The Study On Relationship Of Oocyte And Embryo Quality With Clinical Characteristics And Outcome Of Infertile Women With PCOS

Partâ… The relationship of oocyte and embryo quality with clinical characteristics and outcome of infertile women with polycystic ovarian syndrome and without the syndromeOBJECTIVETo investigate the relationship of oocyte and embryo quality with clinical characteristics and outcome of infertile women with polycystic ovarian syndrome (PCOS),isolated polycystic ovaries(PCO) and normal ovaries when in vitro fertilization-embryo transfer(IVF-ET) was applied.It was expected to be helpful for clinical treatment of infertile women.MATERIALS AND METHODSInfertile women were recruited at reproductive medicine center of Nanfang Hospital in this study during January 2005 and January 2008,while all the infertile couples understood and consented this study.These women were excluded if they met one of the following conditions:(1) they were over 38 years or their serum concentration of follicle stimulating hormone(FSH) was more than 10 miu/ml during the early phase of menstrual cycle;(2) for these infertile couples who proposed to be assisted by IVF-ET,one or more of examination results were abnormal before IVF-ET except the examinations related with the indications.Of all the infertile women after the above exclusion,women were recruited if they met one of the following conditions:(1) they were diagnosed as PCOS according to the PCOS diagnosis criterion recommended in Rotterdam conference;(2) they had polycystic ovaries,regular menstrual cycles and ovulation verified by ultrasound scanning for many menstrual cycles or increased temperatures in ovulation period,but without hyperandrogenism and other endocrine disorders;(3) their ovaries were normal in morphous,and responded normally to gonadotropin(Gn),with regular menstrual cycles and ovulation but without hyperandrogenism and other endocrine disorders. Total IVF-ET fresh cycles were 486 with 460 infertile women.189 infertile women with PCOS were divided into PCOS group,including 202 IVF-ET fresh cycles;129 infertile women with PCO-only were divided into PCO-only group,including 134 cycles;142 women with normal ovaries were divided into control group,including 150 cycles.Experimental materials and instruments were required for controlled ovarian hyperstimulation and in vitro fertilization in conventional IVF-ET.Long protocol during the middle luteal phase of menstrual cycle was applied for superovulation and oocytes were retrieved under the guiding of ultrasound.The semen of their husbands was acquired on the day of oocyte retrieval.4 hours after retrieval,granulosa cells in the outside layer of oocytes were removed and the oocyte morphous and maturation degree of oocyte were observed,when the indications for intracytoplasmic sperm injection(ICSI) were fit based on previous or present results of semen.If there were not ICSI indications,conventional IVF was applied to inseminate.The fertilization rate of oocytes and the status of embryo development were observed and recorded for all the infertile women.On the three day of oocyte retrieval,high-grade embryos were selected to transfer and treatment outcome was followed up.The quality of embryos transferred was evaluated by scoring based on the embryo morphology in two-pronuclear stage and on the three day after oocyte retrieval.The clinical characteristics,oocyte and embryo quality and pregnancy outcome of patients were analyzed when they were treated with IVF-ET.SPSS 11.5 software was applied.Data was expressed by mean±standard deviation,and analyzed statistically using one-way ANOVA,K independent samples test and crosstabs x² test.P＜0.05 was accepted as indication of statistical significance.RESULTS1.The comparison of basic characteristics in PCOS,PCO-only and control groupsThere were no significant diversities among the three groups in age,infertile time,serum estradiol(E₂) and FSH concentration during the early phase of menstrual cycle(P＞0.05).However,body mass index,serum LH and T concentration and LH/FSH during the early phase of menstrual cycle were higher in PCOS group,and antral follicle counting of PCOS and PCO-only groups were more than control group,the diversities were significant statistically(P＜0.05).2.The comparison of clinical characteristics and outcome in PCOS,PCO-only and control groupsAmong the three groups,it was not significant statistically in diversities of the serum E₂ concentration and thickness of endometrium on the day of human chorionic gonadotropin(HCG) injection(P＞0.05).But significant diversities were present that in PCOS and PCO-only groups,the initial and total dosage of Gn were lower,numbers of follicles(including≥10mm,≥14mm and all the total follicles) and oocytes picked up were more,oocyte retrieval rate was higher than in control group(P＜0.05).There were no significant diversities among the three groups in implantation rate,clinical pregnancy rate,sequent pregnancy rate and cumulate pregnancy rate (P＞0.05).Contrasting to control group,PCOS and PCO-only group had higher biochemical pregnancy rate and embryo early loss rate.However,the differences were not significant statistically(P＞0.05).PCOS group had higher early spontaneous abortion rate than other two groups,and PCOS and PCO-only groups had more incidence of ovary hyperstimulation syndrome(OHSS),diversities were significant(P＜0.05).3.The comparison of oocyte quality in PCOS,PCO-only and control groupsThere were no significance in differences of the proportion of vacuolization, reticulum incidence(RB),smooth endoplasmic reticulum(SER),and abnormal granular cytoplasm,polar body,zona pellucida and perivitelline space among the three groups(P＞0.05).But MII oocyte percentage,normal oocyte percentage, and normal fertilization rate were decreased in PCOS and PCO-only groups, significant differences were present(P＜0.05).4.The comparison of embryo quality in PCOS,PCO-only and control groupsAmong the three groups,there were no significant diversities in the number of all the embryos and embryos transferred,percentage of transferring one embryo with gradeâ… and 7-8 blastomeres(P＞0.05).But PCOS group had lower high-grade embryo rate,frozen embryo rate,transferred embryo score and the percentage of transferring two embryos with gradeâ… and 7-8 blastomeres.The diversities were significant(P＜0.05).CONCLUSIONS 1.The clinical characteristics of infertile women with PCOS,PCO-only or normal ovariesThere were some endocrine disorders that maybe resulted in diverse appearances mainly for PCOS partly,for example,the elevated LH and T during the early phase.Infertile women with PCO-only had similar characteristics as infertile patients with normal ovaries.Comparing with other infertile women,patients with PCOS and PCO-only responded sensitively to Gn,with less dosage of Gn and more ooeytes retrieval, causing increased incidence of OHSS.2.The oocyte and embryo quality of infertile women with PCOS,PCO-only or normal ovariesOocyte quality of infertile women with PCOS decreased,manifest mainly in dropped mature degree of cell nuclear and more abnormal morphous of oocytes, decreased fertilization rate,thereby to affect the percentage of high-grade embryos,the number of embryos with gradeâ… and 7-8 blastomeres,the score of embryos transferred.All the above hints may relate with elevated serum LH,T concentration.3.The clinical outcome of in PCOS,PCO-only and control groupsInfertile women with PCOS had similar implantation rate and pregnancy rate as patients without the syndrome in IVF-ET fresh cycles.However,the embryo early loss rate and spontaneous abortion rate increased for PCOS,maybe because of the dropped quality and developing competence of oocyte and embryo. Partâ…¡The relationship of oocyte and embryo quality with clinical characteristics and outcome of infertile women with polycystic ovarian syndrome in different subtypesOBJECTIVETo investigate the relationship of oocyte and embryo quality with clinical characteristics and outcome of infertile women with PCOS in different subtypes when IVF-ET was applied.It was expected to be helpful for clinical diagnosis and treatment of infertile women with PCOS.MATERIALS AND METHODSAccording to the PCOS diagnosis criterion recommended in Rotterdam conference,infertile women with PCOS in Partâ… of this study were identified into three subtypes as three study groups.54 women with PCO and oligo-ovulation/ anovulation and hyperandrogenism were divided into groupâ… ,with 58 IVF-ET fresh cycles;117 women with PCO and oligo-ovulation/anovulation were divided into groupâ…¡,with 126 cycles.18 women with PCO and hyperandrogenism were divided into groupâ…¢,with 18 cycles.Experimental materials and instruments required were the same as Partâ… ,and so were experimental methods.The statistical method was also the same as Partâ… .RESULTS1.The comparison of basic characteristics and glucose metabolic profile in groupâ… ,â…¡andâ…¢.There were no significant diversities among the three groups in age,infertile time,body mass index,E₂,LH,FSH concentration and LH/FSH during the early phase of menstrual cycles,and antral follicle counting(P＞0.05).Serum T concentration during the early phase of menstrual cycle was higher in groupâ… andâ…¢,comparing with groupâ…¡.The diversity was significant(P＜0.05).2.The comparison of clinical characteristics and outcome in groupâ… ,â…¡andâ…¢.Among the three groups,it was not significant statistically in diversities of serum E₂ concentration and the thickness of endometrium on the day of HCG injection,numbers of follicles(including≥10mm,≥14mm and all the total follicles) and oocytes picked up(P＞0.05).The duration and total dosage of Gn in groupâ… were more than other two groups,but the differences were not significant(P＞0.05).Groupâ… had higher initial dosage of Gn,significant diversity was present(P＜0.05).Although there were no significant diversities,implantation rate,clinical pregnancy rate,sequent pregnancy rate and cumulate pregnancy rate were lower in groupâ… than groupâ…¡andâ…¢;embryo early loss rate and spontaneous abortion rate were higher in groupâ… andâ…¢(P＞0.05).Significant diversities were present in elevated incidence of OHSS in groupâ… andâ…¢(P＜0.05).3.The comparison of oocyte quality in groupâ… ,â…¡andâ…¢.There were no significance in diversities of the percentage of vacuolization, RB,abnormal granular cytoplasm,polar body,zona pellucida and perivitelline space among the three groups,and so were MII oocyte percentage,normal oocyte percentage(P＞0.05).It was significant in diversity of SER percentage increased in groupâ… andâ…¢(P＜0.05).4.The comparison of embryo quality in groupâ… ,â…¡andâ…¢.Among the three groups,significance was not present in the total number of embryos and percentage of transferring one embryos with gradeâ… and 7-8 blastomeres(P＞0.05).Groupâ… andâ…¢had lower high-grade embryo rate, frozen embryo rate,transferred embryo score and percentage of transferring two embryos with gradeâ… and 7-8 blastomeres,the differences were significant(P＜0.05)CONCLUSIONS1.The typing and clinical characteristics of patients with PCOSPCOS diagnosis criterion recommended in Rotterdam conference reflected elementary characteristics of this disease to classify patients with PCOS,because in IVF-ET clinic,different types of PCOS had similar features.Patients in subtypeâ… responded to Gn insensitively,manifesting maily in prolonged Gn time,decreased Gn dosage and reduced number of oocyte retrieval, moreover,had increased LH and T and may be the most severe subtype.2.The oocyte and embryo quality and clinical outcome for patients with PCOS in different subtypesComparing with subtypeâ…¡,subtypeâ… andâ…¢with hyperandrogenism had poor quality of oocyte and embryo.Maybe environment with redundant androgen resulted in disturbance of oocyte developing,to affect the formation of embryo.Generally speaking,patients with PCOS in different subtypes could have identical opportunity of favorable pregnancy outcome,though the clinic symptoms were various.Subtypeâ… andâ…¢had elevated embryo loss rate and spontaneous abortion rate.It was presumed that redundant androgen may disturbe the developing competence of oocyte and embryo potentially.