Transvaginal ovarian drilling followed by controlled ovarian stimulation from the next day improves ovarian response for the poor responders with polycystic ovary syndrome during IVF treatment: a pilot study

Abstract

Background: Poor response patients with PCOS who are not susceptible to gonadotropin stimulation are more likely to have canceled cycles or poor clinical outcomes during IVF treatment. However, some limitations exist in the present therapies. In this study, we evaluated the effects of using the transvaginal ovarian drilling (TVOD) followed by controlled ovarian stimulation (COS) from the second day of these poor responders. Methods: During IVF, 7 poor responders with PCOS and 28 PCOS patients (14 normal and 14 high responders) were recruited. All patients received COS with the gonadotropin-releasing hormone antagonist protocol. For the poor responders, after undergoing 10 to 14 days of ovulation induction with no response, the TVOD was applied and then ovarian stimulation was performed from the next day at the same gonadotropin dose. Serum samples during COS and follicular fluid samples from the dominant follicles on the oocyte pickup (OPU) day in all three groups were collected. Besides, follicular fluid from small follicles (diameter < 1 cm) in the normal and high responders on the OPU day and those in the poor responders on the TVOD day were gathered. Hormonal levels were examined in all samples using immunometric assays. Results: All the poor responders restored ovary response after receiving TVOD. There was no significant difference in the stimulation duration, total gonadotrophin dose used and the clinical outcomes among the three groups. The body mass index, serum and follicular levels of anti-Müllerian hormone (AMH) and testosterone in poor responders were higher than those in the other two groups, and the application of TVOD significantly decreased the levels of AMH and testosterone in both serum and follicular fluid.

Live birth rate per fresh embryo transfer and cumulative live birth rate in patients with PCOS under the POSEIDON classification: a retrospective study

“…The management of POR in women with PCOS is varied: cancellation of the cycle, switching to intrauterine insemination (if the tubal obstruction is not present), dual stimulation, switching from IVF to IVM as a salvage strategy ( 37 ), or transvaginal ovarian drilling followed by controlled ovarian stimulation from the next day onwards ( 38 ). Our study provides new data that when the expected number of oocytes is more than four, the live birth rate of a fresh transfer is not affected.…”

Surgery for fertility? Are there possible surgical options in Polycystic Ovary Syndrome

“…Increased insulinsensitivity also occurs after LOD probably in close relationship with decreased androgen secretion (9,23). Transvaginal ovarian drilling results after only one day following procedure in decreased testosterone and AMH in serum and follicular fluid in women undergoing controlled ovarian stimulation protocol with GnRH antagonists for IVF (24).…”

The Feasibility of Switching IVF to IVM in PCOS Patients with Unexpected Poor Ovarian Response Who Underwent Prolonged Protocol

“…Thus, for preventing OHSS and saving cost, we suggested that patients should be performed IVM as earlier as the patients were undergoing moderate to severe OHSS tendency. Even patients obtained no live birth, the puncture of small follicles can be equal to the treatment of transvaginal ovarian drilling which might bene t the next ovarian stimulation cycle (42).…”