Abstract
Objective
During the past three decades, applying IVF for infertility treatment PCOS women has
increased significantly, and the landscape of treatment strategies has changed dramatically.
However, early review of IVF on PCOS have insufficiently accounted for efficacy and
safety of the technic. With abundant studies in recent years, there is a need to reconcile
these new data.
Material and methods
To compare reproductive and obstetric outcomes of IVF between women with and without
PCOS, a meta-analysis of 95 studies involving more than 21289 PCOS patients and 43036
controls was performed.
Results
Despite longer stimulation duration (WMD = 0.34 day, 95 % CI: 0.09, 0.59) and lower
dose of Gn required (WMD = -361.3 IU, 95 % CI: -442.3, -280.4), more oocytes (WMD
= 3.67, 95 % CI: 3.14−4.21) and matured oocytes (WMD = 2.16, 95 % CI: 1.52−2.80) per
cycle were obtained from PCOS women. There were no statistically significant differences
for cleavage, high-grade embryo and implantation rate. Although similar pregnancy
and live birth rates per cycle were achieved in PCOS and non-PCOS women after IVF,
women with PCOS still suffered from significantly increased risks of miscarriage (OR
= 1.44, 95 % CI: 1.20−1.72), biochemical pregnancy loss (OR = 1.89, 95 % CI: 1.48−2.41),
and OHSS (OR = 3.58, 95 % CI: 2.86−4.48), in addition to lower fertilization rate
(OR = 0.79, 95 % CI: 0.71−0.88). Adverse obstetric outcomes including ectopics pregnancy
and multiple pregnancies are comparable between two groups. The overall cycle cancellation
rate was significantly higher among PCOS women with OR of 2.55 (95 % CI: 1.67−3.89),
and concern over OHSS or hyper-response constitute the main cause. Similar results
were also observed after stratified analysis.
Conclusions
Our results support the effectiveness of IVF for infertility treatment among PCOS
patients. However, options to minimize adverse outcomes regarding to lower fertilization,
miscarriage, biochemical pregnancy loss and OHSS are required. Further studies elucidating
detailed mechanism underlying these adverse outcomes could be of great importance
to improve the experience of IVF treatment.
Keywords
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References
- The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria.Hum Reprod. 2010; 25: 544-551
- Understanding variation in prevalence estimates of polycystic ovary syndrome: a systematic review and meta-analysis.Hum Reprod Update. 2018; 24: 694-709
- Polycystic ovary syndrome: etiology, pathogenesis and diagnosis.Nat Rev Endocrinol. 2011; 7: 219-231
- Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome.Fertil Steril. 2018; 110: 364-379
- Forty years of IVF.Fertil Steril. 2018; 110: 185-324
- Oral contraceptive pill, progestogen or oestrogen pretreatment for ovarian stimulation protocols for women undergoing assisted reproductive techniques.Cochrane Database Syst Rev. 2017; 5CD006109
- Fresh versus elective frozen embryo transfer in IVF/ICSI cycles: a systematic review and meta-analysis of reproductive outcomes.Hum Reprod Update. 2019; 25: 2-14
- Fresh versus frozen embryos for infertility in the polycystic ovary syndrome.N Engl J Med. 2016; 375: 523-533
- Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review.Hum Reprod Update. 2002; 8: 559-577
- A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome.Hum Reprod Update. 2006; 12: 13-21
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Ann Intern Med. 2009; 151: 264-269
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560
- (a)Meta-analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188
- (b)Obstetric outcomes after in vitro fertilization in obese and morbidly obese women.Obstet Gynecol. 2006; 108: 61-69
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- Operating characteristics of a rank correlation test for publication bias.Biometrics. 1994; 50: 1088-1101
- Is there a future for ovulation induction in the current era of assisted reproduction?.Hum Reprod. 2003; 18: 2499-2502
- GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type.Hum Reprod Update. 2017; 23: 560-579
- Patients’ preferences for gonadotrophin-releasing hormone analogs in in vitro fertilization.Gynecol Obstet Invest. 2014; 78: 16-21
Article info
Publication history
Published online: February 24, 2021
Accepted:
February 22,
2021
Received in revised form:
January 22,
2021
Received:
November 6,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
