Maternal obesity is not associated with increased miscarriage rates following euploid blastocyst transfer

Abstract

To assess the effect of repetitive transvaginal ovarian needle punctures as compared to laparoscopic ovarian drilling on antral follicle counts (AFC), serum antimulerian hormone levels (AMH) and pregnancy rates in anovulatory women with PCOS.DESIGN: A six month cohort study was undertaken to compare outcomes in PCOS women who underwent transvaginal ultrasound guided ovarian injury using a 16 gauge oocyte collection needle and PCOS women with laparoscopic ovarian drilling (dithermy, 8 punctures). Couples with significant sperm abnormalities were excluded.MATERIALS AND METHODS: 126 anovulatory subjects, 67 with ovarian injury (OI) due to a trans-vaginal in-vitro maturation collection (which failed to result in pregnancy) and 59 who underwent laparoscopic ovarian drilling (LOD) were compared. Primary outcome was spontaneous pregnancy rate. In addition body mass index (BMI), AFC and AMH levels were measured pre intervention and at the 3rd and 6th months. Both groups received no further treatments. Shapiro Wilk's test was used for assessing normal distribution. Chi-squared, T tests or Mann Whitney U test were used. Data is presented as meanAESD or median (range).RESULTS: Pretreatment, median serum total testosterone level were higher in the OI than the LOD groups(P¼0.001), other hormone levels were similar. BMI at time 0, 3 and 6 months did not differ between the two interventions. However, serum AMH levels were lower at time 0, 3 months and 6 months (p<0.001) in the LOD when compared to the OI group. At 3 and 6 months AMH levels decreased more significantly in the LOD than the OI group (-26.4% (-41.5 to -5.5) vs. -12.5% (-26.3 to -0.9), p<0.001)) and (-29.2% (-55.6 to -3.5) vs. -12.6% (-28.7 to 1.86), p<0.001)), respectively. % decrease in AFC was also greater in the LOD group than the OI subjects at 3 months (-24% (-37 to -8) vs. -12% (-56 to 0) , p<0.001) and at 6 months (-27% (-44 to-4) vs. -5% (-29 to 9), p<0.001). However cumulative pregnancy rates at 6 months were similar LOD (35%) vs OI (55%) (P>0.05).CONCLUSIONS: Although, ultrasound guided transvaginal ovarian needle injury results in less significant improvements in AMH and AFC levels in anovulatory PCOS women than does LOD, pregnancy rates trended higher with this OI. This suggests a less invasive method of ovarian injury may be available than laparoscopy for patients requiring this mechanism to conceive.