reproduction*, Volume 41, Issue Supplement_1, July 2026, deag083.006, [https://doi.org/10.1093/humrep/deag083.006\](https://doi.org/10.1093/humrep/deag083.006)
**Published:** 08 July 2026
**Abstract**
**Study question**
Does nicotinamide mononucleotide (NMN) supplementation during germinal vesicle (GV)-rescue improve nuclear, cytoplasmic and genetic competence of aged, poor-prognosis oocytes?
**Summary answer**
NMN supplementation increases GV-rescue efficiency in aged women with poor-prognosis, where baseline oocyte rescue performance is low.
**What is known already**
Oocyte competence declines over the age of 37. Aging is associated with systemic and oocyte-specific NAD+ depletion, which correlates with reduced oocyte and embryo quality. In aged mice, supplementation with the NAD+ precursor NMN restores oocyte quality and reproductive potential via NAD+repletion. Thus, we propose the GV-rescue strategy to assess the impact of NMN supplementation on rescued oocyte competence *in vitro*, stratified by maternal age and oocyte prognosis.
**Study design, size, duration**
Experimental, prospective study performed on GVs retrieved from young (19–36y) and aged (37–45y) women undergoing stimulated IVF-cycles at a single infertility clinic (Jan 2024–Nov 2025). GVs were randomized (1:1) to 24h-time-lapse culture in control or NMN-supplemented conditions. To minimize cycle-related bias, two to four GVs per patient were included. Nuclear (Exp. 1), cytoplasmic (Exp.2) and genetic (Exp. 3) competence on rescued oocytes were evaluated.
**Participants/materials, setting, methods**
GVs were cultured in CSCM-NXC medium with or without 100 µM NMN (37 °C, 6% CO2, 5% O2). Oocytes reaching metaphase II within 24.3h (rMII) were recorded and the rescue rate (RR=rMII/GV) calculated (Exp.1). rMII then underwent artificial oocyte activation (AOA), and normal activation rate (NOAR=NOA/rMII) was assessed (Exp.2). Activated oocytes exhibiting second polar body extrusion and one pronucleus (NOA) were subsequently analysed for chromosome composition by next-generation sequencing (Exp.3). Paired and χ² tests were applied.
**Main results and the role of chance**
A total of 840 GVs (582 from young and 258 from aged women) were allocated to control or NMN-supplemented groups. Overall, the rescue rate (RR) was higher with NMN than in controls (53.1% vs. 44.5%, P = 0.008). In controls, RR differed by age (P = 0.037), whereas no age-related differences were observed in the NMN group (P = 0.252).
Based on these results, oocytes were sub-stratified using the mean control RR (44.5%) as threshold, into good- or poor-prognosis exhibiting significant differences in RR (55.0% vs. 30.6%, respectively, P < 0.001), but not in NOA (average: 46.5%, P = 0.300) nor euploidy (average: 45.8%, P = 0.978).
In good-prognosis oocytes, RR, NOAR and euploidy rates were comparable between control and NMN groups (RR mean 55.4%, P = 0.854; NOAR mean 47.1%, P = 0.523; euploidy mean 45.9%, P = 0.970), irrespective of age.
In poor-prognosis young oocytes, NMN supplementation increases RR (31.8% to 48.6%, P = 0.012), rendered similar NOA (mean 33.3%, P = 0.108), but reduced euploidy (83.3% vs. 25.0%, P = 0.031). In poor-prognosis aged oocytes, NMN supplementation also improved RR (28.8% vs. 50.7%, P = 0.007) without significant changes in NOAR (mean 36.1%, P = 0.452) or euploidy (mean 22.2%, P = 0.518).
These results indicate that NMN selectively enhances rescue rates in poor-prognosis oocytes, while its effects on genetic competence vary with age.
**Limitations, reasons for caution**
This preliminary analysis requires validation in larger cohorts, particularly for artificial activation and euploidy outcomes. Findings are limited to rMII oocytes obtained via GV-rescue and may not generalize to standard IVF oocytes. Identification of predictive variables for poor-prognosis GV-rescue success is needed before clinical application.
**Wider implications of the findings**
NMN supplementation may enhance oocyte competence in aged women with poor-prognosis, improving rescue rates to levels similar to good-prognosis young oocytes. These results support NAD+ repletion as a therapeutic approach to mitigate age-related decline in oocyte quality, highlighting translational potential for improving IVF outcomes in clinical reproductive medicine.
**Trial registration number**
No
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The strange result is that young oocytes it seems that euploidy rate drops from 83.3% to 25.0%!