In vitro maturation in subfertile women with polycystic ovarian hyperstimulation syndrome who are undergoing assisted reproduction

Siristatidis CS, Maheshwari A, Bhattacharya S

Published Online:

May 11, 2011

Women with polycystic ovarian syndrome undergoing conventional assisted reproduction techniques are at an increased risk of ovarian hyperstimulation. Polycystic ovarian syndrome is often associated with the retrieval of immature oocytes, poor fertilisation, and low pregnancy rates. These women might benefit from the earlier retrieval of oocytes followed by maturation of the oocytes in the laboratory (IVM) thus reducing the risk of the women experiencing ovarian hyperstimulation syndrome. Successful fertilisation, embryo development, and term pregnancies resulting from IVM oocytes have been reported, along with some concern regarding the safety of the method with respect to the health of the children and the rate of congenital anomalies.
The update of this review found no trials to help assess the risks and benefits of IVM in infertile women with polycystic ovarian syndrome as compared to conventional assisted reproduction technology techniques.

Abstract (click to read)

Background:

Polycystic ovarian syndrome (PCOS) occurs in 4% to 7% of all women of reproductive age and 20% of women presenting with subfertility. A significant proportion of these women will ultimately need assisted reproductive technology (ART). In women with PCOS, the supra-physiological doses of gonadotrophins used for controlled ovarian hyperstimulation (COH) often result in an exaggerated ovarian response characterised by the development of a large cohort of follicles of uneven quality, retrieval of immature oocytes, and increased risk of ovarian hyperstimulation syndrome. A potentially useful intervention for women with PCOS-related infertility involves earlier retrieval of immature oocytes followed by in vitro maturation.

Objectives:

To compare live birth rates per woman following in vitro maturation (IVM) with conventional in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) for women with PCOS undergoing ART.

Search strategy:

We searched the Menstrual Disorders and Subfertility Group Specialised Register of controlled trials for any relevant trials (January 2011) identified from the title, abstract, or keyword sections. Following a search of the electronic database MEDLINE using Ovid software, in all languages, we also performed a manual search of the references of all retrieved articles; sought unpublished papers and abstracts submitted to international conferences; and contacted experts. In addition, we searched the National Institute of Clinical Excellence fertility assessment and treatment guidelines (NICE 2004) and handsearched reference lists of relevant articles (from 1970 until February 2011).

Selection criteria:

All randomised trials on the intention to perform IVM before IVF or ICSI compared to conventional IVF or ICSI for subfertile women with PCOS.

Data collection and analysis:

Two review authors independently assessed eligibility and quality of trials.

Main results:

There were no trials suitable for inclusion in the review.

Authors' conclusions:

There are no randomised controlled trials upon which to base any practice recommendations regarding IVM before IVF or ICSI for women with PCOS. There is an urgent need for randomised trials in this field.

This record should be cited as:

Siristatidis CS, Maheshwari A, Bhattacharya S. In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006606. DOI: 10.1002/14651858.CD006606.pub2

Assessed as up to date:

February 17, 2011

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Primary Review Group:

Menstrual Disorders and Subfertility Group

Health topics:

Gynaecology > Subfertility > Female: assisted conception techniques

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

In vitro maturation in subfertile women with polycystic ovarian hyperstimulation syndrome who are undergoing assisted reproduction

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