In vitro fertilization in the PCOS patient: clinical considerations

Of all the patients undergoing in vitro fertilization, the patient with polycystic ovary syndrome (PCOS) is probably the most challenging. This is due to the fact that the majority of patients exhibit exaggerated responses to exogenous gonadotropins, frequently leading to an increased rate of cancellation of a treatment cycle. Even those who proceed to oocyte retrieval, and in spite of an increased number of oocytes retrieved, poor fertilization rates may be encountered, probably secondary to an increased rate of oocyte immaturity. To compound the problem further, even fertilized eggs in these patients, generally speaking, may show lower cleavage rates, and this leads to decreased implantation and pregnancy rates. In addition, these are patients who exhibit a much higher incidence of ovarian hyperstimulation syndrome, which puts the patient's health at great risk. Possibly, some of these problems may be inherent in the PCOS ovary. Nevertheless, it is possible that modifications of clinical protocols may improve outcome.