Potential effect of ovarian puncture in the programmes of in vitro oocyte maturation in women with polycystic ovary syndrome

Hormonal stimulation and surgical treatment options are used to achieve ovulation in patients with polycystic ovary syndrome (PCOS). However, these methods can result in a number of complications.

Objective: To examine the possible relationship between mechanical impact on the ovary during puncture in in vitro oocyte maturation (IVM) programmes and the occurrence of ovulation in a typical form of PCOS in patients with a history of primary anovulatory infertility.

Materials and methods: The study included eight patients with androgenic phenotype of PCOS, primary anovulatory infertility and history of unsuccessful attempts of monoovulation induction and IVF.

Results: The patients were divided into two groups according to the outcomes of the IVM programmes. Group 1 (n=4) included women who had embryo developmental arrest. Three of them had spontaneous ovulation in the next cycle with subsequent pregnancy. One patient underwent repeated IVM two months after the first programme; a negative hCG result was obtained after transfer of a 3BB embryo; in the next cycle spontaneous ovulation resulted in a spontaneous pregnancy. In group 2, four patients underwent fresh embryo transfers in the IVM protocol (3BC, 2BB, 3BB, and 1B embryos) but no pregnancy occurred. In the next cycle, spontaneous ovulation resulted in uterine pregnancy in one of the patients. The other had 4BC and 3BB embryos left for cryopreservation; there were two transfers of cryopreserved embryos. The patient did not become pregnant. A repeated IVM was performed six months later. In the next cycle, spontaneous ovulation caused the spontaneous pregnancy. The pregnancy of all eight women in both groups proceeded to term, resulting in delivery.

Conclusion: The technique of mechanical ovary treatment appears to show significant potential. The extent of exposure and the potential for bleeding can be effectively managed, and the procedure itself does not result in a decline in ovarian reserve. Additionally, there is no evidence of thermal damage to the ovarian tissue.