In vitro maturation in women with PCOS

Abstract

OBJECTIVE: In vitro maturation (IVM) was established in our InviMed centers in Poland as a new method for treating infertility. The procedure was applied in our center in patients showing Polycystic Ovary Syndrome (PCOS). DESIGN: The aim of the study was to compare the outcome of maturation, fertilization, embryo scoring and pregnancy rates in patients with PCOS, undergoing IVM procedure with patients with mechanical cause of infertility (control). MATERIALS AND METHODS: Twenty nine patients determined as PCOS underwent 32 IVM cycles. The control group (n=28) underwent conventional ICSI procedure. IVM patients were mildly stimulated using 150 I.U. Gonal-F for 3-4 days. IVM take place according to the procedure of MediCult IVM System (MediCult, Denmark). ICSI was performed 30 hours (Day 0) after IVM medium (MediCult, Denmark). Injected oocytes were then cultured in MediCult ISM1 medium. Number of retrieved oocytes, rates of fertilization and cleavage, quality of embryos and pregnancy rates were compared with PCOS and control group, by Yate's corrected χ2 test. Patients of control group were stimulated in the short protocol using 75 IU of Fostimon with GnRH antagonist Cetrotide. Ovulation was induced by Ovitrelle. Following ICSI, oocytes cultured identically as PCOS oocytes. RESULTS: The mean number of aspirated cumulus enclosed oocytes (CEOs) per patient was 8,8 and was significantly lower in comparison to the control (17,0). A significant difference in the rate of CEOs which reached the MII stage was observed after 30h in the PCO group in comparison to the control (138/257 (53,7%) vs 409/509 (79,4%), respectively, p<0,01). It was not observed differences in fertilization rate (122/156 (78,2%) vs 337/377 (89,4%) however a significant difference was found in cleavage rates (101/119 (84,9%) vs 177/184 (96,2%), p<0.05). A higher value of the mean fragmentation grade of 4-5cell stage embryos was observed on day 2 in the PCO group in comparison to the control group (1,6 vs 1,3 respectively; p<0.01). Twenty six embryo transfers (ET) were performed in the PCO group, resulted in 9 pregnancies (34,6%); 23 ETs were performed in the control group resulted in 13 pregnancies (46,4%; mean of 2.3 vs 2.0 embryos per patient, respectively). CONCLUSIONS: IVM was found to be an efficient method in patients with PCO syndrome. Since our results are based on a small number of patients, further investigation is taking.