MODERN APPROACHES TO THE TREATMENT OF INFERTILITY IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME IN ASSISTED REPRODUCTIVE TECHNOLOGY PROGRAMS
DOI:
https://doi.org/10.11603/24116-4944.2020.1.11494Keywords:
infertility, inositol, gonadotropin-releasing hormone antagonist, polycystic ovary syndrome, in vitro fertilizationAbstract
The aim of the study – to improve infertility treatment by optimizing pregravid therapy and selecting the optimal stimulation protocol and ovulation trigger in patients with PCOS.
Materials and Methods. 157 infertile patients with PCOS were examined. Depending on the method of treatment, patients were divided into three clinical groups. Group 1 consisted of 63 women who received FT 500-Plus and vitamin D3 Aquadetrim for 2–3 months before stimulation, group 2 – 48 women who received folic acid, group 3 – 46 women who did not receive pregravid preparation. Stimulation was conducted with corifolitropin-alpha Elonva according to a short protocol, GnRH antagonist Orgalutran and follicle-stimulating hormone Puregon, as a trigger GnRH agonist Diphereline was used (in groups 2 and 3 – 0.2 mg/ml once, and in group 1 the protocol was modified by us: 0.2 mg/ml + an additional 0.1 mg/ml after 12 hours). The effectiveness of the proposed infertility treatment regimen was assessed by the following indicators: the frequency of complications, in particular OHSS, the total percentage of efficiency of the obtained oocytes, the degree of maturity of the oocytes obtained and the yield of blastocysts.
Results and Discussion. When evaluating the results of superovulation induction, it was found that the duration of stimulation in group 1 was probably lower compared to groups 2 and 3. On the day of the ovulation trigger, a significantly lower concentration of estradiol and progesterone was found in group 1, compared with the data of other groups. In study group 1, where the introduction of the ovulation trigger was modified in own way, significantly fewer immature (GV and MI) oocytes were found, while the average number of mature eggs significantly exceeded the data of groups 2 and 3. The number of blastocysts in women with infertility on the background of PCOS group 1 was also significantly higher than the results obtained in other groups.
Conclusions. Controlled ovarian stimulation according to a short protocol using a vitamin complex with inositol and vitamin D3 in pregravid preparation and gonadotropin-releasing hormone antagonists and GnRH agonist trigger –Diphereline at a dose of
0.2 mg/ml + 0.1 mg/ml after 12 hours is more effective in the program of assisted reproductive technologies in PCOS, as it increases the number of mature cells (by 12.20 %) and blastocysts (by 16.26 %). It is also safer because its use significantly reduces the incidence of ovarian hyperstimulation syndrome (1.6 %) in women with infertility with PCOS compared to other controlled ovarian stimulation (COS) regimens.
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