Using gonadotropins with hCG activity improves controlled response in PCOS patients undergoing IVF compared to cycles using FSH alone

Abstract

OBJECTIVE: To determine if the addition of LH activity to FSH only protocols in GnRH agonist IVF cycles can improve response in PCOS patients. DESIGN: Retrospective cohort study of women diagnosed with PCOS undergoing IVF at a large urban private practice. MATERIALS AND METHODS: Women ages 21-39 years with polycystic ovary syndrome were recruited to participate in an IVF study in 2007 and 2008. Sixty-four participants had FSH <12, E2 levels < 80 and BMI < 39, < 2 prior IVF cycles for canceled for poor response, and no diabetes. All subjects were prescribed metformin during the study. A long luteal phase agonist protocol was used with Menopur (hMG) with or without follicle stimulating hormone. Control subjects were women with PCOS from 2004-2008 who underwent IVF receiving FSH only. An individual's responses determined dose adjustment and oocyte retrieval was performed 36 hours after hCG trigger. Standard laboratory protocols were followed, including ICSI, assisted hatching and extended culture for blastocyst transfer. Ultrasound guided embryo transfer was performed, and all patients received luteal progesterone support. On-going pregnancy was defined as the presence of a fetal cardiac activity on ultrasound. Statistical significance was determined by t-test. RESULTS: There was no difference in BMI or antral follicle count, but the hMG subjects were younger than the FSH group. Patients receiving hMG medication had shorter stimulations but used more gonadotropins (LH + FSH). Patients in the FSH only group had significantly more cycles cancelled for over-stimulation than the study population. There was no difference in estradiol, oocytes retrieved, embryos transferred or pregnancy rates between the two groups. CONCLUSIONS: Concerns that patients with PCOS should be stimulated with FSH alone because of their high endogenous LH levels may not be accurate. This study demonstrates that stimulation with hCG activity are shorter, use more total gonadotropins, but most importantly have a lower cancellation rate due to over-response than stimulations using only FSH.Table 1Gonadotropins in PCOS patients undergoing IVFParameterhMG and FSH (N=64)FSH alone (N=46)Age30.832.4∗BMI26.525.9Days of stimulation11.312.6∗Total dose of gonadotropins24211730∗Peak Estradiol27661730Oocytes retrieved14.214.4Cycles cancelled for OHSS3.6%20.0%∗Embryos tranferred1.351.69Ongoing Pregnancy39.6%30.4%∗ P< 0.05. Open table in a new tab ∗ P< 0.05.