In Vitro Maturation in Women with vs. without Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis

<div><p>Objective</p><p>To evaluate in vitro maturation (IVM) in sub-fertile women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilisation (IVF), by comparing outcomes with a control group of non-PCOS.</p><p>Study design</p><p>A search strategy was developed for PubMed and studies reporting rates of the following outcomes (live birth; clinical pregnancy; implantation; cycle cancellation; oocyte maturation; oocyte fertilization; miscarriage) between patients with PCOS, PCO and controls undergoing IVM were deemed eligible. The review was conducted in accordance to the PRISMA guidelines and included studies quality was assessed through the Newcastle-Ottawa Quality scale. ORs with their corresponding 95% CIs were calculated for the main analysis and subgroup analyses were performed for PCOS cases vs. controls and PCOS vs. PCO cases. Alternative analyses were performed for live birth and clinical pregnancy, based on cycles and on women. Subgroup analyses for FSH stimulation, hCG priming and type of procedure (IVF/ICSI) were undertaken for all meta-analyses encompassing at least four study arms. Random effects models were used to calculate pooled effect estimates.</p><p>Results</p><p>Eleven studies were identified. A total of 268 PCOS patients (328 cycles), 100 PCO patients (110 cycles) and 440 controls (480 cycles) were included in the meta-analysis. A borderline trend towards higher birth rates among PCOS patients emerged (pooled OR = 1.74, 95%CI: 0.99–3.04) mainly reflected at the subgroup analysis vs. controls. Clinical pregnancy (pooled OR = 2.37, 95%CI: 1.53–3.68) and implantation rates (pooled OR = 1.73, 95%CI: 1.06–2.81) were higher, while cancellation rates lower (pooled OR = 0.18, 95%CI: 0.06-0.47) among PCOS vs. non-PCOS subjects; maturation and miscarriage rates did not differ between groups, while a borderline trend towards lower fertilization rates among PCOS patients was observed.</p><p>Conclusion</p><p>The present meta-analysis provides preliminary evidence on the effectiveness of IVM as a treatment option when offered in sub-fertile PCOS women, as the latter present at least as high outcome rates as those in non-PCOS.</p></div

Results of the meta-analyses addressing the three comparisons (PCOS vs. controls; PCO vs. controls; PCOS vs. PCO) in the examined outcomes (Bold cells denote statistically significant associations).

<p>^§number of study arms</p><p>Results of the meta-analyses addressing the three comparisons (PCOS vs. controls; PCO vs. controls; PCOS vs. PCO) in the examined outcomes (Bold cells denote statistically significant associations).</p

PRISMA Flow Diagram of the studies.

<p>PRISMA Flow Diagram of the studies.</p

Description of cycle and outcome parameters.

<p>Footnotes:</p><p>N/A: Not Applicable; NR: Not Reported</p><p>IVF: In Vitro Fertilisation; ICSI: Intracytoplasmic sperm injection; PGD: Pre-implantation genetic diagnosis; ART: Assisted reproductive technology; ESHRE/ASRM: European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM); HEPES buffer: N-(2-hydroxyethyl) piperazine-N'-2-ethanesulfonic acid; TCM 199: tissue culture medium 199; EMEM: Eagle's minimal essential medium; LH: Luteinizing hormone; FSH: Follicle stimulating hormone; HCG: Human chorionic gonadotropin; ET: Embryo transfer.</p><p>Description of cycle and outcome parameters.</p

Characteristics of included studies.

<p>N/A: Not Applicable; NR: Not Reported</p><p>Characteristics of included studies.</p

(a). Comparison PCOS vs. non-PCOS regarding live birth rates (women-based analysis), stratified by stimulation with FSH. (b) Comparison PCOS vs. non-PCOS regarding live birth rates (women-based analysis), stratified by priming with hCG.

<p>(a). Comparison PCOS vs. non-PCOS regarding live birth rates (women-based analysis), stratified by stimulation with FSH. (b) Comparison PCOS vs. non-PCOS regarding live birth rates (women-based analysis), stratified by priming with hCG.</p