Buyalos, R. P., & Lee, C. T. (1996). Polycystic ovary syndrome: pathophysiology and outcome with in vitro fertilization. Fertility and Sterility, 65(1), 1-10. https://doi.org/10.1016/s0015-0282(16)58017-0
Buyalos RP, Lee CT. Polycystic ovary syndrome: pathophysiology and outcome with in vitro fertilization. Fertil Steril. 1996;65(1):1-10. doi:10.1016/s0015-0282(16)58017-0
Buyalos, R. P., and C. T. Lee. "Polycystic ovary syndrome: pathophysiology and outcome with in vitro fertilization." Fertility and Sterility, vol. 65, no. 1, 1996, pp. 1-10.
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IVF pregnancy rates in PCOS are similar to tubal-factor rates
A 1996 literature review by two UCLA physicians found that women with PCOS (also called PMOS, Polyendocrine Metabolic Ovarian Syndrome) had IVF pregnancy rates similar to women with blocked tubes. The authors report less pregnancy loss with a GnRH agonist in one series of 239 women with PCOS. The authors describe the reviewed studies as generally small series.
Key Findings
In 76 women with polycystic ovaries and 76 controls, pregnancy rates per embryo transfer were 25.4% versus 23%. Fertilization was lower with polycystic ovaries (52.8% versus 66.1%).
In 16 women with PCOS and 37 women with tubal disease, pregnancy rates per aspiration were 30.7% versus 29.7%. Fertilization was 40.4% versus 67.6%, and cleavage 34.4% versus 65.6%.
In a retrospective series of 239 women with PCOS, miscarriage after IVF-ET was 18.2% with GnRH-a versus 38.5% without. Cumulative livebirth after 4 cycles was 54% versus 26% with menotropins alone.
In a randomized trial of 31 high-risk patients, 4 of 15 control patients (26.6%) were hospitalized for severe ovarian hyperstimulation syndrome. None who received intravenous albumin were hospitalized.
Interpretation
This is a narrative review. The authors searched the literature by computer and by hand. They describe the underlying studies as small series with poor statistical power and inconsistent patient selection. The IVF comparison group is women with tubal factor infertility. The authors call the reports on whether a GnRH agonist changes IVF fertilization and pregnancy rates at variance. They note that severe ovarian hyperstimulation syndrome remains a serious potential risk with assisted reproductive technologies.
RRM Context
The review reports more pregnancy loss in women with PCOS after ovarian stimulation. It cites studies linking high follicular-phase LH with miscarriage. IVF bypasses the ovulatory and metabolic features of PCOS and leaves them in place. Restorative reproductive medicine evaluates and treats those features.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To assess the efficacy of IVP-ET in infertile women with the polycystic ovary syndrome (PCOS) and to provide a comprehensive review of contemporary therapeutic options and their complications as reflected in the current literature.
Design
Pertinent studies in medical literature identified through computerized bibliographic search and via manual review of relevant scientific publications.
Results
In vitro fertilization and ET is an effective therapy for PCOS patients who are refractory to ovulation induction in vivo or who have coexisting infertility factors. The use of GnRH agonist (GnRH-a) is associated with significant reductions in the incidence of pregnancy loss and may improve fertilization and cleavage rates. In the PCOS patient, the use of purified FSH preparations does not appear to improve pregnancy rates nor other clinical parameters when compared with hMG. Severe ovarian hyperstimulation syndrome (OHSS) is an important consideration when PCOS patients undergo superovulation protocols. Strategies for OHSS prevention include the use of intravenous albumin immediately after oocyte retrieval, triggering of ovulation with a GnRH-a, or withholding menotropin therapy for several days before hCG administration. Cryopreservation of all embryos for future transfer in an artificial cycle has also proven to be an effective alternative in PCOS patients at high risk for severe OHSS.
Conclusions
Pregnancy rates for PCOS patients undergoing IVF-ET are comparable with those for women with tubal factor infertility. Therefore, IVF-ET should be offered to patients with PCOS who are refractory to conventional infertility modalities.
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