A review of IVF in PCOS patients at risk of ovarian hyperstimulation syndrome

ABSTRACT

Introduction: Polycystic ovarian syndrome (PCOS) is the commonest endocrinopathy affecting women in the reproductive age group. The prevalence may vary from 8.7% to 17% depending on the clinical criteria used. PCOS women having IVF presents multiple challenges ranging from a poor to an exaggerated response, poor egg to follicle ratio, poor fertilisation, poor blastocyst conversion and ovarian hyperstimulation syndrome. Ovarian stimulation should be planned with attention paid to the AMH, antral follicle count and LH in particular. The dose of the stimulating gonadotrophin should be planned to achieve an optimal response during a GnRH antagonist cycle.

Areas covered: We obtained evidence from chapters, case studies, practice committee reports, randomised controlled trials, Cochrane and systematic reviews.

Expert opinion: IVF for PCOS is challenging. We have reached an understanding of careful low dose stimulation of ovaries considering AMH and antral follicle count. PCOS women should have the GnRH agonist trigger and freezing of embryos. Segmentation of an IVF cycle in PCOS woman makes it safer and has better outcome

KEYWORDS:

• PCOS
• IVF
• GnRH agonist trigger
• segmentation of IVF

Article highlights

• The main danger for the woman with PCOS undergoing IVF is OHSS.

• This danger may be anticipated before starting treatment by estimating AMH levels and antral follicle count.

• A GnRH antagonist cycle should always be used for PCOS women undergoing IVF principally so that a GnRH trigger may be used, ideally followed by freezing of embryos.

• Segmentation of the protocol for PCOS women undergoing IVF make an OHSS-free clinic a plausible proposition.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.  

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.