Effect of Laser-Assisted Hatching on the Clinical Outcomes of Human Vitrified-Thawed Embryo Transfer Cycles with Different Post-Thaw Culture Duration

Abstract Background: Zona pellucida(ZP)hardening caused by prolonged in vitro culture and exacerbated by the freeze–thaw process making ZP hatching difficult; In theory, assisted hatching may facilitate the hatching process and have the potential to increase implantation and/or pregnancy rates in frozen embryo transfer (FET) cycles. However, a number of studies have shown controversial results on the clinical benefit of laser-assisted hatching (LAH) in FET cycles. This study firstly investigated the efficacy and safety of LAH using vitrified-thawed embryos with different post-thaw culture duration in FET cycles.Methods: Data from the center’s IVF database were retrospectively analyzed, only embryos thawed for the first FET cycle of each ovarian pick-up were eligible for this study, and only cycles in which at least one embryo was available for transfer were included in the present study. Finally, a total of 1225 infertile couples who underwent 1225 FET cycles between July 2013 and March 2015 were analyzed in this study. According to the duration of post-thaw culture in FET cycles, these patients were allocated to three subgroups: the short culture (4-5 h) group (LAH, n=205; control, n=201), overnight culture (20-24 h) group (LAH, n=197; control, n=203), and blastocyst culture (44-48 h) group (LAH, n=210; control, n=209), respectively.Results: In the short culture(4-5 h) subgroup, no statistically significant differences were found related to the implantation, clinical pregnancy and live birth rates between the two groups (28.0% versus 27.8%, 38.0% versus 36.8%, and 30.7% versus 30.3%, respectively, P＞0.05). When the perinatal outcomes of two groups were compared, there was no significant difference in the gestational weeks (37.96±2.23 versus 37.59±2.35, P＞0.05), birth weight (2.70±0.56 versus 2.82±0.62, P＞0.05), as well as the preterm birth (15.4% versus 17.6%, P＞0.05), ectopic pregnancy (2.6% versus 1.4%, P＞0.05), and miscarriage rates (16.7% versus 16.2%, P＞0.05).In the overnight culture(20-24 h) subgroup, no statistically significant differences were found regarding the implantation, clinical pregnancy and live birth rates (29.5% versus 29.1%, 40.1%versus 37.4%, 33.0%versus 30.5%, respectively, P＞0.05).As to the perinatal outcomes, there was no significant difference in the gestational weeks (36.86±2.28 versus 35.69±2.95, P＞0.05), birth weight (2.73±0.76 versus2.62±0.52, P＞0.05), as well as the preterm birth (15.2% versus 17.1%, P＞0.05), ectopic pregnancy (3.8% versus 2.6%, P＞0.05), and miscarriage rates (13.9% versus 15.8%, P＞0.05).In the blastocyst culture(44-48 h) subgroup, the two groups did not differ significantly in the implantation, clinical pregnancy and live birth rates (56.3% versus 59.3%, 68.6% versus 66.5%, and 55.7% versus56.5%, respectively, P＞0.05).Furthermore, there were also no significant difference in the gestational weeks (38.68±2.76 versus 36.95±2.59, P＞0.05), birth weight (2.78±0.74 versus 2.72±0.59, P＞0.05), as well as the preterm birth (8.3% versus 11.5%, P＞0.05), ectopic pregnancy (2.8% versus 2.2%, P＞0.05), and miscarriage rates (16.0% versus 12.9%, P＞0.05).Conclusions: Our results suggested that LAH does not improve the clinical outcomes in FET cycles, irrespective of the duration of post-thaw culture. Though the risk of perinatal period did not increase, it is still necessary to conduct further investigations to validate the safety of LAH.

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P–671 Dual Trigger(low adjuvant HCG4h after GnRHagonist trigger)have positive impact of overall embryo’s quality, implantation ,clinical pregnancy and live birth rates in high-risk patients for OHSS

Human Reproduction ◽

10.1093/humrep/deab130.670 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

E Petanovsk. Kostova

Keyword(s):

High Risk ◽

Live Birth ◽

Clinical Pregnancy ◽

Birth Rates ◽

High Risk Patients ◽

Live Birth Rates ◽

Significant Difference ◽

Risk Patients ◽

Group A ◽

Group B

Abstract Study question Study aim is to compare implantation,clinical pregnancy and livebirth rates between giving1500IU of hCG4hours after GnRHagonist,on trigger day or GnRHagonist as alone trigger with luteal support withHCG1500IU.35h later on OPUday. Summary answer Adjuvant doze of1500IUhCG4h after bolus of GnRHagonist on trigger day significantly improve quality of blastocyst,implantation,clinical pregnancy and live birth rates without increasing the risk ofOHSS. What is known already The use of GnRHagonist for final oocyte maturation in antagonist cycle significantly decrease the incidence of OHSS,but there have been studies showing lower pregnancy rates in patients triggered with GnRHagonist compared with hCG in autologous cycles,attributed to a defective luteal phase, especially in high–risk patients despite intensive luteal phase support.To improve the results of IVF,an alternative approach is adding a small bolus dose of hCG(1500IU)35h later,on the OPU day after GnRHagonist trigger which provides more sustained support for the corpus luteum.The question is does low doses of hCGgiven on the same day with GnRHagonist trigger is making better quality oocytes. Study design, size, duration Single center prospective longitudinal cohort study fromJanuary2017 to Decembar2019.The initial inclusion criteria were:women age≥18and≤39years,AMH≥3,3ng/ml and ≥12 antral follicles on basal ultrasound.Patients with history of OHSS and PCO are also included in the study.Patients with applied “freeze-all” technique with peak estradiol≥4000pg/ml on trigger day>18oocytes on the OPU day,and recognized significant risk for developing OHSS were also included.The cumulative implantation,clinical pregnancy and live birth rates were analyzed,only in embryos from the same COS protocol in every patient. Participants/materials, setting, methods A total of 231 patients were entered for final analysis,who underwent a flexible antagonist protocol,ICSI and fresh or thawed ET on 3th(38.53%) or 5th( 61.47%)day in women’s autologous cycles.Patients were randomized in one of two groups: GroupA-Dual trigger group 1500IUof hCG 4h after GnRH agonist application on trigger day and GroupB –1500IU of HCG 35h later,on the OPU day.We used nonparametric and parametric statistical tests.Significant differences were considered all values of p < 0.05 Main results and the role of chance Both groups are homogenous regarding several variables:age,BMI,type of sterility,smoking status,AMH,PCO, spermogram.There is no significant difference between the two(AvsB)groups according to average number of retrieved oocytes(13.6 vs 14.6 p > 0,05),M II oocytes(11.03 vs 11.99 p > 0.05).The dual trigger group(A)had a higher fertility rate(69.99% vs 64.11% p < 0,05)compared with GnRHagonist trigger group(B).There are no significant difference between groups(AvsB)according to cumulative average number of:transferred embryos(2.4vs2.5 p > 0.05)TQE transfered on 3th day(1.5.vs 1.3.p>0.05);transferred blastocyst(2.6 vs2.7 >0.05);cryo embryos(2.5vs1.9 p > 0.05),but there are significant difference according to cumulative implantation rate of transferred blastocyst in favor of group A(48.18% vs 33.89%p<0.05).Analyzes of morphological characteristics of transferred blastocyst depicted in the order of degree of blastocyst expansion,inner cellular mass(ICM)and trofoectoderm(TE) and ranking overall blastocysts quality from“excellent”,“good”,“average” and “pore” ,shows that there are significantly more percentage of patient with embryo transfer of “excellent” or even one “excellent” blastocyst in group A (30.56%,31.94% vs 21.54%,23.08% p < 0.05) in opposite of percentage of patients with embryo transfer with “poore “” blastocyst in group B (37.5% vs 46.15.%p<0.05). Clinical pregnanacy rate (71.68% vs 50.84% p < 0.05) , and live birth rate (60,18% vs 42,58% ), were significantly higher in group A. There were no cases of moderate or severe OHSS in both groups. Limitations, reasons for caution Dual trigger in GnRH antagonist protocols should be advocated as a safe approach but undetected high risk patients are reasons for caution for developing clinically significant OHSS. Wider implications of the findings: Adjuvant low dose of hCG on GnRHagonist trigger day improve clinical pregnancy and live birth rates without increasing the risk of clinically significant OHSS.Protocol of dual trigger and freezing all oocytes or embryos in patients with high risk of developing OHSS is promising technique in everyday practice. Trial registration number 8698

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Perinatal Outcomes of Babies Born with Fresh or Frozen-Thawed Testicular Sperm in Patients with Azoospermia

Gynecology & Reproductive Health ◽

10.33425/2639-9342.1153 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Mehmet AK ◽

Nur Dokuzeylul Gungor

Keyword(s):

Birth Weight ◽

Live Birth ◽

Gestational Age ◽

Neonatal Death ◽

Perinatal Outcomes ◽

Pregnancy Rates ◽

Clinical Pregnancy ◽

Testicular Sperm ◽

Significant Difference ◽

Gestational Age At Delivery

Aim: To compare the perinatal outcomes of pregnancies obtained with fresh or frozen-thawed sperm in patients who underwent surgical sperm extraction for the diagnosis of azoospermia. Materials and Methods: In this retrospective study, data were collected on couples who conceived following Intracytoplasmic Sperm Injection using surgically retrieved fresh or frozen-thawed sperm. Participants were divided into two equal groups as follows. Group 1 (n = 100) consisted of patients who underwent ICSI and subsequent embryo transfer using fresh testicular sperm and Group 2 (n = 100) consisted of patients who underwent ICSI by using frozen-thawed testicular sperm. Perinatal outcome was compared according to the use of fresh or frozen-thawed sperm. Primary outcome measures included clinical pregancy, miscarriage, live birth, congenital abnormality, birthweight, gestational age at delivery, stillbirth and neonatal death. Results: Live birth and clinical pregnancy rates were found to be significantly higher in patients who underwent ICSI/ET with frozen-thawed testicular sperm compared to fresh sperm group. The miscarriage rates were significantly lower in the frozen-thawed sperm group compared to the fresh testicular sperm group. Clinical pregnancy was detected in 18 cases, while no pregnancy was detected in 82 cases undergoing ICSI with fresh sperm. In the group where ICSI/ET was applied with frozen sperm, clinical pregnancy was detected in 51 cases, whereas pregnancy was not detected in 49 cases. In the frozen sperm group, in addition to C/S and multiple pregnancy rates, the number of babies with a birth weight below 2500 g was significantly higher than in the fresh sperm group. There was no significant difference between the groups in terms of minor and major congenital anomalies, birth weight, gestational age at delivery, stillbirth and neonatal death. Conclusion: Using fresh or frozen testicular sperm does not have a significant effect on perintal outcome in patients with azoospermia.

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Fresh Versus Frozen Testicular Sperm Samples in Microdissection Testicular Sperm Extraction Intracytoplasmic Sperm Injection Treatment

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.636 ◽

2017 ◽

pp. 1

Author(s):

Şafak Hatırnaz ◽

Serdar Başaranoğlu ◽

Ebru Hatırnaz ◽

Mine Kanat Pektaş

Keyword(s):

Clinical Outcomes ◽

Live Birth ◽

Intracytoplasmic Sperm Injection ◽

Clinical Pregnancy ◽

Testicular Sperm Extraction ◽

Obstructive Azoospermia ◽

Testicular Sperm ◽

Birth Rates ◽

Live Birth Rates ◽

Significant Difference

Objective: The present study aims to compare the clinical outcomes of fresh versus frozen testicular samples in patients with non-obstructive azoospermia who would undergo intracytoplasmic sperm injection procedure. Study Design: This is a retrospective review of 541 patients with non-obstructive azoospermia who consecutively underwent microdissection testicular sperm injection and intracytoplasmic sperm injection between January 2010 and October 2014. Results: A total of 4896 mature oocytes were collected from the partners of azoospermic men and 1894 sperms were retrieved by microdissection testicular sperm procedures. About 1036 fresh sperms were used to perform intracytoplasmic sperm injection in 296 men with non-obstructive azoospermia whereas 858 in 245 azoospermic men. Approximately 1228 embryos were obtained after intracytoplasmic sperm injection and 1080 embryos were transferred. After embryo transfer, 146 clinical pregnancies occurred and 125 pregnancies ended up with live birth. The fertilization, implantation, clinical pregnancy and live birth rates were respectively 44.6%, 33.4%, 28.0% and 24.7% for 296 fresh microdissection testicular sperm cycles. On the other hand, the fertilization, implantation, clinical pregnancy and live birth rates were respectively 46.5%, 32.7%, 25.7% and 21.2% for 245 frozen microdissection testicular sperm cycles. There was no statistically significant difference between the fresh and frozen microdissection testicular sperm injection cycles in aspect of fertilization, implantation, clinical pregnancy and liver birth rates (p=0.125, p=0.194, p=0.196 and p=0.182). Conclusion: The utilization of fresh and frozen sperms in microdissection testicular sperm - intracytoplasmic sperm injection cycles has similar clinical outcomes. The use of frozen sperms obtained by testicular sperm can be considered as an efficient and safe approach for avoiding unnecessary ovarian hyperstimulation and repetitious interventions on testicular tissues.

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Complete zona removal using laser assisted hatching for vitrified-warmed day 6 blastocysts increased clinical pregnancy and live birth rates following single vitrified-warmed blastocyst transfer

Fertility and Sterility ◽

10.1016/j.fertnstert.2017.07.513 ◽

2017 ◽

Vol 108 (3) ◽

pp. e172

Author(s):

S. Ueno ◽

K. Uchiyama ◽

T. Okimura ◽

A. Yabuuchi ◽

T. Okuno ◽

...

Keyword(s):

Live Birth ◽

Clinical Pregnancy ◽

Blastocyst Transfer ◽

Assisted Hatching ◽

Birth Rates ◽

Live Birth Rates

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The effects of low-dose human chorionic gonadotropin for luteal phase support on pregnancy outcomes in poor ovarian responders: a randomized clinical trial

10.21203/rs.3.rs-328212/v1 ◽

2021 ◽

Author(s):

Tahereh Madani ◽

Arezoo Arabipoor ◽

Fariba Ramezanali ◽

Shabnam Khodabakhshi ◽

Zahra Zolfaghari

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Live Birth ◽

Pregnancy Outcomes ◽

Luteal Phase ◽

Clinical Pregnancy ◽

Birth Rates ◽

Luteal Phase Support ◽

Live Birth Rates ◽

Significant Difference

Abstract Purpose: The question that remains is, does changing the type of luteal phase support (LPS) improve the pregnancy outcomes in patients with poor ovarian response (POR) diagnosis?. Therefore, this study was designed to investigate and compare the efficiency of different methods of luteal phase support (progesterone alone or hCG alone and the combination of progesterone with hCG) in these patients.Methods: This randomized clinical trial evaluated three hundred seventy five patients who were diagnosed as POR on the basis of Bologna criteria undergoing intracytoplasmic sperm injection- embryo transfer (ICSI-ET) cycles at Royan institute from November 2015 to June 2019. The patients were allocated randomly into three different LPS groups on the day of oocyte pickup. In first group, 1500 IU of hCG IM on the ET day, as well as 4 days after that were administrated. In the second group, the patients received 1500 IU of hCG IM on the ET day, as well as 3 and 6 days after the ET along with vaginal suppositories 400 mg twice daily. For the third group, only vaginal suppositories twice daily was administrated from the day of oocyte pick up until the pregnancy test day.The clinical pregnancy, miscarriage and live birth rates were the main outcomes. Results: The data analysis showed that the three groups were comparable. In the following, there is no significant difference in terms of implantation, clinical pregnancy, and miscarriage and live birth rates among groups. The twin pregnancy rate in the hCG-only group was higher than those of in the other two groups, although this difference was not statistically significant (P=0.06).Conclusion: The type of LPS does not improve the pregnancy and live birth rates in POR patients. A multi-center clinical trial is warranted to confirm or refute these findings.Trial registration: The study was registered in the clinicaltrial.gov site on 14 June 2015. (NCT02798653 at www. clinicaltrials.gov, registered prospectively).

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The effects of the day of trophectoderm biopsy and blastocyst grade on the clinical and neonatal outcomes of preimplantation genetic testing–frozen embryo transfer cycles

Zygote ◽

10.1017/s0967199421000435 ◽

2021 ◽

pp. 1-6

Author(s):

Linjun Chen ◽

Zhenyu Diao ◽

Jie Wang ◽

Zhipeng Xu ◽

Ningyuan Zhang ◽

...

Keyword(s):

Birth Weight ◽

Genetic Testing ◽

Embryo Transfer ◽

Live Birth ◽

Frozen Embryo Transfer ◽

Neonatal Outcomes ◽

Miscarriage Rate ◽

Birth Rates ◽

Preimplantation Genetic Testing ◽

Live Birth Rates

Summary This study analyzed the effects of the day of trophectoderm (TE) biopsy and blastocyst grade on clinical and neonatal outcomes. The results showed that the implantation and live birth rates of day 5 (D5) TE biopsy were significantly higher compared with those of D6 TE biopsy. The miscarriage rate of the former was lower than that of the latter, but there was no statistically significant difference. Higher quality blastocysts can achieve better implantation and live birth rates. Among good quality blastocysts, the implantation and live birth rates of D5 and D6 TE biopsy were not significantly different. Among fair quality and poor quality blastocysts, the implantation and live birth rates of D5 TE biopsy were significantly higher compared with those of D6 TE biopsy. Neither blastocyst grade nor the day of TE biopsy significantly affected the miscarriage rate. Neonatal outcomes, including newborn sex, gestational age, preterm birth, birth weight and low birth weight in the D5 and D6 TE biopsies were not significantly different. Both blastocyst grade and the day of TE biopsy must be considered at the same time when performing preimplantation genetic testing–frozen embryo transfer.

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P–184 Assisted hatching does not improve live birth rates, a prospective double-blinded randomized study

Human Reproduction ◽

10.1093/humrep/deab130.183 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

V Montalvo ◽

J Masso ◽

A Garcia-Faura ◽

B Marques ◽

M Lopez-Teijon

Keyword(s):

Live Birth ◽

Human Embryos ◽

Assisted Hatching ◽

Small Data ◽

Success Rates ◽

Birth Rates ◽

Data Set ◽

Positive Effects ◽

Live Birth Rates ◽

Frozen Embryo Transfers

Abstract Study question Does Assisted hatching (AH) improve success rates when applied to frozen embryo transfers? Summary answer AH does not improve implantation, ongoing pregnancy or live birth rates when applied to thawed embryos. What is known already Vitrification has been proven to be the most efficient technique to preserve human embryos. However, vitrification has some consequences for the embryos, zona pellucida (ZP) hardening being one of them. Multiple studies suggest the need to apply laser Assisted hatching or ZP thinning to thawed embryos in order to improve success rates. Still, there is not enough evidence to ensure the utility of AH, and considering the great variation in design between studies more evidence is needed. Study design, size, duration Study performed from October 2019 and January 2020. Disregarding embryos with natural Hatching and PGT-A. Embryos that, immediately after thawing, were completely expanded (trophectoderm in contact with ZP) were also excluded from the study. We applied a randomization to choose in which embryos we had to perform AH. Neither the gynecologist nor the embryologist performing the embryo transfer knew whether the embryo had AH performed or not. Participants/materials, setting, methods 353 frozen embryo transfers of one blastocist were considered for the study, 71 excluded for expansion after thawing, 65 excluded because of PGT-A, 103 in which we performed AH (AH+) and 114 without AH (AH-). In the AH+ group we performed laser-AH of 1/3 of the ZP, avoiding to damage the trophectoderm and performing the laser shots as far away to the ICM as possible. We used Chi-square testing to assess the effects of AH. Main results and the role of chance We assessed all relevant clinical data parameters. No statistical differences were found in egg age, maternal age, embryo quality, nor endometrial thickness between groups. Implantation and miscarriage rates were equivalent between AH+ group (40.9%; 20.5%) and AH- group (47.4%; 18.5%). The main outcome of this study was live birth rates. No statistical differences were found between groups (AH-= 38.6%; AH + = 30.1%; p = 03221) proving that making it easier to get out of the ZP does not affect success rates. Analyzing the data from the excluded embryos we found no improvement on live birth rates when embryos were expanded just after thawing (38.0%; p = 0.457). As expected, PGT-A embryos yielded higher live birth rates (52.3%; p < 0,05) Limitations, reasons for caution Preliminary study with a small data set. Wider implications of the findings: This study suggest that thawed embryos have the capacity to get out of the ZP regardless if AH was performed or not. Having no positive effects, AH seems to be unnecessary in this scenario. Trial registration number Not applicable

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P–666 Validating the hypo-androgenic PCOS-like phenotype (H-PCOS), derived from the “lean” PCOS phenotype at younger ages

Human Reproduction ◽

10.1093/humrep/deab130.665 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

S Darmon ◽

E Molinari ◽

D F Albertini ◽

P Patrizio ◽

D H Barad ◽

...

Keyword(s):

Live Birth ◽

Case Control Study ◽

Treatment Resistance ◽

Study Groups ◽

Case Control ◽

Clinical Pregnancy ◽

Retrospective Case ◽

Birth Rates ◽

Live Birth Rates ◽

Control Study

Abstract Study question Is the resistance to standard infertility treatments of the H-PCOS-like phenotype reversed through reconstitution of androgen levels and can principle diagnostic markers of H-PCOS be validated? Summary answer Pre-supplementation with dehydroepiandrosterone (DHEA) eliminated treatment resistance of H-PCOS in comparison to matched infertile controls, also validating previously reported diagnostic features of this condition. What is known already H-PCOS evolves at older ages from a hyper-androgenic “lean” PCOS phenotype at young ages. Its ontogeny diverts from other PCOS phenotype between 20s and mid–30s by going from being hyper- to being hypo-androgenic due to insufficiency in adrenal androgen production, believed to represent an autoimmune process. In contrast to other PCOS phenotypes, the “lean” PCOS phenotype appears highly treatment resistant to standard fertility treatments. Study design, size, duration Retrospective case control study. Participants/materials, setting, methods We investigated 54 H-PCOS patients with qualifying diagnostic criteria1,2 and 50 matched infertility patients without diagnostic H-PCOS criteria as controls. Both study groups underwent routine in vitro fertilization (IVF) cycles, including androgen pre-supplementation in both groups via dehydroepiandrosterone (DHEA) for women diagnosed as hypo-androgenic. Main outcome measures were clinical pregnancy and live birth rates. 1Gleicher et al., J Sterodi Biochem Mol Biol 2017;167:144–152; 2Gleicher N, et al., Endocrine 2018;59(3):661–676 Main results and the role of chance Study groups were similar in age, number of prior IVF cycles and previous live births. H-PCOS patients in contrast to controls, however, demonstrated previously reported characteristics of H-PCOS diagnosis, including a significantly higher DHEA/DHEAS ratio, significantly higher AMH, confirming higher functional ovarian reserve, significantly lower free testosterone and significantly higher sex hormone binding globulin (SHBG), further confirming lower androgens. Finally, H-PCOS patients also demonstrated significantly increased evidence for immune system hyperactivity. Clinical pregnancy and live birth rates were separately assessed in first IVF cycles and cumulatively. Both analyses demonstrated, even after age-adjustments, absolutely no outcome differences in cycle cancellations, numbers of oocytes retrieved, first and cumulative pregnancy and live birth rates. At least one pregnancy was achieved in 12 women in both groups (22.2% and 24.0%) and at least one live birth in 11 (20.4%) vs. 8 (14.8%), respectively. Limitations, reasons for caution As a retrospective case control study, here presented data must be interpreted with caution. The close match between H-PCOS and control patients and the very clear differentiation in patient characteristics between the two groups, however, support the credibility of this study. Wider implications of the findings: This study demonstrated that androgen reconstitution in H-PCOS patients completely reversed treatment resistance compared to well-matched infertile control patients. It also validated previously defined diagnostic criteria of H-PCOS, hopefully facilitating a timelier diagnosis of a, still, widely overlooked condition in female infertility. Trial registration number NA

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Fertility and Pregnancy Outcomes in Women with Polycystic Ovary Syndrome Following Bariatric Surgery

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa439 ◽

2020 ◽

Vol 105 (9) ◽

pp. e3384-e3391

Author(s):

Estela Benito ◽

Jesús M Gómez-Martin ◽

Belén Vega-Piñero ◽

Pablo Priego ◽

Julio Galindo ◽

...

Keyword(s):

Bariatric Surgery ◽

Birth Weight ◽

Polycystic Ovary Syndrome ◽

Live Birth ◽

Polycystic Ovary ◽

Premenopausal Women ◽

Obese Women ◽

Ovary Syndrome ◽

Birth Rates ◽

Live Birth Rates

Abstract Context Restoration of ovulation is quite common in women with polycystic ovary syndrome (PCOS) after surgically induced weight loss. Whether or not this results in an improvement of PCOS-associated infertility is uncertain. Objective To study fertility and gestational outcomes in women with PCOS after bariatric surgery. Design Unicenter cohort study. Setting Academic hospital. Patients Two hundred and sixteen premenopausal women were screened for PCOS before bariatric surgery. Women were followed-up after the intervention until mid-2019 regardless of having or not PCOS. Interventions All participants underwent bariatric surgery from 2005 to 2015. Main outcome measures Pregnancy and live birth rates in the PCOS and control groups. Results In women seeking fertility, pregnancy rates were 95.2% in PCOS and 76.9% in controls (P = 0.096) and live birth rates were 81.0% and 69.2%, respectively (P = 0.403). The time to achieve the first pregnancy after surgery was 34 ± 28 months in women with PCOS and 32 ± 25 months in controls. Albeit the mean birth weight was lower (P = 0.040) in newborns from women with PCOS (2763 ± 618 g) compared with those from controls (3155 ± 586 g), the number of newborns with low birth weight was similar in both groups (3 in the PCOS group and 1 in the controls, P = 0.137). Maternal (17.6% in PCOS and 22.2% in controls, P = 0.843) and neonatal (23.5% in PCOS and 14.8% in controls, P = 0.466) complications were rare, showing no differences between groups. Conclusions Pregnancy and fertility rates in very obese women with PCOS after bariatric surgery were high, with few maternal and neonatal complications.

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