EVALUATION OF EFFICIENCY ACCORDING TO CONTROLLED LONG PROTOCOL OVARIAN STIMULATION IN INFERTILITY WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS)
DOI:
https://doi.org/10.11603/24116-4944.2019.2.10934Keywords:
infertility, controlled ovarian stimulation, OHSS, PCOS, long protocol of stimulationAbstract
The aim of the study – to analyze the effectiveness of controlled long protocol ovarian stimulation in women with polycystic ovary syndrome.
Materials and Methods. The study included 130 patients, of whom 100 were women with polycystic ovary syndrome (PCOS) and 30 were women with tubal factor infertility. The patients were divided into three groups: group 1 consisted of 22 patients who were embryotransferred on the 5-6th day after puncture; group 2 consisted of 78 patients who went to the cryocycle protocols; group 3 control group consisted of 30 patients with tubal-peritoneal infertility factor. The division of women into the first two groups was based on the degree of risk of developing ovarian hyperstimulation syndrome (OHSS). Controlled ovarian stimulation was performed according to a long protocol from 19–22 days of the previous menstrual cycle. Evaluation of the effectiveness of quality of controlled ovarian stimulation under the long protocol was performed according to the indicators, which are described in detail in the section "study results".
Results and Discussion. When evaluating the results of the induction of superovulation, it was found that the duration of stimulation in patients with PCOS was higher than in patients with tubal factor infertility – 11.92 days and 10.63 days, respectively. The total dose of gonadotropins in women with PCOS was 1050.5 (725; 1250) IU and was significantly higher relative to the control group – 845.0 (700; 900) IU. In women with infertility due to PCOS and the onset of OHSS as a result of long protocol, the average number of follicles exceeded 2.7 times the control group. During the aspirations we received significantly higher number of oocytes (2.4-fold) relative to the control group, and the number of mature eggs in PCOS women went under the "long" α-GnRH protocol were significantly higher (2.1 fold) than in control group. Blastocyst output in women with PCOS was 1.7 times higher than in control. It was found that in patients with PCOS, and OHSS grade 1, the number of follicles and oocytes was the lowest. In women with PCOS who were diagnosed with OHSS grade 3, the number of follicles was significantly higher than those with grade 1 OHSS (19.5 %), respectively, and the oocyte count was 22.2 % higher. It was found that the number of clinically induced pregnancies achieved in women with PCOS with fresh embryo transfer was 40.9 %.
Conclusions. Controlled ovarian stimulation over a long protocol using agonist-GnRH in women with polycystic ovary syndrome is accompanied in 92.0 % by the development of ovarian hyperstimulation syndrome (49.0 %), which limits the use of this scheme.
References
Alper, M.M., & Fauser, B.C. (2017). Ovarian stimulation protocols for IVF: is more better than less? Reproductive BioMedicine, 34, 4, 345-353.
Fatemi, H.M., Blockeel, C., & Devroey, P. (2012). Ovarian stimulation: today and tomorrow. Curr. Pharm. Biotechnol, 13, 392-397. DOI: https://doi.org/10.2174/138920112799362007
Khmil, M.S., Khmil, S.V., Chudiyovych, N.Ya., & Khmil-Doswald, A.S. (2018). Porivnialna kharakterystyka protokoliv stymuliatsii ovuliatsii z vykorystanniam ahonistiv ta antahonistiv honadotropin-rylizynh-hormoniv u prohramakh dopomizhnykh reproduktyvnykh tekhnolohii (ohliad literatury) [Comparative characteristics of protocols of ovulation stimulation with using of agonists and antagonists of gonadotropin-releasing hormone in the programs of assisted reproductive technologies (literature review)]. Visnyk sotsialnoi hihiieny ta orhanizatsii okhorony zdorovia Ukrainy – Bulletin of Social Hygiene and Health Care Organization of Ukraine, 4 (78), 90-96 [in Ukrainian].
Sighinolfi, G., Sunkara, S.K., & La Marca, A. (2018). New strategies of ovarian stimulation based on the concept of ovarian follicular waves: From conventional to random and double stimulation. Reproductive BioMedicine, 37, 4, 489-497. DOI: https://doi.org/10.1016/j.rbmo.2018.07.006
Body Mass Index: Considerations for Practitioners. Retrieved from: https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf
(2011). The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Human Reproduction, 26, 6, 1270-1283. DOI: https://doi.org/10.1093/humrep/der037
Dokras, A., Sargent, I.L., & Barlow, D.H. (1993). Human blastocyst grading: an indicator of developmental potential? Hum. Reprod., 8 (12), 2119-2127.
Gardner, D.K., Schoolcraft, W.B., Wagley, L., Schlenker, T., Stevens, J., & Hesla, J. (1998). A prospective randomized trial of blastocyst culture and transfer in in-vitro fertilization. Hum. Reprod., 13 (12), 3434-3440. DOI: https://doi.org/10.1093/humrep/13.12.3434
Veeck, L.L., & Zaninovic, N. (2003). An Atlas of Human Blastocysts. Encyclopedia of visual medicine series. Taylor & Francis, 286 p. DOI: https://doi.org/10.3109/9780203008935
Dagan, G.F., & Balaban, M.O. (2006). Pasteurization of Beer by a Continuous Dense‐phase CO2 System. J. of Food Sci., 71, 3, E164-E169. DOI: https://doi.org/10.1111/j.1365-2621.2006.tb15630.x
Dankovich, M.D., Vorobei-Vykchovsky, V.N. (2013). Prichiny i formy besplodiya. Sovremennyye vozmozhnosti diagnostiki i lecheniya [The course and forms of infertility. The opportunity of diagnostic and treatment today]. Zdorovye zhenshchiny − Women's Health, 3, 192-197 [in Russian].
Ke, H., Chen, X., Liu, Y.D., Ye, D.S., He, Y.X., & Chen, S.L. (2013). Cumulative live birth rate after three ovarian stimulation IVF cycles for poor ovarian responders according to the bologna criteria. J. Huazhong Univ. Sci. Technolog. Med. Sci., 33 (3), 418-422. doi: 10.1007/s11596-013-1134-7. DOI: https://doi.org/10.1007/s11596-013-1134-7
Shcherbyna, M.O., & Antonian, M.I. (2013). Optymizatsiia vedennia vahitnosti pislia zastosuvannia ekstrakorporalnoho zaplidnennia [Optimization of pregnancies conduction after assisted in vitro fe]. Tavricheskiy mediko-biologicheskiy vestnik – Tauride Medical and Biological Bulletin, 16, 2, ch. 1 (62), 258-260 [in Ukrainian].
Smith, V., Osianlis, T., & Vollenhoven, B. (2015). Prevention of ovarian hyperstimulation syndrome: A review. Obstet. Gynecol. Int., 2015, Article ID: 514159.
Wei, J., Wu, Q.-J., Zhang, T.-N., Shen, Z.-Q., Liu, H., Zheng, D.-M., …, & Liu, C.-X. (2016). Complications in multiple gestation pregnancy: A cross-sectional study of ten maternal-fetal medicine centers in China. Oncotarget, 7, 21, 30797-30803. doi: 10.18632/oncotarget.9000 DOI: https://doi.org/10.18632/oncotarget.9000
Humm, K.C., Dodge, L.E., Wu, L.H., Penzias, A.S., Malizia, B.A., Sakkas, D., & Hacker, M.R. (2015). In vitro fertilization in women under 35: counseling should differ by age. J. Assist. Reprod.. Genet., 32, 10, 1449-1457. DOI: https://doi.org/10.1007/s10815-015-0570-7
Vityuk, A.D., & Korop, Z.A. (2014). Vplyv ozhyrinnia ta hiperandrohenii na chastotu nastannia vahitnosti u zhinok z anovuliatornym bezpliddiam [Influence of obesity and hyperandrogenia on the frequency of pregnancy in women with anovulatory infertility]. Zbirnyk naukovykh prats spivrobitnykiv NMAPO imeni P.L. Shupyka – P.L. Shupyk NMAPE Collection of Scientific orks, 23, 5 (ch. 2), 172-177 [in Ukrainian].
Auerbach, A.B., Norinsky, R., Ho, W., Losos, K., Guo, Q., Chatterjee, S., & Joyner, A.L. (2003). Strain-dependent differences in the efficiency of transgenic mouse production. Transgenic Res., 12, 1, 59-69. DOI: https://doi.org/10.1023/A:1022166921766
Alper, M.M., & Fauser, B.C. (2017). Ovarian stimulation protocols for IVF: is more better than less? Reproductive BioMedicine Online, 34, 4, 345-353. DOI: https://doi.org/10.1016/j.rbmo.2017.01.010. DOI: https://doi.org/10.1016/j.rbmo.2017.01.010
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
