Myotonic dystrophy: does it affect ovarian follicular status and responsiveness to controlled ovarian stimulation?
BACKGROUND
Myotonic dystrophy (MD) is characterized by myotonia, multisystemic lesions and hypogonadism. In women, the relationship between MD and infertility remains controversial. This study investigated the ovarian status and response to controlled ovarian stimulation (COS) in MD women entering our preimplantation genetic diagnosis programme.


METHODS
We elected to compare MD patients with X-linked disorders (XLD) carriers, given that XLD have not been shown to affect ovarian status. On the one hand, we analysed all the cycles performed and, on the other hand, we conducted a subanalysis based on only first cycles.


RESULTS
MD and XLD groups were similar with regard to women's ages, day 3 parameters, number of oocytes retrieved, embryos obtained and prevalence of top quality embryos. The day of HCG was significantly delayed and the prevalence of poor quality embryos was higher in the MD group. The subanalysis on first cycles only also showed significantly fewer mature follicles on the day of HCG in MD population. Implantation and pregnancy rates were similar in both groups; however, no pregnancy occurred at the first cycle in MD (0 out of 4), whereas 77% of pregnancies (10/13) occurred at the first attempt in XLD carriers.


CONCLUSIONS
These results indicate that the responsiveness to COS was moderately hindered in MD women as compared to controls. Reassuring data about implantation and pregnancy rates support the feasibility of PGD in selected mildly affected MD women.
Feyereisen
E
E
Service de Gynécologie-Obstétrique et de Médecine de la Reproduction, Hôpital Antoine Béclère, Clamart, France. estelle.feyereisen@abc.aphp.fr
Amar
A
A
Kerbrat
V
V
Steffann
J
J
Munnich
A
A
Vekemans
M
M
Frydman
R
R
Frydman
N
N
D000328:Adult; D006063:Chorionic Gonadotropin / Q000032:analysis; D010064:Embryo Implantation; D004622:Embryo, Mammalian / Q000473:pathology; D005260:Female; D040181:Genetic Diseases, X-Linked / Q000503:physiopathology; D006801:Humans; D009223:Myotonic Dystrophy / Q000503:physiopathology*; D009865:Oocytes / Q000473:pathology; D006080:Ovarian Follicle / Q000473:pathology*; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D019836:Preimplantation Diagnosis
D006063:Chorionic Gonadotropin