The detrimental influence of functional ovarian cysts during in-vitro fertilization cycles

Abstract

Reviewing 780 in-vitro fertilization (IVF) cycles, where buserelin was commenced in the preceding luteal phase and human menopausal gonadotrophin on day 4 of the ensuing menses, 53 cycles were identified with sonolucent cysts (30-50 mm diameter). Of the latter 53 cycles, the serum oestradiol was significantly greater on day 4 in 22 cycles abandoned for poor follicular development than in 31 cycles which proceeded to oocyte retrieval (P less than 0.05). Of the 31 cycles proceeding to oocyte retrieval, nine had a day 4 serum oestradiol greater than 200 pmol/l (95th centile for day 4 oestradiol in patients without apparent cysts), and these cycles produced significantly fewer grade 1 embryos than the cycles with day 4 oestradiol levels less than or equal to 200 pmol/l (P less than 0.05). Six of the 53 cycles with cysts resulted in conception, and all of these cycles had a day 4 serum oestradiol less than 200 pmol/l. Among the 53 cycles with ovarian cysts, the serum progesterone on the day of abandonment in four cycles and on the day of human chorionic gonadotrophin administration in one non-abandoned cycle, was above the range established for 104 cycles without cysts. No significant difference was seen in day 4 serum androstenedione levels, and the day 4 serum progesterone was less than 5 nmol/l in all but one patient. Functional activity of ovarian cysts is associated with an adverse influence on IVF cycles.

Ovarian Cyst Formation Following Gonadotropin-Releasing Hormone-Agonist Administration Decreases the Oocyte Quality in IVF Cycles

“…The impressive transient flare-up effect of GnRH-a on immature antral follicles with LH surge inhibition has been the most frequent explanation (5)(6)(7)(8). The presence of an ovarian cyst in IVF cycles has been studied frequently in terms of its effect on the clinical outcomes.…”

“…Such cysts may impair folliculogenesis in such a way as to decrease the pre-ovulatory follicle numbers and their quality (2,3). In addition to the studies showing the negative effect of the cysts that appear during GnRH-a administration, other studies have concluded that the functional cysts have no effect on the IVF outcome (5)(6)(7)(8)(9)(10)(11).…”

Assisted conception following poor ovarian response to gonadotrophin stimulation

“…Functional ovarian cysts associated with elevated basal oestradiol levels have been shown to exert a detrimental influence on IVF cycles 16 . Functionally active follicular ovarian cysts occur in at least 5% of IVF cycles when GnRH agonists are used for pituitary desensitisation 17 .…”

“…Functionally active follicular ovarian cysts occur in at least 5% of IVF cycles when GnRH agonists are used for pituitary desensitisation 17 . If gonadotrophins are commenced in the presence of a functionally active cyst there is a high likelihood that the response to gonadotrophins will be impaired 16 .…”

“…A conservative approach has been shown to be effective where GnRH agonists are continued until serum oestradiol levels fall, although occasionally this may take several weeks 44,45 . An alternative effective, simple method of dealing with persistent functional ovarian cysts is cyst aspiration 46–48 . A seven‐day course of progestagen commenced three days before GnRH agonists may reduce or prevent cyst formation 49 .…”