A case of polycystic ovary syndrome conceived by intracytoplasmic sperm injection following laparoscopic ovarian drilling.
Polycystic ovary syndrome (PCOS) is a disease in which an ovulation disorder is the main cause of infertility. Clomifene citrate (CC) is the treatment of first choice for ovulation induction in PCOS. If ovulation cannot be induced by CC, then either laparoscopic ovarian drilling (LOD) or gonadotropin therapy is selected as a subsequent treatment. Assisted reproductive technology (ART) is indicated for women with PCOS, similar to other infertility patients, when pregnancy is not achieved by intrauterine insemination (IUI). In this study, we experienced a case of PCOS in which pregnancy was achieved by ART following LOD. The case pertains to a 26-year-old patient. She consulted our hospital with a chief complaint of primary infertility. IUI with administration of CC plus recombinant follicle-stimulating hormone (rFSH) was carried out; however, pregnancy was not achieved. Subsequently, ART was carried out. In the first attempt, the development of several follicles was observed under the gonadotropin releasing hormone (GnRH) agonist long protocol. However, a fertilized oocyte was not obtained. In the second attempt, an ovum could not be collected after CC-rFSH ovarian stimulation. In the third attempt, a good quality embryo could not be obtained under the GnRH antagonist protocol, and therefore pregnancy could not be achieved. We performed LOD using a harmonic scalpel for the purpose of preventing severe OHSS and improving the quality of embryos. Following the operation, ovarian stimulation was performed under the CC-rFSH-antagonist protocol. Eighteen follicles were aspirated, six oocytes were picked-up, and five oocytes were normally fertilized. As a result, four embryos from day 2 culture were cryopreserved. Cryopreserved-thawed embryo transfer was thereafter performed, and a single pregnancy was achieved. LOD is a clinically effective treatment for PCOS requiring ART.
Department of Obstetrics and Gynecology, Joetsu General Hospital, Joetsu City, Japan. mususu@msg.biglobe.ne.jp
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Sugaya
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Honma
D000328:Adult; D015925:Cryopreservation; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control; D010053:Ovary / Q000601:surgery*; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000601:surgery; D019233:Retreatment; D056826:Single Embryo Transfer; D020554:Sperm Injections, Intracytoplasmic
D007987:Gonadotropin-Releasing Hormone