Optimization of assisted reproductive technology outcomes in patients with polycystic ovarian syndrome: updates and unanswered questions

Abstract

Purpose of reviewNarrative review of recent literature on optimization of assisted reproduction technology outcomes in patients with polycystic ovarian syndrome (PCOS). Recent findingsThe key areas of focus include pre cycle treatment with the goal of cohort synchronization, methods of ovulation suppression and trigger medication. There is no definitive evidence that precycle treatment with combined oral contraceptives (COCs) or progestins improve or negatively impact in vitro fertilization outcomes in patients with PCOS. The reviewed evidence supports consideration of progestins as suppression of premature ovulation in patients with PCOS as an alternative to gonadotropin releasing hormone (GnRH) antagonist if a freeze all protocol is planned. There is limited prospective evidence in PCOS populations regarding use of a dual trigger using GnRH agonist and human chorionic gonadotropin (hCG).

Progestin-Primed Ovarian Stimulation (PPOS) Versus Flexible GnRH Antagonist Protocol (FGnRHan) In Women with Polycystic Ovary Syndrome (PCOS): A Retrospective Analysis of Clinical Outcomes and Ovarian Response of a Substantial Cohort

“…clinical outcomes obtained from both FPPOS protocol and the FGnRHan protocol on freeze-all cycles conducted on ladies with PCOS were shown to be similar, this aligns with the Turkan's retrospective analysis of 258 ladies in the progestins group and 267 ladies in the GnRHan group (38) and with Egyptian RCT involved 76 PCOS ladies (24). The FPPOS group exhibited a greater duration of stimulation and total dose of Gn compared to the FGnRHan group, which aligns with findings from prior studies (29-Our research suggests that the FPPOS protocol may be a viable alternative to the WHO-recommended GnRHan protocol for ladies with PCOS who are classified as hyper respondents in terms of COS (43)(44)(45)(46)(47).…”