IVF in PCOS

The Natural Pcos Diet

PCOS No More

Get Instant Access

PCOS is the most common cause of anovulatory infertility. As described in Chapters 35 and 37, the treatment of anovulation comprises lifestyle modification through diet, exercise, and weight loss, insulin sensitizers, oral ovulation induction agents, surgical treatments, and gonadotropins. Patients who have not conceived with other treatment approaches or couples who have additional infertility factors may require IVF. In vitro fertilization treatment outcomes for PCO/PCOS patients may even be better than for patients with normal ovaries. After three cycles of IVF treatment, the odds of achieving a pregnancy with polycystic ovaries were 69% higher than those of a woman with normal ovaries (9).

PCOS has been shown to exist in 4-10% of the general population and can be found in even higher incidences in certain populations. Polycystic ovary is a morphological definition based on ultrasound without any manifestation of the syndrome and can be defined as the presence of 12 or more follicles in one ovary measuring 2-9 mm in diameter and/or increased ovarian volume (>10 mL) (Fig. 1). Isolated polycystic ovaries in ultrasound scans has been shown to occur in 16-23% of the normal population (10-12); however, in an IVF population, the incidence may be as high as 33% (13). Therefore, many women with polycystic ovaries or PCOS will need IVF for indications other than anovulation.

¡Js RIC 5-9 H/Gyn e c o lo gy

Ml 1.2

McGILL Reproductive Center

J>)------ 4,2cm / 38H2

Tls 0.2

10/18/2005 W;42t»PM-

Uterus Har-mid Pwr100 % Gn 1

Uterus Har-mid Pwr100 % Gn 1

Fig. 1. Ultrasound appearance of a polycystic ovary. Polycystic ovaries is a morphological definition based on ultrasound without any manifestation of the syndrome and can be defined as the presence of 12 or more follicles in one ovary measuring 2-9 mm in diameter, and/or increased ovarian volume (>10 mL).

When treated with gonadotropins, patients with polycystic ovaries/PCOS have a narrow therapeutic window because a slight increase in dose may lead to an exaggerated response. When gonadotro-pin-treatment cycles for ovulation induction and/or intrauterine insemination result in hyperresponse with multiple follicle counts, this increases the rate of high-order multiple pregnancy. In order to avoid this, cycles need to be either canceled or converted to IVF. Controlled ovarian hyperstimulation in patients with polycystic ovaries or PCOS also carries the risk of OHSS.

2.3. Pretreatment Counseling in PCOS 2.3.1. Insulin Resistance

A large number of women with PCOS exhibit insulin resistance, which has been shown to play an important role in the pathophysiology of PCOS (14). Patients with PCOS should be screened for type 2 diabetes mellitus or impaired glucose tolerance before treatment. In addition, insulin resistance has also been suggested to cause higher doses of gonadotropin consumption (15). Some authors suggest that when metformin is added to the IVF treatment, although the gonadotropin requirement does not change, more oocytes are retrieved (16), and that co-administration of metformin in IVF treatment decreases the total number of follicles (17) with higher clinical pregnancy rates (18). However, other authors found that metformin had no effect on duration of stimulation, total FSH dose, number of follicles 10-16 mm and 17 mm or greater in diameter, serum levels of estradiol (E2) on the day of human chorionic gonadotropin (hCG) injection, number of retrieved oocytes, fertilization rate, number of transferred embryos, and total and clinical pregnancy rates (19,20).

Ivf Protocols For Pcos
  1. 2. The "long" gonadotropin-releasing hormone (GnRH) suppression protocol for in vitro fertilization (IVF), accompanied by pretreatment with combined oral contraceptive pills, has been widely accepted as the most effective stimulation protocol for polycystic ovary/polycystic ovary syndrome (PCO/PCOS) patients.
  2. 2. The "long" gonadotropin-releasing hormone (GnRH) suppression protocol for in vitro fertilization (IVF), accompanied by pretreatment with combined oral contraceptive pills, has been widely accepted as the most effective stimulation protocol for polycystic ovary/polycystic ovary syndrome (PCO/PCOS) patients.

Was this article helpful?

0 0
Get Pregnant - Cure Infertility Naturally

Get Pregnant - Cure Infertility Naturally

Far too many people struggle to fall pregnant and conceive a child naturally. This book looks at the reasons for infertility and how using a natural, holistic approach can greatly improve your chances of conceiving a child of your own without surgery and without drugs!

Get My Free Ebook


Post a comment