DOES OVARIAN MORPHOLOGY AFFECT THE REPRODUCTIVE OUTCOMES OF IN-VITRO MATURATION CYCLES IN POLYCYSTIC OVARY SYNDROME?

To investigate whether the ovarian morphology in polycystic ovary syndrome (PCOS) has an effect on the reproductive outcomes of in-vitro maturation cycles (IVM) This was a retrospective study in a tertiary university affiliated reproductive center conducted over 3 years. All the charts of patients with PCOS who underwent IVM were reviewed for possible inclusion. The diagnosis of PCOS was based on the 2003 Rotterdam criteria. The patients were divided into two groups based on the ovarian morphology imaged by trans-vaginal sonography. Group 1 had polycystic ovarian morphology (PCOM) in which the antral follicles were concentrated on the periphery surrounding a hyperechoic stroma (string of pearls), and Group 2 had multicystic ovarian morphology (MCOM) in which the antral follicles were distributed evenly across the stroma of the ovary. Measurements were performed at the midpoint of the ovary. The IVM protocol included 3 days of gonadotropin stimulation and hCG priming when the leading follicle size was 10-12 mm. Collected cumulus-oocyte complexes were cultured for 48 h for maturation. Intracytoplasmic sperm injection (ICSI) was used for fertilization. Embryo transfer was performed two days after fertilization. Demographic and clinical parameters were compared between the two groups, the primary outcomes was the number of mature oocytes and total number of good quality embryos. A total of 143 subjects were included in the study. Seventy eight were included in group 1 and 65 subjects were included in group 2. The mean age was similar (31.8 vs. 32.05 years, p=0.45), however women in group 1 had higher BMI (24.8 vs. 23.0 Kg/m2, p=0.02). When comparing the IVM cycles outcome, women in group 1 had a higher number of oocytes collected (23.1 vs. 18.2, p=.001) and more MII oocytes (15.8 vs. 12.1, p=.03). The maturation rate (66.7% vs. 66.8%) and fertilization rate (66.9% vs. 66.4%) were similar between the groups. The total number of embryos produced (9.7 vs. 7.3, p=0.04) and the number of top quality embryos (4.4 vs. 3.3, p=0.03) were higher in group 1. Furthermore, a higher proportion of cycles resulted in vitrification of surplus embryos in group 1 (48% vs. 31%. p=0.03). The clinical pregnancy rate following fresh embryo transfer was similar between the groups (32% vs. 29%, p=0.12). In logistic regression analysis, PCOM was the only factor significantly correlated with higher oocyte number (OR 3.1 ,CI 1.8-4.5, p=.001) Polycystic ovarian morphology has a significant role on the outcomes of IVM cycles in PCOS. Specifically, it is associated with higher oocyte yield. Considering the lower competence of oocytes in IVM cycles, higher oocyte number can be crucial to the IVM success and ovarian morphology should be considered when planning IVM cycles in patients with PCOS