In vitro maturation in polycystic ovary syndrome and poor responders - Effect of follicular size and FSH concentration in culture media

Objectives: - To determine the effect of recombinant Follicle Stimulating Hormone (r-FSH) concentration in culture media on in vitro maturation outcomes. - To determine the effect of the follicle size on in vitro maturation outcomes. - To determine the in vitro maturation outcomes of immature oocytes recovered from infertile patients with polycystic ovaries (PCO) and poor responders. Design & Methods: Two-stage prospective study was performed in an IVF unit in the eastern province of Saudi Arabia. The first stage compared the fertilization and pregnancy outcomes in patients with Polycystic Ovary (PCO) Syndrome and patients with poor response to recombinant Follicular Stimulation Hormone (rFSH). The second compared these outcomes according to follicular size. Oocytes retrieved after 5 days rFSH course were divided into two groups according to follicular size (8-10mm and 1113mm) and were cultured in a 0.075 IU/ml medium.. The effect of follicular size on oocytes-maturation, fertilization, embryo cleavage, and pregnancy rate was assessed in the two groups and in those with PCO and poor responders. Results: There was no difference in the main outcome measures between oocytes cultured in the two concentrations of FSH. Oocytes retrieved from 11-13 mm follicles showed higher rates of maturation, fertilization and pregnancy, than those retrieved from 8-10 mm follicles. In both PCO and poor responders patients embryos produced from regularly cycling patients had a significantly higher embryo development ratio, even though cleavage was not significantly different. Conclusion: Concentrations higher than 0.075 IU ml in culture media for IVM are not necessarily associated with better outcomes. Larger follicular size produces better fertilization and pregnancy rates. In both PCO and poor responders, cycle irregularity is associated with poorer outcomes.