INNOVATIVE CONTROLLED OVARIAN STIMULATION (COS) METHOD FOR SEVERE POLYCYSTIC OVARY SYNDROME (PCOS) WITHOUT OVARIAN HYPERSTIMULATION SYNDROME (OHSS) AND HIGHER OOCYTE QUALITY

Abstract

We developed an innovative controlled ovarian stimulation method for severe PCOS cases without OHSS, higher oocyte quality and optimal number of oocytes using an aromatase inhibitor (Letrozole). Twenty-five severe PCOS patients who had over 20 antral follicles in both ovaries, over 10 mg/ml of anti-Mullerian hormone (AMH) and had been hospitalized due to severe OHSS participated in this study. From the third day of the period, 5mg of Letrozole and 150iu of FSH/HMG were administered every day until the day of trigger administration. When the leading follicle reached 18mm in diameter, the injection of 0.25mg of GnRH antagonist started and continued until the day of the trigger shot. Estradiol (E2), luteinizing hormone (LH) and progesterone (P) were measured every day. After confirmation that the largest follicle was 22-24 mm in diameter and E2 level was less than 500-700pg/ml , 5000iu of HCG was administered as trigger and oocyte collection was performed 37 hours later under general anesthesia with Propofol. All embryos were cryopreserved after IVF or ICSI. 2.5mg of Letrozole, 0.5mg of Cabergoline and 0.25mg of GnRH antagonist were administered just after the oocyte retrieval for five days consecutively. The levels of vessel endothelial growth factor (VEGF)of all patients were examined carefully and then the patients discharged. All of them were re-examined after 3-4 days. Characteristics of this COS are shown in Table.TableCharacteristics of new COS methodn=25Age at OPU(y)33.1±2.4AMH(ng/mL)13.2±3.1Peak E2(pg/mL)624.3±311.2AFC38.1±15.2Peak follicle size(mm)24.2±3.1No. of days stimulated10.0±2.3No. of retrieved oocytes15.7±6.3Matured (M2) oocytes (%)83.3 (250/300)MI oocytes (%)4.0(12/300)GV oocytes (%)11.3(34/300)Degenerated oocytes (%)1.3(4/300)No. of frozen embryos4.3±2.1level of VEGF (pg/ml)56.7±23.1Days between oocyte collection and withdrawal hemorrhage5.4±2.4 Open table in a new tab This newly developed controlled ovarian stimulation with consecutively used Letrozole for severe PCOS cases seems to be a possible first line treatment for severe PCOS though no clinical data is available yet.