Oocyte and Embryo Quality of Infertile Patients with Classic Phenotype Polycystic Ovarian Syndrome after Controlled Ovarian Hyperstimulation

Abstract

The polycystic ovary syndrome (PCOS) is a combination of conditions, closely associated with female infertility and metabolic syndrome. It is recognized mainly with a polycystic ovary morphology (PCOM) of increased ovarian volume and pearl chain-like follicles on ultrasound, producing a large cohort of growing follicles during controlled ovarian hyperstimulation (COH) that are frequently heterogeneous in size and with poor quantity or quality of mature oocytes. However, recent data has proposed controversial opinions. The objective of the present study was to evaluate the relationship between the classical phenotype PCOS and the oocyte and embryo quality after COH for intracytoplasmic sperm injection (ICSI). An observational case control study was conducted for a four years period at the IVF department of a private gynecological hospital. Infertile females under 39, who performed COH for ICSI were included. A total of 496 ICSI cycles were divided into two groups – a PCOS group with 109 ICSI cycles and a control group with tube infertility that encompasses 387 ICSI cycles. The main outcome measures were the quantity and quality of the retrieved oocytes and embryos as well as the ICSI outcomes (fertilization rate, implantation rate and clinical pregnancy rate). The statistical analyses were performed, using SPSS version 12.0 and MEDCALC® statistical software and statistical significance was considered at p < 0.05. Significantly higher mean number of total oocytes (14±6.02 SD vs. 9±3.25 SD; p < 0.0001) and meta-phase II oocytes (10±1.94 SD as opposed to 6±2.89 SD; p = 0.0001), as well as immature and atretic ones were retrieved in the PCOS group compared to the controls (p < 0.0001). However, the fertilization rate did not differ among the two groups (66.8% and 62.4%, respectively). Despite obtaining significantly more embryos in the PCOS patients (9±5.17 SD vs. 6±2.96 SD; p < 0.0001), there were no differences between the two groups regarding the figures of the top quality embryos (25.6% and 29%, respectively), implantation rate (19.7% and 19.95%, respectively) and clinical pregnancy rate (28.4% and 33.6%, respectively, NS). Patients with classic phenotype PCOS are not associated with poor oocyte and embryo quality or with unfavourable ICSI outcome after controlled ovarian hyperstimulation.