Abstract
BackgroundPoor response patients with PCOS who are not susceptible to gonadotropin stimulation are more likely to have canceled cycles or poor clinical outcomes during IVF treatment. However, some limitations exist in the present therapies. In this study, we evaluated the effects of using the transvaginal ovarian drilling (TVOD) followed by controlled ovarian stimulation (COS) from the second day of these poor responders.MethodsDuring IVF, 7 poor responders with PCOS and 28 PCOS patients (14 normal and 14 high responders) were recruited. All patients received COS with the gonadotropin-releasing hormone antagonist protocol. For the poor responders, after undergoing 10 to 14 days of ovulation induction with no response, the TVOD was applied and then ovarian stimulation was performed from the next day at the same gonadotropin dose. Serum samples during COS and follicular fluid samples from the dominant follicles on the oocyte pick-up (OPU) day in all three groups were collected. Besides, follicular fluid from small follicles (diameter < 1 cm) in the normal and high responders on the OPU day and those in the poor responders on the TVOD day were gathered. Hormonal levels were examined in all samples using immunometric assays.ResultsAll the poor responders restored ovary response after receiving TVOD. There was no significant difference in the stimulation duration, total gonadotrophin dose used and the clinical outcomes among the three groups. The body mass index, serum and follicular levels of anti-Müllerian hormone (AMH) and testosterone in poor responders were higher than those in the other two groups, and the application of TVOD significantly decreased the levels of AMH and testosterone in both serum and follicular fluid.ConclusionsTVOD followed by ovulation induction from the next day is effective and convenient for poor responders with PCOS. The decline of AMH and testosterone resulted from TVOD may be the main reason resulting in the recovery of ovary sensitivity to gonadotropins. The small sample size is the primary limitation of this study, future studies using a large population cohort and monitoring the long-term outcomes of this strategy will be required.Trial registrationChiCTR1900023612. Registered 04 June 2019-Retrospectively registered.
Highlights
Poor response patients with Polycystic ovary syndrome (PCOS) who are not susceptible to gonadotropin stimulation are more likely to have canceled cycles or poor clinical outcomes during In vitro fertilization (IVF) treatment
transvaginal ovarian drilling (TVOD) followed by ovulation induction from the day is effective and convenient for poor responders with PCOS
The decline of anti-Müllerian hormone (AMH) and testosterone resulted from TVOD may be the main reason resulting in the recovery of ovary sensitivity to gonadotropins
Summary
Poor response patients with PCOS who are not susceptible to gonadotropin stimulation are more likely to have canceled cycles or poor clinical outcomes during IVF treatment. In vitro maturation (IVM) is a fertility treatment option for poor responding PCOS patients to controlled ovarian stimulation (COS) [6, 7]. Ferraretti et al first applied the transvaginal ovarian drilling (TVOD) and performed COS 2–6 months later for PCOS patients who experienced multiple unsuccessful cycles (cases including OHSS, poor response and poor embryo quality) and found that the ovulation response of these poor responders was restored [5]. We aim to improve the strategy for poor responders with PCOS by performing the COS from the second day after TVOD in the same cycle. To understand the mechanism underlying the effect of TVOD on enhancing ovary response, we investigate the serum hormonal levels in patients during COS and the follicle fluid samples collected from small and dominant follicles of the three groups of patients with PCOS (i.e., poor responders, high responders and normal responders)
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