Management of PCOS IVF Cycle

Abstract

PCOS is the most common Endocrine and Metabolic disorder in reproductive age women, being the most common cause of anovulatory Infertility. PCOS is a vicious circle of Insulin Resistance, Hyperandrogenism and improper LH secretions. This leads to ovulatory dysfunction, anovulation and hence infertility. Studies have observed impaired oocyte maturation and sub optimal and endometrial receptivity in women with PCOS. Hence management in such patients is aimed to enhance pretreatment and stimulation protocols for better pregnancy outcomes. Pretreatment with insulin sensitizers, antiandrogens and achieving optimization of weight before a stimulation cycle helps achieve optimum cycle outcomes. Multiple ovarian stimulation protocols have been used to prevent LH surge during controlled ovarian stimulation including GnRh agonist, antagonist, or progestin primed protocol. Similar pregnancy rates have been observed using both agonist or antagonist protocols, while the prevalence of OHSS is considerably lower with antagonist and progestin protocols. The type of protocol utilized for ovarian stimulation, the trigger used or the type of Gonadotropin ideal for PCOS women is still debatable. In order to avoid complications due to ovarian hyperstimulation, a freeze all strategy has been adopted worldwide as the optimum protocol for PCOS women, giving superior success rates, especially in PCOS women due to the disparity in endometrial receptivity. Various studies done on the Preparation of the Endometrium for a thaw cycle, have shown no difference in live birth rates following different methods. The route and type of progesterone luteal phase support and optimum progesterone values prior to embryo transfer also need further evaluation. Recent metanalysis have proved that hormone replacement cycles are associated with a lower risk of Preterm birth, but a higher risk of larger babies and pre-eclampsia. Further studies are needed to establish whether there is any long-term effect on the metabolic and growth parameters of children born out of frozen embryos.