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Rev Bras Ginecol Obstet. 2008;30(4):201-209
DOI 10.1590/S0100-72032008000400008
Polycystic ovary syndrome (PCOS) occurs in 6 to 10% of women during the reproductive age. Insulin resistance and compensatory hyperinsulinemia are currently two of the main factors involved in the etiopathogenesis of PCOS. The objective of the present review was to discuss the controversies related to the treatment of infertile women with PCOS and during their pregnancy, focusing on the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) current consensus.
Summary
Rev Bras Ginecol Obstet. 2008;30(4):201-209
DOI 10.1590/S0100-72032008000400008
Polycystic ovary syndrome (PCOS) occurs in 6 to 10% of women during the reproductive age. Insulin resistance and compensatory hyperinsulinemia are currently two of the main factors involved in the etiopathogenesis of PCOS. The objective of the present review was to discuss the controversies related to the treatment of infertile women with PCOS and during their pregnancy, focusing on the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) current consensus.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):32-37
DOI 10.1590/S0100-72032006000100006
PURPOSE: to evaluate the rate of chemically diagnosed pregnancy (serum beta-HCG>25 mIU/mL levels obtained fourteen days after the embryonic transfer) clinically diagnosed pregnancy (gestational sac visualized by ultrasound four to six weeks after the embryonic transfer) and miscarriage rates in women submitted in vitro fertilization to (IVF) and intracytoplasmic sperm injection (ICSI) in a tertiary center of assisted reproduction and to correlate these rates with age. METHODS: retrospective transverse study with analysis of 1016 cycles of controlled ovarian hyperstimulation of 932 infertile women with indication of IVF (370 cycles) or ICSI (646 cycles). The patients' age ranged from 22 to 46 years. All women with age over 35 years included in the study had FSH<15 IU/L. The studied cycles were divided into two groups: the first including the cycles referring to women of 22 to 30 years and the second group, to those of 31 to 46 years. The studied variables were: pregnancy (chemical or clinical) and miscarriage rates. The chi2 test was used to compare these rates between the groups. RESULTS: the total pregnancy rate was 36.42%, with a significant reduction starting at 30 years (p=0.0001). From 22 to 30 years (303 cycles) the pregnancy rate was 45.4%, while in the range from 31 to 46 years (713 cycles), it was 25.1%. The miscarriage rates were, 10.2 11,6%, respectively (p=0.6854). CONCLUSION: although the miscarriage rates did not differ between the groups, a decrease in the pregnancy rate of infertile women submitted to IVF or ICSI was observed after the age of 30 years. Thus, we recommend the gynecologists not to postpone the investigation and the referral for treatment of infertility.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):32-37
DOI 10.1590/S0100-72032006000100006
PURPOSE: to evaluate the rate of chemically diagnosed pregnancy (serum beta-HCG>25 mIU/mL levels obtained fourteen days after the embryonic transfer) clinically diagnosed pregnancy (gestational sac visualized by ultrasound four to six weeks after the embryonic transfer) and miscarriage rates in women submitted in vitro fertilization to (IVF) and intracytoplasmic sperm injection (ICSI) in a tertiary center of assisted reproduction and to correlate these rates with age. METHODS: retrospective transverse study with analysis of 1016 cycles of controlled ovarian hyperstimulation of 932 infertile women with indication of IVF (370 cycles) or ICSI (646 cycles). The patients' age ranged from 22 to 46 years. All women with age over 35 years included in the study had FSH<15 IU/L. The studied cycles were divided into two groups: the first including the cycles referring to women of 22 to 30 years and the second group, to those of 31 to 46 years. The studied variables were: pregnancy (chemical or clinical) and miscarriage rates. The chi2 test was used to compare these rates between the groups. RESULTS: the total pregnancy rate was 36.42%, with a significant reduction starting at 30 years (p=0.0001). From 22 to 30 years (303 cycles) the pregnancy rate was 45.4%, while in the range from 31 to 46 years (713 cycles), it was 25.1%. The miscarriage rates were, 10.2 11,6%, respectively (p=0.6854). CONCLUSION: although the miscarriage rates did not differ between the groups, a decrease in the pregnancy rate of infertile women submitted to IVF or ICSI was observed after the age of 30 years. Thus, we recommend the gynecologists not to postpone the investigation and the referral for treatment of infertility.
Summary
Rev Bras Ginecol Obstet. 2010;32(9):447-453
DOI 10.1590/S0100-72032010000900006
PURPOSE: to evaluate the concentration of steroid hormones in follicular fluid (FF) of small (10-14 mm) and large (> 18 mm) follicles of women with polycystic ovary syndrome (PCOS) submitted to controlled ovarian hyperstimulation (COH) and in vitro fertilization (IVF) cycles. METHODS: a case-control study was conducted on 13 infertile women with PCOS (17 cycles) and 31 infertile women due to male factor - Control Group (31 cycles). FF was aspirated individually and divided into four groups: G1 (FF of small follicles of the Control Group), G2 (FF of small follicles of the PCOS group), G3 (FF of large follicles of the Control Group) and G4 (FF of large follicles of the PCOS group). Estrogen, progesterone and β-hCG were determined by chemiluminescence, and testosterone and androstenedione by radioimmunoassay. The unpaired t-test was used to compare the hormone determinations in the FF of the PCOS and Control Groups, and the four groups were compared by ANOVA. Fisher's exact test was used to compare the pregnancy rates. RESULTS: the small follicles of the two groups had lower progesterone levels (8,435±3,305 ng/mL) than large follicles (10,280±3,475 ng/mL), p-value <0.01. The progesterone levels of all follicles of group PCOS (8,095±4,151 ng/mL) were lower than Control (9,824±3,128 ng/mL), p-value =0.03. Testosterone differed between G1 (326.6±124.4 ng/dL) and G3 (205.8±98.91 ng/dL), p-value <0.001, and between G3 (205.8±98.91 ng/dL) and G4 (351.10±122.1ng/dL), p-value <0.001. Small follicles had higher testosterone levels (508.9±266 ng/dL) than large follicles (245.10±123 ng/dL), p-value <0.0001. The pregnancy rates did not differ between the PCOS (5/13, 38.5%) and the Control groups (9/31, 40.9%), p-value =072. CONCLUSIONS: women with PCOS had high testosterone concentrations in the FF, regardless of the stage of follicle development, and reduced progesterone levels, suggesting that paracrine factors may inhibit the secretion of the latter by follicular cells. The pregnancy rates showed that treatment with COH and IVF is a good option for women with infertility secondary to PCOS.
Summary
Rev Bras Ginecol Obstet. 2010;32(9):447-453
DOI 10.1590/S0100-72032010000900006
PURPOSE: to evaluate the concentration of steroid hormones in follicular fluid (FF) of small (10-14 mm) and large (> 18 mm) follicles of women with polycystic ovary syndrome (PCOS) submitted to controlled ovarian hyperstimulation (COH) and in vitro fertilization (IVF) cycles. METHODS: a case-control study was conducted on 13 infertile women with PCOS (17 cycles) and 31 infertile women due to male factor - Control Group (31 cycles). FF was aspirated individually and divided into four groups: G1 (FF of small follicles of the Control Group), G2 (FF of small follicles of the PCOS group), G3 (FF of large follicles of the Control Group) and G4 (FF of large follicles of the PCOS group). Estrogen, progesterone and β-hCG were determined by chemiluminescence, and testosterone and androstenedione by radioimmunoassay. The unpaired t-test was used to compare the hormone determinations in the FF of the PCOS and Control Groups, and the four groups were compared by ANOVA. Fisher's exact test was used to compare the pregnancy rates. RESULTS: the small follicles of the two groups had lower progesterone levels (8,435±3,305 ng/mL) than large follicles (10,280±3,475 ng/mL), p-value <0.01. The progesterone levels of all follicles of group PCOS (8,095±4,151 ng/mL) were lower than Control (9,824±3,128 ng/mL), p-value =0.03. Testosterone differed between G1 (326.6±124.4 ng/dL) and G3 (205.8±98.91 ng/dL), p-value <0.001, and between G3 (205.8±98.91 ng/dL) and G4 (351.10±122.1ng/dL), p-value <0.001. Small follicles had higher testosterone levels (508.9±266 ng/dL) than large follicles (245.10±123 ng/dL), p-value <0.0001. The pregnancy rates did not differ between the PCOS (5/13, 38.5%) and the Control groups (9/31, 40.9%), p-value =072. CONCLUSIONS: women with PCOS had high testosterone concentrations in the FF, regardless of the stage of follicle development, and reduced progesterone levels, suggesting that paracrine factors may inhibit the secretion of the latter by follicular cells. The pregnancy rates showed that treatment with COH and IVF is a good option for women with infertility secondary to PCOS.
Summary
Rev Bras Ginecol Obstet. 2004;26(9):727-733
DOI 10.1590/S0100-72032004000900009
PURPOSE: to evaluate the results of ovulation hyperinduction followed by in vitro fertilization (IVF) in women with polycystic ovary syndrome (POS), as compared to normal cycle women. METHODS: a controlled retrospective study conducted on 36 women with POS (POS group) and on 44 women with infertility due to mild male factor (control group), submitted to IVF from 1997 to 2003. Subject ages ranged from 18 to 36 years. Ovulation hyperinduction was obtained with recombinant follicle-stimulating hormone and a gonadotrophin-releasing hormone agonist. The analyzed variables were the follicles with a mean diameter of 14 to 17 mm and the follicles with diameters of 18 mm or above on the day of human chorionic gonadotrophin administration, percentage of follicles >18 mm, the number of retrieved oocytes, fertilization rate, cleavage rate, incidence of ovarian hyperstimulation syndrome (OHS), clinical pregnancy rate, and abortion rate. The variables were analyzed by the unpaired t test, Fisher exact test and Mann-Whitney test, with level of significance set at p<0.05. RESULTS: the POS group presented a larger number of retrieved follicles, most of them measuring 14 to 17 mm in diameter, compared to the control group (64.8 vs 53.9%), a lower fertilization rate (59.43 vs 79.57%) and a higher incidence of OHS (38.9 vs 9.1%). The number of retrieved oocytes, cleavage rates, pregnancy rates per embryo transfer, abortion rates and live born rates did not differ between groups. CONCLUSION: the success of IVF is impaired in women with POS due to their larger number of retrieved follicles of reduced diameter, reduced fertilization rate and high OHS rates.
Summary
Rev Bras Ginecol Obstet. 2004;26(9):727-733
DOI 10.1590/S0100-72032004000900009
PURPOSE: to evaluate the results of ovulation hyperinduction followed by in vitro fertilization (IVF) in women with polycystic ovary syndrome (POS), as compared to normal cycle women. METHODS: a controlled retrospective study conducted on 36 women with POS (POS group) and on 44 women with infertility due to mild male factor (control group), submitted to IVF from 1997 to 2003. Subject ages ranged from 18 to 36 years. Ovulation hyperinduction was obtained with recombinant follicle-stimulating hormone and a gonadotrophin-releasing hormone agonist. The analyzed variables were the follicles with a mean diameter of 14 to 17 mm and the follicles with diameters of 18 mm or above on the day of human chorionic gonadotrophin administration, percentage of follicles >18 mm, the number of retrieved oocytes, fertilization rate, cleavage rate, incidence of ovarian hyperstimulation syndrome (OHS), clinical pregnancy rate, and abortion rate. The variables were analyzed by the unpaired t test, Fisher exact test and Mann-Whitney test, with level of significance set at p<0.05. RESULTS: the POS group presented a larger number of retrieved follicles, most of them measuring 14 to 17 mm in diameter, compared to the control group (64.8 vs 53.9%), a lower fertilization rate (59.43 vs 79.57%) and a higher incidence of OHS (38.9 vs 9.1%). The number of retrieved oocytes, cleavage rates, pregnancy rates per embryo transfer, abortion rates and live born rates did not differ between groups. CONCLUSION: the success of IVF is impaired in women with POS due to their larger number of retrieved follicles of reduced diameter, reduced fertilization rate and high OHS rates.