Infertile polycystic ovary syndrome patients undergoing in vitro fertilization with the gonadotropin-releasing hormone-antagonist protocol: role of hyperandrogenism

Abstract

This retrospective cohort study is to assess the effects of hyperandrogenism (HA) in polycystic ovary syndrome (PCOS) patients with gonadotropin-releasing hormone (GnRH)-antagonist protocol during in vitro fertilization (IVF). Total 892 infertile Patients between 20 and 35 years of age with normal body mass index (BMI, 18.50 −24.99 kg/m²), including those with tubal factor infertility (control, n = 318), PCOS infertility with HA (HA PCOS, n = 244), and PCOS infertility without HA (non-HA PCOS, n = 330), were included. Number of retrieved oocytes was significantly higher and total Gonadotropin consumption was significant lower in the HA PCOS group, whereas abortion rate was significantly higher and live birth rate was significantly lower in the HA PCOS group, compared with the control and non-HA PCOS groups. In the HA PCOS group, the number of available embryos tended to be higher with no significance. The GnRH-antagonist protocol is more suitable for HA PCOS patients, with lower cost and more number of embryos available for transfer. Due to the high abortion rate and low live birth rate, a freeze-all approach might be a preferable option for HA PCOS patients so as to create a buffer for reducing androgen levels before transferring freeze-thawed embryos.

Chinese abstract

高雄激素血症：对在进行体外受精期间使用促性腺激素释放激素拮抗剂方案治疗多囊卵巢综合征所致不孕患者的作用

摘要

本回顾性队列研究的目的是明确高雄激素血症（HA）对在进行体外受精期间采用促性腺激素释放激素（GnRH）拮抗剂方案治疗多囊卵巢综合征（PCOS）患者的作用。共纳入年龄在20-35岁的不孕患者892名, 其中包括输卵管异常者（即对照组, n = 318）、PCOS伴HA升高者（即HA PCOS组, n = 244）和PCOS不伴HA升高者（即non-HA PCOS 组, n = 330）。所有患者BMI值均在正常范围内（18.50 -24.99 kg/m²）。与对照组和non-HA PCOS组患者相比, HA PCOS组患者的获卵数明显增加且总促性腺激素使用量明显降低。同时HA PCOS组患者的流产率明显高于另外两组, 而活产率则明显降低。促性腺激素释放激素拮抗剂治疗方案的费用较低, 可移植的胚胎数较多, 因此更适合于伴有HA升高的PCOS患者。但由于该方案可导致流产率的增加及活产率的降低, 在未寻找到可在移植冻融胚胎前降低雄激素水平的优效药物前, 冻存胚胎仍为伴有HA升高的PCOS患者的首选。

关键词: 促性腺激素释放激素拮抗剂, 多囊卵巢综合征, 高雄激素血症, 体外受精

Keywords:

• Gonadotropin-releasing hormone antagonist
• polycystic ovary syndrome
• hyperandrogenism
• in vitro fertilization

Acknowledgements

The authors thank the academy of Public Health, Peking University for support in providing assistance with statistical analyses. The authors thank Coleen, an experienced editor whose first language is English, for carefully reviewing the article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by National Natural Science Foundation of China [81550022].