Polycystic ovaries and infertility: Our experience.

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common (15-20%) endocrine disorders in women of childbearing age. Although it is a major cause of infertility, its etiology remains unknown and its treatment difficult. AIM: To evaluate the incidence, treatment and outcome of patients with PCOS. DESIGN: Retrospective analysis. MATERIALS AND METHODS: PCOS patients (914 of the 1057) attending the outpatient department (OPD) from June 2003 to February 2008 were evaluated for this study. Of the 914 patients investigated, 814 came for treatment and these patients were studied for hormonal disturbances and their response to various modalities of treatment. RESULTS: Of the 2270 infertility patients, 46.50% (1057) had PCOS, out of these, 86.47% (914) were investigated and 77% (814) came for treatment. Our overall pregnancy rate was 48.40% (394/814). The pregnancy rate per cycle with timed intercourse (TI) was 44.77% (47/105), 17.09% (286/1673) with intrauterine insemination (IUI), 29.82% (51/171) with in vitro fertilization (IVF) and 22.22% (10/45) with frozen embryo transfer (FET). The maximum number of pregnancies (85.29%, 284/333) were achieved in the first three treatment cycles. The abortion rate was 19.01% (73/384) and the incidence of ectopic pregnancy was 5.47% (21/384). Complications seen were in the form of ovarian hyperstimulation (OHSS), retention cyst on day two and multiple pregnancies in 11.71% (228/1946) of the total treatment cycles. CONCLUSION: Most PCOS symptoms could be adequately controlled or eliminated with proper diagnosis and treatment. Thus, ovulation induction (OI) protocols and treatment modalities must be balanced for optimal results.

Clinical Efficacy of Assisted Hatching with Partial Zona Dissection in Intrauterine Embryo Transfer / 대한산부인과학회잡지

OBJECTIVE: To investigate the clinical efficacy of assisted hatching (AH) with partial zona dissection (PZD) in intrauterine embryo transfer in the patients who failed more than 2 times with standard IVF-ET protocol (Group R), were more than 37 years old (Group A), or had high basal serum FSH levels more than 15 mIU/ml (Group F). METHODS: From January, 1998 to June, 2002, 156 cycles of AH with partial zona dissection were performed in 117 infertile patients in Department of Obstetrics and Gynecology, Seoul National University Hospital. The outcomes of AH were analyzed according to pregnancy rate. RESULTS: The number of oocytes retrieved after controlled ovarian hyperstimulation (COH) was 8.3 +/- 5.2 in 104 cycles of 75 patients who failed more than 2 times with standard IVF-ET protocol (Group I: Groups R, R+A, R+F, and R+A+F), 7.7 +/- 5.0 in 82 cycles of 67 patients who were more than 37 years old (Group II: Groups A, R+A, A+F, and R+A+F), and 7.2 +/- 4.9 in 38 cycles of 30 patients who had high basal serum FSH levels more than 15 mIU/ml (Group III: Groups F, R+F, A+F, and R+A+F). The number of embryos transferred after AH was 4.1 +/- 1.5 in Group I, 3.7 +/- 1.3 in Group II, and 4.0 +/- 1.7 in Group III. The mean cumulative embryo score (CES) was 81.9 +/- 46.5 in Group I, 75.9 +/- 43.0 in Group II, and 75.7 +/- 40.2 in Group III. There were no significant differences in the numbers of oocytes retrieved, embryos transferred and CES among 3 groups. The overall clinical pregnancy rate was 22.4% (35/156) per cycle and 29.9% (35/117) per patient. The clinical pregnancy rate per cycle and per patient was 18.3% (19/104) and 25.3% (19/75) in Group I, 15.9% (13/82) and 19.4% (13/67) in Group II, and 31.6% (12/38) and 40.0% (12/30) in Group III, and there was a significant difference between Group II and Group III. CONCLUSION: AH of human embryos with PZD might be promising for the improvement of pregnancy rates, especially in the patients with the past history of repeated failure, old age, or high basal serum FSH level.

Outcome of In Vitro Fertilization and Embryo Transfer in Patients with Multifollicular Ovarian Pattern inTransvaginal Ultrasonography / 대한산부인과학회잡지

In performing in vitro fertilization and embryo transfer(IVF-ET) program, we haveIdentified multifollicular ovarian pattern which can be distinguished from polycystic ovaries(PCO) by transvaginal ultrasonograpy. Mutifollicular ovaries(MFO) are normal in size ofslightly enlarged, and filled with six or more cysts 4~10 mm in diameter: in contrast toPCO, ovarian stroma is not increased. Women with MFO have the characteristic clinical andEndocrine features which are distinct from those associated with PCO.The objective of this retrospective clinical study was to evaluate the outcomes ofcontrolled ovarian yperstimulation(COH) in infertile patients with MFO, and to compare thepregnancy outcomes in MFO patients with those of PCO or tubal factor only patients. IVF-ET was performed using COH with midluteal GnRH agonist suppression and gonadotropinsin 61 MFO patients(68 cycles), 9 PCO patients(11 cycles), and 188 patients(296 cycles) withtubal factor infertility at Seoul National University Hospital from January, 1995 to August,1996.There were no statistically significant differences in the age of patients, the durationof infertility, and the cancellation rate of COH among three groups. Although patients withMFO of PCO needed less amount of gonadotropins, they showed higher peak serum E2Level and more oocytes were retrieved compared with tubal factor patients(p < 0.05). However,no significant differences existed in the fertilization rate, the number of embroys transferred,and the cumulative embryo score(CES) among three groups. The clinical pregnancy rate(PR) per ET and the implantation rate per embroy were 33.3%(22/66) and 10.1%(36/358),respectively, in MFO, 40.0%(4/10) and 9.4%(5/53) in PCO, and 28.7%(83/289) and 7.6%(108/1,403) in tubal factor patients, and they showed no significant differences. In addition,the ectopic PR, the abortion rate, and the multiple PR were not different among three groups.The occurrence rate of ovarian hyperstimulation syndrome(OHSS) was higher in MFO(10.3%) and PCO(18.2%) compared with tubal factor patients(2.7%,p < 0.05).These data suggest that althought patients with MFO or PCO have the different clinicaland endocrine features, the outcomes of IVF-ET using midluteal GnRH agonist andgonadotropins are similar each other. However, as patients with MFO parttern in transvaginalultrasonography have a higher incidence of OHSS than tubal factor patients, morecareful monitoring of COH for IVF-ET is required.

Impreovement in Endometrial Implantation of Humman Embryos with Assisted Hatching Using Micromanipulation in Intrauterine Embryo Transfer / 대한산부인과학회잡지

Although the fertilization rate exceeds to 80~90% with much progress in vitro fertilizaton and embyo transfer(IVF-ET) program, the prgnancy rate rmains at 20~30%, and the endometrial implantaion rate per embryo transferred at 10~15%. Recently, many attempts have been made to improve embrynic implantion after IVF-ET including serveral procedures of assisted hatching(AH) using micromanipulation, and pregnacies and births have been obtained after AH. This clinical study was performed to develop and estabilish AH as an effective procedure to improve embryonic implantioan in IVF-ET patients who had previous repeated failure of standard IVF-ET more than 2 times(Group R), were more than 37 years old(Group A), or had high basal serun FSH levels more than 15 mIU/ml(Group F). From January, 1995 to Februry, 1996, 132 cycles of AH using partial zona dissection(PZD) were performed in 104 infertile patients, and the outcomes of AH were analyzed according to pregnancy rate. The number of oocytes retrieved after controlled ovarian hyperstimulation(COH) was 9.9+/-7.1 in 71 cycles of 54 patients who had previous repeated failure more than two times(Group I: Group R,R+A,R+F, and R+A+F), 8.4+/-5.9 in 62 cycles of 46 patients whose age was more than 37 years old(Group II : Groups A, R+A, A+F, and R+A+F), and 8.7+/-6.5 in 49 cycles of 47 patients who had high basal serum FSH levels more than 15 mIU/ml(Group III:Groups F,R+F, A+F, and R+A+F). The number of embroys transferred after AH was 4.7 +/-1.8 in Group I, 4.2 +/-1.9 in Group II, and 4.2+/-2.0 in Froup III. The mean cumulative embryo score(CES) was 56.8+/-30.0 in Group I, 52.6+/-30.6 in Group II, and 52.6+/-29.9 in Group III. There were no significant differences in the numbers of oocytes rerieved and embryos transferred, and CES among 3 groups. The overall clinical pregnancy rate was 14.4%(19/132) per cycle and 18.3%(19/104) per patient. THe clinical pregnancy rate per cycle and per patient was 12.7%(9/71) and 16.7%(9/54) in Group I, 4.8% (3/62) and 6.5%(3/46) in Group II, and 26.5%(13/49) and 27.7%(13/47) in Group III, and there was a significant difference between Group II and Group III. In conclusion, AH of human embryos using micromanipulation might be promising for IVF-ET patients, especially with the past history of repeated failure, old age, and high basal serum FSH level and AH will provide a range of novel techiques which may dramatically improve the implanatation and pregnancy rates in IVF-ET program and contribute much to effective management of infertile couples.