Fertility management in the PCOS population: results of a web-based survey at IVF-worldwide.com

Abstract

Purpose To identify the leading treatment strategies for infertile women with PCOS on an international scale. Methods A retrospective evaluation using the results of a web-based survey, (IVF-Worldwide (www.IVF-worldwide. com), posted from 1 to 30 September 2010 was performed. Binomial confidence intervals for proportions were calculated by the modified Wald method with significance defined as P <0. 05 using a DataStar software package (DataStar, Waltham, MA, USA). Incomplete surveys were excluded from the analysis. ResultsThe results from 262 centers in 68 nations were obtained. Clomiphene citrate was the clear first choice, 68 %, for PCOS treatment in the respondent group. Eightyeight percent of respondents utilized ultrasound follicular monitoring when conducting ovulation induction with oral medications. A significant (p <0.05) proportion of respondents (66 %) did use some BMI cutoff beyond which IVF treatment was not offered. The preferred IVF protocols for PCOS patients were gonadotropin releasing hormone (GnRH) antagonist, 46 %, and GnRH agonist, 51 %. There was heterogeneity of responses observed regarding the management of a patient at very high risk of OHSS. Conclusions While some advances, such as the use of GnRH antagonist regimen in IVF cycles, were relatively underutilized, the survey gives an unfiltered snapshot at the practice patterns of a large number of clinics. Results from this survey may be used by researchers and professional organizations to improve the clinical care of PCOS women suffering with infertility.

Early miscarriage rate in lean polycystic ovary syndrome women after euploid embryo transfer – a matched-pair study

“…Embryo aneuploidy, which is widely known to be the most important factor for early miscarriage, was not given enough attention in previous studies when comparing the rate of early pregnancy loss between PCOS and non-PCOS women. The serum level of oestradiol and number of oocytes retrieved in patients with PCOS after ovarian stimulation in fresh assisted reproductive technique cycles tend to be higher when compared with non-PCOS women (Brezina et al, 2013;Palomba et al, 2015), which may affect the endometrial receptivity. Therefore, comparing pregnancy outcomes in FET cycles could adjust these confounding factors.…”

The stair-step approach in treatment of anovulatory PCOS patients

“…A recent web-based survey on the management of infertility in PCOS patients revealed that CC was regarded as first-line treatment by 68% of respondents. 5 CC acts by reducing the negative feedback of estrogen on the hypophysis and the hypothalamus, therefore increasing the secretion of follicle-stimulating hormone (FSH) from the hypophysis and encouraging follicular growth followed by ovulation.…”

Efficacy of the Levonorgestrel-Releasing Intrauterine System on IVF-ET Outcomes in PCOS With Simple Endometrial Hyperplasia

“…2,3 A proportion of women with infertility from PCOS do not respond to conventional infertility treatments (clomifene citrate, gonadotropins, ovarian drilling, or insulin-sensitizing agents) 4 and ultimately require assisted reproductive technology (ART). 5 Despite recent advances in in vitro fertilization embryo transfer (IVF-ET) that allow for the selection of high-quality embryos, the implantation rate of women with PCOS remains low and has not increased sufficiently in the recent decades. 6 Successful implantation requires that the endometrium continues to grow and undergoes further morphological and molecular changes to provide sufficient support for the growing embryo.…”