Human Reproduction Update Advance Access originally published online on August 25, 2005
Human Reproduction Update 2006 12(1):13-21; doi:10.1093/humupd/dmi036
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A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome
1 Department of Reproductive Medicine, University Medical Center, Utrecht, 2 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, 3 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands and 4 Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Ontario, Canada
5 To whom correspondence should be addressed at: Department of Reproductive Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. E-mail: e.heijnen{at}erasmusmc.nl
Submitted on May 11, 2005; revised on July 15, 2005; accepted on July 27, 2005
This meta-analysis was conducted to compare outcomes of conventional IVF in women presenting with polycystic ovary syndrome (PCOS) and non-PCOS patients. Studies in which PCOS patients undergoing IVF were compared with a matched—no male factor—control group were considered for this review. A definition consistent with the Rotterdam consensus criteria of PCOS was required, and all patients within a given study had to be treated with the same ovarian stimulation protocol. Information regarding patient characteristics and pregnancy outcome was also required. Nine out of 290 identified studies reporting data on 458 PCOS patients (793 cycles) and 694 matched controls (1116 cycles) fulfilled these inclusion criteria. PCOS patients demonstrated a significantly reduced chance of oocyte retrieval per started cycle, odds ratio (OR) = 0.5 [95% confidence interval (CI) = 0.2–1.0]. However, no difference was observed in chance of embryo transfer per oocyte retrieval between the groups (OR = 0.7, 95% CI = 0.4–1.3). Significantly more oocytes per retrieval were obtained in PCOS patients compared with controls [random effects estimate 3.4 [95% (CI) = 1.7–5.1)]. The number of oocytes fertilized did not differ significantly between PCOS patients and controls, weighted mean difference (WMD) 0.1 oocytes (95% CI = 21.4–1.6). No significant difference was observed in the clinical pregnancy rates per started cycle, OR = 1.0 (95% CI = 0.8–1.3). The incidence of ovarian hyperstimulation syndrome (OHSS) after oocyte retrieval was rarely reported. This meta-analysis demonstrates an increased cancellation rate, but more oocytes retrieved per retrieval and a lower fertilization rate in PCOS undergoing IVF. Overall, PCOS and control patients achieved similar pregnancy and live birth rates per cycle.
Key words: IVF outcome / meta-analysis / PCOS
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