PRETREATMENT AND SELECTION OF THE OPTIMAL PROTOCOL OF CONTROLLED OVARY STIMULATION IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME

Authors

  • M. S. Khmil I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine Medical Center “Clinic of Professor Stefan Khmil”, Ternopil, Ukraine

DOI:

https://doi.org/10.11603/1681-2786.2020.2.11412

Keywords:

infertility, GnRH antagonist, polycystic ovary syndrome, FT500 Plus, vitamin D3, folic acid, assisted reproductive technologies, in vitro fertilization

Abstract

Purpose: to improve the effectiveness of infertility treatment by optimizing pretreatment program and selecting the optimal stimulation protocol and ovulation trigger in patients with polycystic ovary syndrome in the protocols of assisted reproductive technologies.

Materials and Methods. A clinical examination of 157 infertile women with PCOS was performed, who were offered various pretreatment methods before controlled ovarian stimulation (COS) in in vitro fertilization (IVF) programs.

Results. The study was dominated by women aged 30–34 years with a duration of infertility up to 5 years, which in 82.8 % of patients was primary; among concomitant pathologies, PCOS was most often combined with the male factor in 42 (33.1 %) women.

The duration of controlled ovulation stimulation in patients was approximately the same in all three groups. The total dose of gonadotropins in patients of the experimental groups was small, but the lowest doses were prescribed to women with PCOS, who underwent IVF protocol pretreatment with vitamin complex FT500 Plus and vitamin D3 in a modified IVF protocol with a double ovulation trigger. Thus, the average additional dose of follicle stimulating hormone (FSH) in patients of the first group was (675. 25±85.2) IU, in the second – (750.45±90.8) IU, in the third – (760.70±105.5)  IU.

One of the complications in controlled ovarian stimulation protocols in patients with PCOS is ovarian hyperstimulation syndrome. Use of protocols with gonadotropin-releasing hormone antagonists (ant-GnRH) and use of the recommended GnRH agonist (Diferelin) 0.2 mg/ml  as an ovulation trigger, 0.1 mg/ml  after 12 h which significantly reduces the risk of OHSS. In the examined patients of the first group mild OHSS was diagnosed in 1 (1.6 %) persons, in the second – 3 (6.3 %), and in the third control group – 2 (4.3 %) patients. Patients did not require hospitalization, were treated on an outpatient basis. To date, replacement of the ovulation trigger with a GnRH agonist is the most effective method of OHSS prevention.

Conclusions. The use of pretreatment program in short modified protocols of controlled ovarian stimulation using gonadotropin-releasing hormone antagonists (GnRH) and agonist trigger (Diferelin) according to the scheme 0.2 mg/ml after 12 h 0.1 mg/ml can significantly reduce the risk of OHSS, which is safer and more comfortable for patients due to the shorter duration and lower cost of ovulation stimulation.

Author Biography

M. S. Khmil, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine Medical Center “Clinic of Professor Stefan Khmil”, Ternopil, Ukraine

Assistant of the Department of Obstetrics and Gynecology № 1, I. Horbachevsky Ternopil National Medical University. Medical Director of the Medical Center "Professor Stefan Khmil Clinic"

References

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Published

2020-09-25

How to Cite

Khmil, M. S. (2020). PRETREATMENT AND SELECTION OF THE OPTIMAL PROTOCOL OF CONTROLLED OVARY STIMULATION IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME. Bulletin of Social Hygiene and Health Protection Organization of Ukraine, (2), 60–64. https://doi.org/10.11603/1681-2786.2020.2.11412

Issue

No. 2 (2020)

Section

Organization of medical care

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