Purpose: Our purpose was to assess the endocrine status of women with polycystic ovaries (PCO) undergoing IVF, and to compare oocyte quality with endocrine markers of the syndrome, in an attempt to define a subpopulation with poor quality oocytes.
Methods: This was a retrospective study. Patients were first endocrinologically analyzed: serum levels of androgens (T, androstenedione, DHEAS), FSH, and LH as well as glucose and insulin after an oral glucose tolerance test (OGTT) were recorded and are expressed as absolute values and area under the curve (AUC). Subsequently, they were followed over a 2-year period in which patients underwent several attempts of IVF as well as serving as oocyte donors. Patients were divided into three groups: group I (n=4) was women who displayed embryos unable to implant in 15 IVF cycles and 10 ovum donation cycles in which they served as donors; group II (n=16) was PCO patients in whom IVF (n=38) and/or oocyte donation cycles (n=42) resulted in pregnancies; and group III (n=13) was IVF patients with normal appearance of the ovaries by ultrasound. The endocrine status was compared with the IVF results.
Results: There was no difference among groups in the endocrinological parameters tested, except for the OGTT which identified women in group I as having higher serum glucose and insulin levels than patients in groups II and III. Similarly, the OGTT showed higher serum glucose values in group II compared to group III. Women in group I were also obese. Patients in group III were older than PCO patients and needed more gonadotropins to reach an ovarian response which resulted in a reduced number of oocytes retrieved. Fertilization was also impaired in group I, in which no pregnancy was recorded.
Conclusions: This study shows that there is a particular subgroup of PCO patients with lower fertilization rates and embryos unable to implant. These patients are obese and nonhyperandrogenic and show derangements of insulin secretion.
Salat-Baroux J, Alvarez S, Antoine JM, Cornet D, Tibi Ch, Plachot M, Mandelbaum J: Results of IVF in the treatment of polycystic ovary disease. Hum Reprod 1988;3:331–335PubMedGoogle Scholar
Dor J, Shulman A, Levran D, Ben-Rafael Z, Rudak E, Mashiach S: The treatment of patients with polycystic ovarian syndrome by in-vitro fertilization and embryo transfer: A comparison of results with those of patients with tubal infertility. Hum Reprod 1990;5:816–818PubMedGoogle Scholar
MacDougall MJ, Tan SL, Balen A, Jacobs HS: A controlled study comparing patients with and without polycystic ovaries undergoing in-vitro fertilization. Hum Reprod 1993;8:233–237PubMedGoogle Scholar
Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA: Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992;167:1807–1812PubMedGoogle Scholar
Balen AH, Conway GS, Kaltsas G, Techatraisak K, Manning PJ, West Ch, Jacobs HS: Polycystic ovary syndrome: The spectrum of the disorder in 1741 patients. Hum Reprod 1995;10:2107–2111PubMedGoogle Scholar
Polson DW, Wadsworth J, Adams J, Franks S: Polycystic ovaries—a common finding in normal women. Lancet 1988;2:870–872CrossRefGoogle Scholar
Wong IL, Morris RS, Lobo RA, Paulson RJ, Sauer MV: Isolated polycystic morphology in ovum donors predicts response to ovarian stimulation. Hum Reprod 1995;10:524–528PubMedGoogle Scholar
Pellicer A, Ruiz A, Castellví RM, Calatayud C, Ruiz M, Tarín JJ,et al.: Is the retrieval of high numbers of oocytes desirable in patients treated with gonadotrophin-releasing hormone analogues (GnRHa) and gonadotrophins?. Hum Reprod 1989;4:536–540PubMedGoogle Scholar
Testart J, Belaisch-Allart J, Forman R, Gazengel A, Hazout A, Strubb N, Frydman R: Influence of different stimulation treatments on oocyte characteristics and in vitro fertilizing ability. Hum Reprod 1989;4:192–197PubMedGoogle Scholar
Remohí J, Vidal A, Pellicer A: Oocyte donation in low responders to conventional ovarian stimulation for in vitro fertilization. Fertil Steril 1993;59:1208–1215PubMedGoogle Scholar
Ashkenazi J, Farhi J, Orvieto R, Homburg R, Dekel A, Feldberg D, Ben Rafael Z: Polycystic ovary syndrome patients as oocyte donors: the effect of ovarian stimulation protocol on the implantation rate of the recipient. Fertil Steril 1995;64:564–567PubMedGoogle Scholar
Simón C, Cano F, Valbuena D, Remohí J, Pellicer A: Clinical evidence for a detrimental effect on uterine receptivity of high serum estradiol levels in high and normal responder patients. Hum Reprod 1995;10:2432–2437PubMedGoogle Scholar
Hardy K, Robinson FM, Paraschos T, Wicks R, Franks S, Winston RML: Normal development and metabolic activity of preimplantation embryos in vitro from patients with polycystic ovaries. Hum Reprod 1995;10:2125–2135PubMedGoogle Scholar
WHO: Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction, 3rd ed. Cambridge, Cambridge University Press, 1992, IA, pp 43–44Google Scholar
Pasquali R, Antenucci D, Venturoli S,et al.: Insulin resistance in patients with polycystic ovaries: its relationship to body weight and androgen levels. Acta Endocrinol (Copenh) 1983;104:110–116Google Scholar
Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A, Licholai T: Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes 1992;41:1257–1266PubMedCrossRefGoogle Scholar
Willis D, Franks S: Insulin action in human granulosa cells from normal and polycystic ovaries is mediated by the insulin receptor and not the type-I insilin-like growth factor receptor. J Clin Endocrinol Metab 1995;80:3788–3790PubMedCrossRefGoogle Scholar
Baulieu EE: Induction by progesterone and a “maturation-promoting factor” of soluble protein in xenopus laevis oocytes in vitro. Ann NY Acad Sci 1977;286:421–433CrossRefGoogle Scholar
Silverberg KM, Burns WN, Olive DL, Riehl RM, Schenken RS: Serum progesterone levels predict success of in vitro fertilization/embryo transfer in patients stimulated with leuprolide acetate and human menopausal gonadotropins. J Clin Endocrinol Metab 1991;73:797–803PubMedCrossRefGoogle Scholar
Andersen CY: Characteristics of human follicular fluid associated with successful conception after in vitro fertilization. J Clin Endocrinol Metab 1993;77:1227–1234PubMedCrossRefGoogle Scholar
Gómez E, Tarín JJ, Pellicer A: Oocyte maturation in humans: Effect of gonadotropins and growth factors. Fertil Steril 1993;60:40–46PubMedGoogle Scholar
Filicori M, Flamigni C, Cognigni G, Dellai P, Michelacci L, Arnone R: Increased insulin secretion in patients with multifollicular and polycystic ovaries and its impact on ovulation induction. Fertil Steril 1994;62:279–285PubMedGoogle Scholar
Homburg R, Armar NA, Eshel A, Adams J, Jacobs HS: Influence of serum luteinising hormone concentrations on ovulation, conception, and early pregnancy loss in polycystic ovary syndrome. Br Med J 1988;297:1024–1026CrossRefGoogle Scholar
Pellicer A, Valbuena D, Cano F, Remohí J, Simón C: Lower implantation rates in high responders: Evidence for an altered endocrine milieu during the pre-implantation period. Fertil Steril 1996;65:1190–1195Google Scholar