Uticaj protokola stimulacije kod policističnog ovarijalnog sindroma na ishod vantelesnog oplođenja

Abstract

Polycystic ovarian syndrome (PCOS) is considered one of the most common endocrine disorders of women of reproductive age. It is characterized by chronic anovulation, signs of hyperandrogenism, polycystic appearance of ovaries and subfertility or sterility. Although polycystic ovaries are a common finding in infertile women, the exact incidence of these patients included in the in vitro fertilization program is not known. The aim of this study was to assess the effect of PCOS on the course and the outcome of in vitro fertilization; compare the characteristics of ovarian response and compare the clinical pregnancy and miscarriage rates in women with PCOS to those in women with tubal factor sterility; examine which ovarian stimulation protocol in patients with PCOS has a higher success rate and a lower risk of the occurrence of Ovarian Hyperstimulation Syndrome (OHSS); examine the effect of age, body mass index, levels of Anti-Mullerian hormone and the use of metformin on in vitro fertilization (IVF) outcomes in patients with PCOS. The research was conducted as a prospective comparative study. The study included 123 patients with PCOS and 94 patients participating IVF program due to tubal sterility. The patients were treated by a long GnRH agonist protocol, a short GnRH agonist protocol or a flexible GnRH antagonist protocol. The patients with PCOS have a higher number of the oocytes retrieved and a lower fertilization rate. Clinical pregnancy and miscarriage rates did not differ significantly between the two groups, while OHSS was present only in the group of patients with PCOS. The length of stimulation of patients with PCOS was shorter in the antagonist group, whereas the total number of aspirated oocytes was statistically significantly higher in the agonist group. Significantly higher number of the obtained embryos as well as a higher number of best quality embryos in the agonist group did not affect the clinical pregnancy rate. We have concluded that patients with PCOS achieve clinical pregnancy rates similar to those of women with tubal factor infertility. The antagonist protocol has clinical pregnancy rate comparable to that of the agonist protocol. Although there is no statistically significant difference in the incidence of OHSS, a less frequent occurrence of this serious complication has been noticed in the antagonist protocol.