The efficacy of converting high response – Ovulation induction cycles to in vitro fertilization in patients with PCOS

Objective: To evaluate the outcomes of high response clomiphene citrate (CC)-gonadotropin ovulation induction cycles for natural unassisted conception in patients with PCOS (Polycystic Ovary Syndrome) being converted to IVF–ICSI–ET and compare them with other PCOS patients who underwent planned IVF–ICSI–ET using the GnRH-antagonist protocol. Study design: Prospective study with a retrospective controlled section. The study was conducted at Taiba Hospital in Kuwait during the period from January 2010 to August 2012. It included 128 infertile patients with the diagnosis of PCOS, divided into two groups. Group I comprised 64 PCOS patients who received ovulation induction, using CC-gonadotropin, in view of natural conception and were converted to IVF–ICSI–ET due to high response. Group II comprised 64 age-matched PCOS patients who underwent planned IVF using the GnRH-antagonist protocol. Primary outcomes were number of mature oocytes, number of grade 1 embryos transferred, and implantation and clinical pregnancy rates. Results: The implantation and clinical pregnancy rates were comparable in the two groups (in group I were 23.43% and 43.75%, respectively and in group II were 25% and 45.31%, respectively). There was no statistically significant difference between group I and group II as regards number of retrieved oocytes (7.7 ± 1.3 vs. 8.1 ± 1.4, respectively), number of mature oocytes (5.7 ± 1.1 vs. 6.1 ± 1.3, respectively), total number of embryos (4.9 ± 0.8 vs. 5.1 ± 0.5, respectively), number of cells/embryo (8.1 ± 0.8 vs. 7.9 ± 0.7, respectively). Conclusion: Conversion of high response CC-gonadotropin ovulation induction cycles in patients with PCOS to IVF–ICSI–ET is a safe, economic and effective strategy