Ovarian response to controlled ovarian stimulation in women with different polycystic ovary syndrome phenotypes

Abstract

Controlled ovarian stimulation (COH) in PCOS is a challenge for fertility expert both ovarian hyperstimulation syndrome (OHSS) and oocytes immaturity are the two major complication. Ovarian response to COH vary widely among POCS patients and while some patients are more likely to show resistance to COH, other experienced an exaggerated response. The aim of our study is to investigate a possible correlation between PCOS phenotypes and the variety of ovarian response to COH and ART outcomes in patients with different PCOS phenotypes. We retrospectively analyzed a total of 71 cycles performed in 44 PCOS infertile patients attending ART at Centre of Infertility and Assisted Reproduction of Pisa University between January 2013 and January 2016. Patientsundergoing IVF with GnRH-antagonist protocol and 150–225 UI/days of recombinant FSH; triggering was carried out using 250 mg of recombinant hCG or a GnRH analogous on the basis of the risk to OHSS. We observed that Phenotype B had a tendency to have a greater doses of gonadotropins used respect to all phenotypes. Phenotype A group showed a greater serum estrogen levels compared to all phenotypes groups, a greater number of follicles of diameter between 8–12 mm found by ultrasound on the day of triggering and a greater mean number of freeze embryo. Additionally serum AMH and antral follicles count (AFC) follow the same trend in the different phenotypes ad they were significantly higher in phenotype A and in phenotype D. In conclusion this study shows that the features of PCOS phenotypes reflect the variety of ovarian response to COH as well as the risks to develop OHSS. Serum AMH and AFC are related to the degree of ovulatory dysfunction making these ‘added values’ in identifying the different PCOS phenotypes. Phenotype A seems to be the phenotype with the higher risk to develop OHSS and the use of GnRH as a trigger seems to improve oocyte quality. To classify PCOS phenotype at diagnosis might help clinicians to identify patients at greater risk of OHSS, customize therapy and subsequently plan the trigger agent.

Chinese abstract

多囊卵巢综合征中控制性卵巢刺激（COH）是生殖专家的一个挑战, 卵巢过度刺激综合征（OHSS）和卵母细胞不成熟是两个主要的并发症。PCOS患者卵巢对COH反应各异, 有些患者对COH产生抵抗, 有些则产生过度反应。本研究旨在探讨不同PCOS表型的患者中PCOS表型与对COH的不同卵巢反应和ART结局之间的可能相关性。我们回顾性分析了2013年1月至2016年1月在比萨大学不孕不育和辅助生殖中心接受ART（共71个周期）的44例PCOS不孕患者。患者接受GnRH拮抗剂方案和150–225IU/天重组FSH的IVF；在OHSS风险的基础上使用250mg重组HCG或GnRH类似物诱发排卵。我们观察到, 有关所有表现, B型有更大剂量使用促性腺激素的倾向。与所有表型组相比, A型组表现出更大的血清雌激素水平、触发当天超声下更多直径8-12mm的卵泡和更大平均数量的冻胚。此外, 血清AMH、窦卵泡数（AFC）在不同表型中遵循相同的趋势, 在A型和D型中明显较高。综上, 本研究表明PCOS表型特征反映了COH和OHSS风险的不同卵巢反应。血清AMH和AFC与为确定不同PCOS表型而产生”附加值”的排卵功能障碍有关。A型似乎是OHSS高风险和使用GnRH提高卵细胞质量的表型。诊断PCOS表型可能助于临床医师识别OHSS高风险患者, 制定治疗方案和其后诱发排卵药物。

Keywords:

• PCOS
• PCOS phenotypes
• ovarian response
• assisted reproductive technology
• ovarian stimulation

Disclosure statement

The authors report no declaration of interest.