Clinical Outcomes of In Vitro Maturation After Oocyte Retrieval With Gynecological Surgery for Refractory Polycystic Ovary Syndrome: A Retrospective Cohort Study

Abstract

ObjectiveTo explore the clinical outcomes of unstimulated in vitro maturation (IVM) after oocyte retrieval with gynecological surgery (IVM-surgery) for refractory polycystic ovary syndrome (PCOS) and analyze the influencing factors.MethodsPatients with refractory PCOS who underwent unstimulated IVM-surgery from June 2014 to September 2018 were included in this retrospective cohort study. Matured IVM oocytes were freshly fertilized and subsequently frozen at the blastocyst stage. Frozen-thawed embryo transfer was then conducted according to the desire of patients. Oocytes and embryological outcomes, reproductive outcomes were evaluated. Influencing factors of oocytes and embryological outcomes were analyzed by univariate analysis and multivariate analysis. Receiver operating characteristic curves were used to evaluate the predict value of serum hormone levels for oocytes and embryological outcomes.ResultsA total of 93 patients with refractory PCOS who underwent unstimulated IVM-surgery were included in this study.13 patients (13/85, 15.3%) had spontaneous pregnancy and live birth after surgery. 34 patients (34/93, 36.6%) obtained blastocysts and received embryo transfer, of which 13 patients (13/34, 38.2%) eventually achieved live birth by IVM. Higher anti-Mullerian hormone, antral follicle count and basal serum luteinizing hormone (LH) levels were strongly correlated with higher number of oocytes retrieved (P = 0.004, 0.004, 0.040, respectively). Higher basal serum follicle-stimulating hormone (FSH) and LH were significantly associated with higher oocyte maturation rate (P = 0.001 and P = 0.004, respectively) and blastocyst formation (P = 0.036 and P = 0.003, respectively). There was a significant linear correlation between basal serum FSH and LH (r = 0.500, P <0.001). What is more, basal serum FSH and LH had predictive value for oocytes and embryological outcomes.ConclusionUnstimulated IVM-surgery provided the opportunity for both spontaneous pregnancy and assisted reproductive technology. Basal FSH and LH were significantly associated with oocyte maturation rate and blastocyst formation of unstimulated IVM-surgery.

IVM of human immature oocytes for infertility treatment and fertility preservation

“…73,74 Recently, it has been reported that a total of 93 women with refractory PCOS who underwent unstimulated IVM-surgery were included and the clinical outcomes were analyzed for the influencing factors, indicating that unstimulated IVM-surgery during laparoscopy and hysteroscopy procedures provided the opportunity for both spontaneous pregnancy and ART treatment. 75 Ovarian tissue cryopreservation is the primary method of fertility preservation for prepubertal girls who are at risk of premature ovarian failure (POF). Ovarian tissue cryopreservation followed by a transplant later may be offered as a method of fertility preservation for pubertal cancer patients who cannot receive ovarian stimulation due to time constraints or contraindications.…”

“…IVM‐surgery has proposed transvaginal retrieval of immature oocytes during endoscopic gynecological procedures 73,74 . Recently, it has been reported that a total of 93 women with refractory PCOS who underwent unstimulated IVM‐surgery were included and the clinical outcomes were analyzed for the influencing factors, indicating that unstimulated IVM‐surgery during laparoscopy and hysteroscopy procedures provided the opportunity for both spontaneous pregnancy and ART treatment 75 …”

Ultrasound-based radiomic analysis of the peripheral nerves for differentiation between CIDP and POEMS syndrome

“…Second, the Welch t-test (26). The diagnosis of POEMS syndrome was confirmed based on the diagnostic criteria defined by Misawa et al (6). CIDP, chronic inflammatory demyelinating polyneuropathy; POEMS, polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes.…”

“…Initially, there was a belief that the disease had a higher occurrence rate among individuals of Japanese descent, primarily based on initial reports from Japan (2,3). However, subsequent large series have been reported from France, the United States, China, and India (4)(5)(6)(7)(8). The diagnosis of POEMS syndrome in advanced stages with pathognomonic features is not always difficult.…”