IN-VITRO FERTILIZATION AND EMBRYO-TRANSFER FOR THE TREATMENT OF INFERTILITY ASSOCIATED WITH POLYCYSTIC-OVARY-SYNDROME

Objective: To examine the outcome of treatment with IVF-ET of women wi th polycystic ovarian syndrome (PCOS) who failed to conceive on conven tional treatment. Design: Retrospective analysis with an age-matched c ontrol group. Setting: University hospital infertility clinic and IVF unit. Patients, Interventions: Sixty-eight women with PCOS who had fai led to conceive on treatment with clomiphene citrate and during six ov ulatory cycles on gonadotropins underwent 208 cycles of IVF-ET. An age -matched group of 68 women with a tubal mechanical factor who received 143 treatment cycles during the same period served as controls. Main Outcome Measures: Cumulative conception rates, the cumulative livebirt h rates, and IVF-ET data were compared between the two groups. Results of treatment with and without GnRH agonist (GnRH-a) within the groups were also compared. Results: A comparison of PCOS and mechanical fact or (control) groups showed almost identical results at 6 months for cu mulative conception rate (82% versus 85%) and cumulative livebirth rat e (69% versus 65%). Significantly more oocytes were retrieved but a sm aller percentage fertilized in PCOS, and the pregnancy rate per ET did not differ between the two groups (23% versus 26%). Treatment with Gn RH-a and gonadotropins as opposed to gonadotropins alone improved the cumulative conception rate, miscarriage rate, and cumulative livebirth rate in the PCOS but not in the control group and improved fertilizat ion rates in both groups. Conclusions: For patients with PCOS who fail to conceive with gonadotropin treatment, IVF-ET is a successful treat ment alternative, producing results equal to those for women with a me chanical tubal factor. Better results were achieved with GnRH-a in wom en with PCOS but made no difference to those with a mechanical tubal f actor compared with treatment with gonadotropins alone.