Treatment of polycystic ovary patients undergoing IVF

A low-dose stimulation protocol using highly purified follicle-stimulating hormone can lead to high pregnancy rates in in vitro fertilization patients with polycystic ovaries who are at risk of a high ovarian response to gonadotropins

OBJECTIVE

To study the benefits of a low-dose stimulation (LDS) protocol with purified urinary follicle-stimulating hormone in patients with polycystic ovaries who have presented previously with a very high ovarian response to a standard hMG stimulation.

DESIGN

Cohort study.

SETTING

Fertility center in a university hospital.

PATIENT(S)

Sixty-one patients involved in an IVF/ICSI program from January 1995 to December 1996.

INTERVENTION(S)

The patients were first stimulated with a standard protocol using hMG and presented with a very high ovarian response. These patients were then stimulated a second time using a low-dose protocol. Cryopreserved embryos were transferred in later artificial or natural cycles until to December 1999.

MAIN OUTCOME MEASURE(S)

Number of gonadotropin ampules; estradiol level on the day of ovulation induction; follicles, oocytes, and cryopreserved zygotes; fertilization, implantation, and pregnancy rates; and number of ovarian hyperstimulation syndromes (OHSS).

RESULT(S)

The number of ampules used, the estradiol level reached, and the number of oocytes obtained were significantly lower under the LDS than the standard protocol. High implantation (21.8%) and clinical pregnancy (38.4%) rates were obtained after LDS. The cumulated deliveries per cycle started and per patient were, respectively, 41.6% and 52.5%. Five patients suffered OHSS with the standard protocol, and none with the LDS.

CONCLUSION(S)

The LDS protocol offers a safe and efficient treatment for patients who present with echographic polycystic ovaries and are at risk of an excessive ovarian response to standard IVF stimulation protocols.

Semen analysis and antisperm antibody

Evaluation of the fertilizing potential of sperm is an important procedure in in vitro fertilization and embryo transfer (IVF-ET) clinic, in order to avoid performing invalid conventional IVF-ET or unnecessary intracytoplasmic sperm injection (ICSI). However, none of the standard semen parameters are reliable indices in predicting IVF outcome. The test examining sperm-zona interaction is the best present method, though the short supply of the human zona component should be solved. IVF-ET treatment is useful for pregnancy in women having sperm immobilizing antibodies because it avoids exposing sperms to antibodies that block fertilization. ICSI should be used in immunologically infertile men diagnosed by specific method to demonstrate the in vivo exposure of sperms to antisperm autoantibodies that block fertilization.