Effect of Metabolic Surgery on Live Birth Rate of Offspring in Obesity Polycystic Ovarian Syndrome Patients

ABSTRACT Background Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women and its prevalence is rising. Management of the disease is usually medical and some resistant cases may require surgical treatment in the form of laparoscopic ovarian drilling (LOD). Medical management exposes the patient to increased risk of multiple pregnancy and hyperstimulation. LOD avoids the need of medical therapy or makes the ovaries more responsive to treatment. Aim The objective of this descriptive study was to study the outcome of LOD in patients of PCOS with clomiphene resistance in the form of clinical pregnancy and live birth rate. Setting Tertiary assisted conception center. Design Observational study. Materials and methods 100 patients of clomiphene resistant PCOS who underwent LOD. Outcome measure Primary outcome was clinical pregnancy rate and secondary outcome was ovarian hyperstimulation syndrome (OHSS) rate, multiple pregnancy rate, miscarriage rate, prevalence of hypothyroidism and live birth rate in PCOS patients. Results Clinical pregnancy rate—47.3%, OHSS rate—2.7%, multiple pregnancy rate—4%, miscarriage rate—6.7%, prevalence of hypothyroidism—48% and live birth rate—40.5%. Conclusion Patients with irregular cycles, high LH/FSH ratio usually have CC resistance. PCO patients have high prevalence of hypothyroidism and it should be specifically screened and treated. Low incidence of miscarriage rate, OHSS rate and multiple pregnancy rates is seen after LOD with 47.3% clinical pregnancy and 40.5% live birth rates. Patients with high values of LH/FSH ratio are the candidates who stay nonpregnant in spite of LOD and this information is very useful in prognosticating the patients. How to cite this article Kaur M, Pranesh G, Mittal M, Gahlan A, Deepika K, Shashikala T, Rao KA. Outcome of Laparoscopic Ovarian Drilling in Patients of Clomiphene Resistant Polycystic Ovarian Syndrome in a Tertiary Care Center. Int J Infertility Fetal Med 2013;4(2):39-44.

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Reproductive Outcomes of Women with Polycystic Ovarian Syndrome Following In-Vitro Fertilization — A Meta-Analysis and Systematic Review

Fertility & Reproduction ◽

10.1142/s2661318219500221 ◽

2019 ◽

Vol 01 (04) ◽

pp. 193-201

Author(s):

I-Ferne Tan ◽

Audrey J. R. Lim ◽

Inthrani R. Indran ◽

Michael S. Kramer ◽

Eu-Leong Yong

Keyword(s):

Live Birth ◽

Ovarian Hyperstimulation Syndrome ◽

Birth Rate ◽

Meta Analysis ◽

Live Birth Rate ◽

Ovarian Hyperstimulation ◽

Vitro Fertilization ◽

Ivf Outcomes ◽

Ovarian Syndrome

Background: Polycystic ovarian syndrome (PCOS) is a common cause of infertility in women. In-vitro fertilization (IVF) is required in 20–30% of women with PCOS trying to conceive. This is associated with increased risk of multiple gestation and ovarian hyperstimulation syndrome. Improvements in IVF techniques, safety standards, and the increased use of frozen embryos in recent years have lead to improved outcomes for women with PCOS. We performed a systematic review and meta-analysis to compare these outcomes with women without PCOS. Search Methods: A search of PubMed, EMBASE, the Cochrane Central Register of clinical trials, and Scopus databases for all articles published until November 16th, 2017 identified 21 studies comparing IVF outcomes in PCOS and non-PCOS women. Inclusion criteria were Rotterdam criteria PCOS, comparable IVF regimes, immediate IVF outcomes, and pregnancy outcomes. Studies were excluded if the control group included any PCOS criteria, donor oocytes, or in-vitro maturation. Outcomes: No difference was observed in live birth rate per cycle in women with vs. without PCOS (RR [Formula: see text] 1.01 [0.89, 1.16]; [Formula: see text] 82%), but the live birth rate per first cycle in PCOS cycles (RR [Formula: see text] 0.93 [0.88, 0.99]) was slightly lower. There was also no difference in the clinical pregnancy rate (RR 1.02 [0.89, 1.17]) or biochemical pregnancy rate (RR 1.03 [0.99, 1.08]) observed between the two groups. PCOS was associated with a significantly higher number of oocytes retrieved (mean difference [Formula: see text] 3.6; 95% CI [2.8, 4.4]), risk of miscarriage (RR 2.90 [2.09, 4.02]), and risk of ovarian hyperstimulation syndrome (RR 3.42 [2.28, 5.13]) per cycle. Conclusion: Despite a widespread perception of poor reproductive potential, women with PCOS experience IVF outcomes similar to those without PCOS. Although there is a slightly lower live birth rate during their first stimulation cycle, success rates are similar after multiple cycles. PCOS is associated with a higher risk of ovarian hyperstimulation syndrome. Further studies are required to mitigate this risk.

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Lipid Metabolism Was Associated With Oocyte in vitro Maturation in Women With Polycystic Ovarian Syndrome Undergoing Unstimulated Natural Cycle

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2021.719173 ◽

2021 ◽

Vol 9 ◽

Author(s):

Tao Liu ◽

Dongming Liu ◽

Xueling Song ◽

Jiangxue Qu ◽

Xiaoying Zheng ◽

...

Keyword(s):

Lipid Metabolism ◽

Live Birth ◽

Birth Rate ◽

Live Birth Rate ◽

Developmental Potential ◽

Maturation Rate ◽

Low Hdl ◽

The Relationship ◽

Ovarian Syndrome ◽

Natural Cycles

ObjectiveHyperlipidemia are common polycystic ovarian syndrome (PCOS)-related metabolic dysfunctions and can adversely affect assisted reproductive technology (ART) outcomes in controlled ovarian hyperstimulation (COH) cycles. The objective of this study is to analyze the relationship between lipid metabolism and ART outcomes in unstimulated natural cycles without the utilization of ovarian induction drugs, which is still uncertain.MethodsThis retrospective study included infertile women with PCOS between 21 and 40 years old undergoing unstimulated natural cycles from January 01, 2006 to December 31, 2019. Lipid metabolism was measured by body mass index (BMI) and serum biochemical parameters including total cholesterol (TC), triglycerides (TG), high and low density lipoprotein cholesterol (HDL-C and LDL-C). ART outcomes were measured by number of oocytes retrieved, oocyte maturation quality and developmental potential, clinical pregnancy and live birth.ResultsA total of 586 patients were included in this study. Multivariate Poisson log-linear analysis showed that high TC (≥5.18 mmol/L), triglycerides (TG) (≥1.76 mmol/L), LDL-C (≥3.37 mmol/L) levelsand low HDL-C levels (≤1.04 mmol/L) were significantly (PTC = 0.001, PTG < 0.001, PHDL–C < 0.001, PLDL–C < 0.001) associated with increased number of oocytes retrieved. BMI was significantly negatively associated with maturation rate (P < 0.001), fertilization rate (P < 0.001) and transferrable embryo rate (P = 0.002). High TG levels and low HDL-C levels were also associated with decreased maturation rate (PTG < 0.001, PHDL–C = 0.026). Logistic regression analysis showed statistically significant association between obesity (≥28.0 kg/m2) and decreased live birth rate (P = 0.004) as well as cumulative live birth rate (P = 0.007).ConclusionThis is the first study that focused on the relationship between basal lipid metabolism and ART outcomes in women with PCOS undergoing unstimulated natural cycles. The results showed that high levels of lipid metabolic parameters were associated with increased number of oocytes retrieved and obesity was closely associated with impaired oocyte maturation quality and developmental potential as well as poor live birth outcomes.

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