OPTIMIZATION OF IVF PROTOCOLS IN PATIENTS WITH POLICYCTIC OVARIAN SYNDROME

Problem statement: The main principal problem in Polycystic ovarian syndrome (PCOS) patients undergoing IVF were poor oocyte quality, low fertilization rates, and high miscarriage rates. Although various protocols have been used, the clinical outcomes of PCOS patients remain unsatisfactory. We assumed, that Clomiphene citrate 50 mg/d can demonstrated to be an effective oral alternative for preventing premature LH surges during controlled ovarian hyperstimulation (COH) in PCOS women undergoing IVF/ICSI treatments, with optimal pregnant outcomes in frozen-thawed embryo transfer cycles.Methods: The Clomiphene citrate 50 mg/d from MC2 was administered until the trigger day in 62 PCOS patients enrolled in the study group. Urinary human menopausal gonadotropin (hMG) or recombinant FSH 150 to 225 IU from MC7 till the trigger day (Figure 1). Maturation was triggered using triptorelin 0.2 mg when the diameter of the dominant follicle had reached 18 mm or more and also the oestradiol concentration per follicle had reached 300 pg/ml or more (Table 1). A short protocol was used for 38 PCOS women in the control group. Patients were administered 0.1mg of triptorelin daily beginning on MC2 and 150 to 225IU of hMG daily beginning on MC3. HCG 3000 IU was injected when dominant follicles reached 18mm in diameter. Results:. The primary outcome was the viable embryo rate per oocyte retrieved. The secondary outcomes included the number of oocytes retrieved, fertilization rate, and clinical pregnancy outcomes from FET cycles. No significant between-group differences were observed in the number of oocytes retrieved (13.1±7.76 vs 12.9±7.88), number of viable embryos (5.31±3.17 vs 4.9±3.32), mature oocyte rate (90.31±10.01% vs 92.8±9.21%), and cleavage rate (96.88±5.92% vs 94.91±8.97%). The fertilization rate (75.91±18.87% vs 68.73±20.71%; P<0.05), viable embryo rate per oocyte retrieved (39.84% vs 34.67%; P<0.05), biochemical pregnancy rate (71.43% vs 55.56%; P<0.05), clinical pregnancy rate (65.31% vs 48.89%; P<0.05), and implantation rate (46.47% vs 31.18%; P<0.05) in the study group were significant higher than those in the control group. This study shows that new protocol was feasible to improve the oocyte quality, possibly providing a new choice for PCOS patients undergoing IVF/ICSI treatments in combination with embryo cryopreservation.Conclusion: This protocol is promising with the advantages of cost reduction, being well tolerated, user convenience, which will help to establish a convenient user regimen in combination with a “freeze all” strategy.