title: In-vitro maturation of oocytes vs in-vitro fertilization with a gonadotropin-releasing hormone antagonist for women with polycystic ovarian syndrome: can superiority be defined?
abstract: OBJECTIVE
  Patients with polycystic ovarian syndrome (PCOS) are at increased risk of ovarian hyperstimulation syndrome (OHSS) in controlled ovarian hyperstimulation cycles. Interventions to reduce the risk of OHSS in these patients include in-vitro fertilization (IVF) with a gonadotropin-releasing hormone (GnRH) antagonist, and retrieval of immature oocytes followed by in-vitro maturation (IVM). The aim of this study was to compare the outcomes of IVM and IVF-GnRH antagonist protocols in women with PCOS undergoing assisted reproductive technology.
  
  
  METHODS
  Retrospective cohort study. Records of women with PCOS who underwent IVM or IVF-GnRH antagonist protocols between 2010 and 2011 were reviewed. In total, there were 61 IVM cycles and 53 IVF-GnRH antagonist cycles. The treatment protocols were compared in terms of the number of oocytes retrieved, dose of gonadotropin administrated, fertilization rates, quality of embryos, pregnancy, and delivery and abortion rates.
  
  
  RESULTS
  The number (mean±standard deviation) of mature oocytes did not differ significantly between the two groups (7.11±5.7 vs 8.16±5.07 for the GnRH antagonist group and the IVM group, respectively; p=0.38). The average dose of gonadotropin (1938 IU±838 IU/cycle vs 118±199 IU/cycle; p<0.001), fertilization rate (77% vs 60%; p<0.001) and high-quality embryo rate (58.8% vs 48.3; p<0.001) were significantly higher in the GnRH antagonist group compared with the IVM group. Pregnancy rates (40% vs 25%; p=0.08), livebirth rates per pregnancy (71% vs 53%; p=0.265) and abortion rates (10% vs 27%; p=0.17) were comparable.
  
  
  CONCLUSIONS
  The IVM protocol can be an alternative for infertile women with PCOS who wish to prevent the potential adverse effects of gonadotropin treatment. Prospective studies are needed to compare the outcomes of these two treatment protocols.
authors: IVF Unit, Obstetrics and Gynaecology Department, Hillel Yaffe Medical Centre, Hadera, Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. Electronic address: Tal.shavit@gmail.com.
authors: T
authors: T
authors: Shavit
authors: IVF Unit, Obstetrics and Gynaecology Department, Hillel Yaffe Medical Centre, Hadera, Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors: A
authors: A
authors: Ellenbogen
authors: IVF Unit, Obstetrics and Gynaecology Department, Hillel Yaffe Medical Centre, Hadera, Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors: M
authors: M
authors: Michaeli
authors: IVF Unit, Obstetrics and Gynaecology Department, Hillel Yaffe Medical Centre, Hadera, Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors: E
authors: E
authors: Kartchovsky
authors: IVF Unit, Obstetrics and Gynaecology Department, Hillel Yaffe Medical Centre, Hadera, Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors: O
authors: O
authors: Ruzov
authors: IVF Unit, Obstetrics and Gynaecology Department, Hillel Yaffe Medical Centre, Hadera, Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors: E
authors: E
authors: Shalom-Paz
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D009865:Oocytes / Q000166:cytology* / Q000187:drug effects; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control; D010062:Ovulation Induction / Q000379:methods; D011085:Polycystic Ovary Syndrome / Q000150:complications*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone
keywords: Antagonist protocol; Assisted reproductive technology outcome; In-vitro maturation; Polycystic ovarian syndrome