Polycystic ovary syndrome: pathophysiology and outcome with in vitro fertilization.
OBJECTIVE
To assess the efficacy of IVP-ET in infertile women with the polycystic ovary syndrome (PCOS) and to provide a comprehensive review of contemporary therapeutic options and their complications as reflected in the current literature.


METHODS
Pertinent studies in medical literature identified through computerized bibliographic search and via manual review of relevant scientific publications.


RESULTS
In vitro fertilization and ET is an effective therapy for PCOS patients who are refractory to ovulation induction in vivo or who have coexisting infertility factors. The use of GnRH agonist (GnRH-a) is associated with significant reductions in the incidence of pregnancy loss and may improve fertilization and cleavage rates. In the PCOS patient, the use of purified FSH preparations does not appear to improve pregnancy rates nor other clinical parameters when compared with hMG. Severe ovarian hyperstimulation syndrome (OHSS) is an important consideration when PCOS patients undergo superovulation protocols. Strategies for OHSS prevention include the use of intravenous albumin immediately after oocyte retrieval, triggering of ovulation with a GnRH-a, or withholding menotropin therapy for several days before hCG administration. Cryopreservation of all embryos for future transfer in an artificial cycle has also proven to be an effective alternative in PCOS patients at high risk for severe OHSS.


CONCLUSIONS
Pregnancy rates for PCOS patients undergoing IVF-ET are comparable with those for women with tubal factor infertility. Therefore, IVF-ET should be offered to patients with PCOS who are refractory to conventional infertility modalities.
Buyalos
R P
RP
Department of Obstetrics and Gynecology, University of California School of Medicine, Los Angeles, UCLA, USA.
Lee
C T
CT
D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D008596:Menotropins / Q000627:therapeutic use; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology; D011085:Polycystic Ovary Syndrome / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D017329:Triptorelin Pamoate / Q000627:therapeutic use
D017329:Triptorelin Pamoate; D008596:Menotropins; D005640:Follicle Stimulating Hormone; D016729:Leuprolide