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Semin Reprod Med 2003; 21(3): 317-324
DOI: 10.1055/s-2003-43310
DOI: 10.1055/s-2003-43310
In Vitro Fertilization in the PCOS Patient: Clinical Considerations
Further Information
Publication History
Publication Date:
31 October 2003 (online)
ABSTRACT
Of all the patients undergoing in vitro fertilization, the patient with polycystic ovary syndrome (PCOS) is probably the most challenging. This is due to the fact that the majority of patients exhibit exaggerated responses to exogenous gonadotropins, frequently leading to an increased rate of cancellation of a treatment cycle. Even those who proceed to oocyte retrieval, and in spite of an increased number of oocytes retrieved, poor fertilization rates may be encountered, probably secondary to an increased rate of oocyte immaturity. To compound the problem further, even fertilized eggs in these patients, generally speaking, may show lower cleavage rates, and this leads to decreased implantation and pregnancy rates. In addition, these are patients who exhibit a much higher incidence of ovarian hyperstimulation syndrome, which puts the patient's health at great risk. Possibly, some of these problems may be inherent in the PCOS ovary. Nevertheless, it is possible that modifications of clinical protocols may improve outcome.
KEYWORDS
In vitro fertilization - polycystic ovaries - high responders - oocyte - implantation - ovarian hyperstimulation syndrome
REFERENCES
- 1 Adams J, Polson D W, Franks S. Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J . 1986; 293 355-359
- 2 Hull M G. Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies. Gynecol Endocrinol . 1987; 1 235-245
- 3 Polson D W, Adams J, Wadsworth J, Franks S. Polycystic ovaries: a common finding in normal women. Lancet . 1988; 1 870-872
- 4 Carmina E, Koyama T, Chang L, Stanczyk F Z, Lobo R A. Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome?. Am J Obstet Gynecol . 1992; 167 1807-1812
- 5 Dor J, Shulman A, Levran D, Ben-Rafael Z. The treatment of patients with polycystic ovarian syndrome by in-vitro fertilisation and embryo transfer: a comparison of results with patients with tubal infertility. Hum Reprod . 1990; 5 816-818
- 6 Salat-Baroux J, Alvarez S, Antoine J M. et al . Results of IVF in the treatment of polycystic ovary disease. Hum Reprod . 1988; 3 331-335
- 7 MacDougall M J, Tan S L, Balen A, Jacobs H S. A controlled study comparing patients with or without polycystic ovaries undergoing in-vitro fertilisation. Hum Reprod . 1993; 8 233-237
- 8 Aboulghar M, Mansour R T, Serour G, Ramzy A M, Amin Y. Oocyte quality in patients with severe ovarian hyperstimulation syndrome. Fertil Steril . 1997; 68 1017-1021
- 9 Engmann L, Macanochie N, Sladkevicius P, Bekir J, Cambell S, Tan S L. The outcome of in-vitro fertilization treatment in women with sonographic evidence of polycystic ovarian morphology. Hum Reprod . 1999; 14 167-171
- 10 Cano F, Garcia-Velasco J A, Millet A, Remohi J, Simon C, Pellicer A. Oocyte quality in polycystic ovaries revisited: identification of a particular subgroup of women. J Assist Reprod Genet . 1997; 14 254-261
- 11 Remohi J, Vidal A, Pellicer A. Oocyte donation in low responders to conventional ovarian stimulation for in vitro fertilization. Fertil Steril . 1993; 59 1208-1215
- 12 Wong I L, Morris R S, Lobo R A, Paulson R J, Sauer M V. Isolated polycystic morphology in ovum donors predicts response to ovarian stimulation. Hum Reprod . 1995; 10 524-528
- 13 Simon C, Cano F, Valbuena D, Remohi J, Pellicer A. Clinical evidence for a detrimental effect on uterine receptivity of high serum oestradiol concentrations in high and normal responder patients. Hum Reprod . 1995; 10 2432-2437
- 14 Simon C, Garcia Velasco J J, Valbuena D. et al . Increasing uterine receptivity by decreasing estradiol levels during the preimplantation period in high responders with the use of a follicle-stimulating hormone step-down regimen. Fertil Steril . 1998; 70 234-239
- 15 Hardy K, Robinson F, Paraschos T, Wicks R, Franks S, Winston R. Normal development and metabolic activity of preimplantation embryos in vitro from patients with polycystic ovaries. Hum Reprod . 1995; 10 2125-2135
- 16 Testart J, Forman R, Belaisch-Allart J. et al . Embryo quality and uterine receptivity in in-vitro fertilization cycles with or without agonists of gonadotrophin-releasing hormone. Hum Reprod . 1989; 4 198-201
- 17 Owen E J, Shoham Z, Mason B A, Ostergaard H, Jacobs H S. Cotreatment with growth hormone after pituitary suppression for ovarian simulation in in-vitro fertilization: a randomized, double-blind, placebo-control trial. Fertil Steril . 1991; 56 1104-1110
- 18 Tan S L, Kingsland C, Campbell S. et al . The long protocol of administration of gonadotropin-releasing hormone agonist is superior to the short protocol for ovarian stimulation for in vitro fertilization. Fertil Steril . 1992; 57 810-814
- 19 Homburg R, Levy T, Berkowitz D. et al . Gonadotropin-releasing hormone agonist reduces the miscarriage rate for pregnancies achieved in women with polycystic ovarian syndrome. Fertil Steril . 1993; 59 527-531
- 20 Balen A, Tan S L, MacDougall J, Jacobs H. Miscarriage rates following in-vitro fertilization are increased in women with polycystic ovaries and reduced by pituitary desensitization with buserelin. Hum Reprod . 1993; 8 959-964
- 21 Tesarik J, Mendoza C. Direct non-genomic effects of follicular steroids on maturing human oocytes: oestrogen versus androgen antagonism. Hum Reprod Update . 1997; 3 95-100
- 22 Tesarik J, Mendoza C. Nongenomic effects of 17 beta-estradiol on maturing human oocytes: relationship to oocyte developmental potential. J Clin Endocrinol Metab . 1995; 80 1438-1443
- 23 Yen S S. The polycystic ovary syndrome. Clin Endocrinol (Oxf) . 1980; 12 177-207
- 24 Franks S. Polycystic ovary syndrome. N Engl J Med . 1995; 333 853-861
- 25 Regan L, Owen E J, Jacobs H S. Hypersecretion of the luteinizing hormone, infertility and miscarriage. Lancet . 1990; 336 1141-1144
- 26 Homburg R, Armrar N A, Eshel A, Adams J, Jacos H S. Influence of serum luteinizing hormone concentrations on ovulation conception and early pregnancy loss in polycystic ovary syndrome. Br Med J. 1988; 297 1024-1026
- 27 Stanger J D, Yovich J L. Reduced in-vitro fertilization of human oocyte from patients with based basal luteinizing hormone levels during the follicular phase. Br J Obstet Gynaecol . 1985; 92 385-393
- 28 Craft I, Gorgy A, Hill J, Menon D, Podsiadly B. Will GnRH antagonists provide new hope for patients considered "difficult responders" to GnRH agonist protocols?. Hum Reprod . 1999; 14 2959-2962
- 29 Olivennes F, Fanchin R, Bouchard P. et al . The single or dual administration of the gonadotropin-releasing hormone antagonist Cetrorelix in an in vitro fertilization-embryo transfer program. Fertil Steril . 1994; 62 468-476
- 30 Damario M A, Barmat L, Liu H C, Davis O K, Rosenwaks Z. Dual suppression with oral contraceptives and gonadotrophin-releasing hormone agonists improves in-vitro fertilization outcome in high responder patients. Hum Reprod . 1997; 12 2359-2365
- 31 Smitz J, Camus M, Devroey P, Wistano A, Van Steirteghem C A. Incidence of severe hyperstimulation syndrome after GnRH agonist/HMG superovulation for in-vitro fertilization. Hum Reprod . 1991; 6 933-937
- 32 Hamilton-Failrey D, Franks S. Common problems in induction ovulation. Baillieres Clin Obstet Gynaecol . 1990; 4 609-625
- 33 Seang-Lin T, Balen A, El Hussein E, Cambell S, Jacobs H. The administration of glucocorticoids for the prevention of ovarian hyperstimulation syndrome in in vitro fertilization: a prospective randomized study. Fertil Steril . 1992; 58 378-383
- 34 Rimington M R, Walker S M, Shaw R W. The use of laparoscopic ovarian electrocautery in preventing cancellation of in-vitro fertilization treatment cycles due to risk of ovarian hyperstimulation syndrome in women with polycystic ovaries. Hum Reprod . 1997; 12 1443-1447
- 35 Marci R, Senn A, Dessole S. et al . A low-dose stimulation protocol using highly purified follicle-stimulating hormone can lead to high pregnancy rates in in vitro fertilization patients with polycystic ovaries who are at risk of a high ovarian response to gonadotropins. Fertil Steril . 2001; 75 1131-1135
- 36 Benadiva C A, Davis O, Kligman I, Moomjy M, Liu H-C, Rosenwaks Z. Withholding gonadotropin administration is an effective alternative for the prevention of ovarian hyperstimulation syndrome. Fertil Steril . 1997; 67 724-727
- 37 Cha K Y, Koo J J, Ko J J, Choi D H, Han S Y, Yoon T K. Pregnancy after in vitro fertilization of human follicular oocytes collected from nonstimulated cycles, their culture in vitro and their transfer in a donor oocyte program. Fertil Steril . 1991; 55 109-113
- 38 Trounson A, Wood C, Kausche A. In vitro maturation and the fertilization and developmental competence of oocytes recovered from untreated polycystic ovarian patients. Fertil Steril . 1994; 62 353-362
- 39 Russell J B, Knezevich K M, Fabian K F, Dickson J A. Unstimulated immature oocyte retrieval: early versus midfollicular endometrial priming. Fertil Steril . 1997; 67 616-620
- 40 Thornton M H. Francis MM, Paulson RJ. Immature oocyte retrieval: lessons from unstimulated IVF cycles. Fertil Steril . 1998; 70 647-650
- 41 Chian R C, Buckett W M, Tulandi T, Tan S L. Prospective randomized study of human chorionic gonadotrophin priming before immature oocyte retrieval from unstimulated women with polycystic ovarian syndrome. Hum Reprod . 2000; 15 165-170