@2024 Afarand., IRAN

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ISSN: 2251-8215    Sarem Journal of Reproductive Medicine 2018;2(4):153-157

Background
One of the most important causes of infertility in people with PCOS is ovulation disorders or lack of it. ‎When these people enter the ART procedure for a therapeutic intervention, according to existing ‎protocols, one should receive a series of ovarian stimulants, one of the side effects of which is the ‎possibility of Ovarian Hyper Stimulation Syndrome (OHSS).‎
Previous Studies
Symptoms of polycystic ovary, which are characterized by ultrasound, have characteristics that ‎include an increase of 2 to 8 mm cysts of 10 or more in one surface and an increase in stroma density ‎‎[1]. This mark is one of the most important foundations for diagnosis in polycystic ovary syndrome, ‎which, when combined with other symptoms including oligomenorrhoea (prolonged menstruation ‎periods), increases blood androgens, insulin, thickening of the body hair, abdominal obesity, and ‎ovulation failure, is defined as a polycystic Ovarian Disease (PCOS) [1-3]. The PCO ultrasound sign ‎also exist in polycystic ovarian disease (PCOD). Since this mark is one of the most important and ‎pivotal symptoms, and considering that serious discussions are now underway to accurately define ‎PCOS and PCOD and need to be reviewed, in this study, it has been tried to compare the presence or ‎absence of ultrasound sign of polycystic ovaries, while seeing this mark is the most important ‎predictor of the incidence of OHSS. Polycystic ovary is a complex heterogeneous and genetic ‎complicated multifactorial disorder that causes metabolic and endocrine abnormalities in the body. ‎Because of the obesity in this disease, normal ovulation faces with disorder [3, 4]. Based on previous ‎studies, PCOS is a systemic disease that can affect both the quality of the‏ ‏oocytes and endometrial ‎admission [5].‎
Aim(s)
The purpose of this study was to investigate the effects of mild to moderate OHSS on PCO patients ‎compared with non-PCO patients.‎
Research type
This study is a cross-sectional and retrospective study.‎
Research society, place and time
In this study, infertile patients are candidate to do an intracytoplasmic sperm injection (ICSI) with a ‎mild to moderate degree of OHSS was investigated through examination of files in Sarem Specialized ‎Hospital in Tehran for 2 years.‎
Sampling method and number
‎321 patients who were classified according to the criteria of Abolqhar et al. were classified as mild to ‎moderate OHSS classes [6]. Patients with insulin resistance syndrome were not included in the study. ‎Finding PCO symptoms, especially in ultrasound, was a prerequisite for separation of patients in both ‎PCO and non PCO-dependent groups. The reason why patients were nominated for ICSI and ovulation ‎stimulation was not only the observation of PCO symptoms.‎
Used devices&materials
All patients were diagnosed with OHSS with ultrasound, and their OHSS severity was mild to moderate ‎in their records, due to follicular numbers or symptoms such as sickness, nausea, vomiting and ‎abdominal distension. All patients with OHSS in this study treated with 20% mannitol as a treatment ‎for Sarem Specialized Hospital [7-9]. Most patients received this drug while they were hospitalized. All ‎of these patients were treated with ovulation stimulant drugs, including Nostymone, Gonal F, HMG, or ‎a combination of these.‎ Patients' data included age, weight, body mass index (BMI), number of follicles, number of oocytes, ‎number of embryos, number of transferred embryos, number of injection, duration of treatment with ‎gonadotropins, number of hospitalization days and day of injection of HCG (quantitative parameters) ‎and severity of OHSS, etiology and type of infertility, type of drugs, clinical pregnancy outcomes ‎‎(based on observation of embryo sac gestational age and embryonic heart) were collected, and ‎compared between the two groups with and without PCO. Data were analyzed using SPSS 13 software ‎using Fischer T-test and Fisher exact tests.‎
Findings by Text
‎102 (31.8%) patients had PCO conditions and symptoms, either PCOS or PCOD. The number of people ‎who were only ICSI candidates due to PCO and ovarian factors was 40 (39.2%), and the reason for ‎being candidate was 62 (60.8%) of the remaining patient was the combination of other infertility ‎factors (6 with combination of female factors and 56 with male and female factor combination). In the ‎non-PCO-induced group the cause of the ICSI and stimulation of ovulation, in 141(64.4%), 23(10.5%), ‎‎12(5.5%) and 45(19.65) was male factor, female tube factor, unknown, or combination of male and ‎female factors respectively. The severity of OHSS in the two PCO and Non-PCO groups was ‎significantly different (p=0.0001) and patients in PCO group, generally, had higher grade of OHSS ‎‎(Table 1). ‎ Mean age was not significantly different between PCO and non PCO groups (p = 0.341). There was no ‎significant relationship between age and severity of OHSS (p = 0.136). There was no significant ‎correlation between age and outcome of pregnancy (based on clinical pregnancy confirmation) due to ‎limited age range of patients (p = 0.992). There was not a significant relationship between the number ‎of follicles, number of oocytes, number of embryos, number of transmitted fetuses, duration of ‎treatment, and duration of hospitalization in patients with age (p> 0.05). Concerning the type of ‎infertility, 259 (80.7%) patients had primary infertility and 62 (19.3%) had secondary infertility. In ‎terms of type of infertility, there was no difference between PCO and non PCO groups (p = 0.762). The ‎type of infertility (primary or secondary) was not significantly correlated with severity of OHSS (p = ‎‎0.13). There was no significant difference between weight and BMI in PCO group (p> 0.05) compared to ‎non-PCO subjects.‎ No significant correlation was found between the dose of injected HCG and OHSS severity (p = 0.384), ‎so that the dose of injected HCG in patients with mild OHSS was relatively moderate compared to ‎OHSS, however, patients had varying degrees of OHSS severity (Table 2).‎ The embryo transfer was postponed to next cycle in 23 (11.9%) patients with mild OHSS and in 18 ‎‎(14.1%) patients with moderate OHSS, which was not statistically significant (p = 0.610). Embryo ‎transfer was postponed to the next cycle in 17 (16.7%) patients in the PCO group and 24 (11%) in the ‎non-PCO group, which was not statistically significant (p = 0.156). There was a significant difference ‎between the mean number of transferred embryos in the non-PCO group compared to the PCO group (p ‎‎= 0.015). The severity of OHSS was also significantly associated with the number of transmitted ‎fetuses (p = 0.03), so that in mild OHSS and moderate OHSS, 3.86 ± 1.2 and 3.16 ± 1.01 embryos had ‎been transferred respectively (Table 2).‎ Overall, 13.4% of patients had successful pregnancies in form of clinical pregnancy (gestational sac ‎and embryo heart). There was no significant relationship between the success rate of pregnancy and ‎the PCO domain (p = 0.602), so that in the PCO group, the success rate was 11.8% and in the non-PCO ‎group it was 14.2%. There was no significant difference in success rate in pregnancy in terms of ‎severity of OHSS (p = 0.741), so that success rate in mild OHSS and moderate OHSS, based on the ‎transferred embryo in the same cycle, was 14% and 12.5% respectively. ‎
Main comparison to the similar studies
The severity of OHSS in both PCO and non-PCO groups was significantly different, so that the number ‎of patients with moderate OHSS in the PCO group was more than the non-PCO group, which was ‎consistent with the findings of Tomon et al. [10]. ... [11-16]. ‎ There was a significant difference between the mean numbers of transferred embryos in the non-PCO ‎group compared to PCO group. McCormick et al. have shown that the increase in androgen in PCO ‎individuals affects the quality of the fetus and may also impair the implantation. On the other hand, in ‎PCO individuals in that study, the lower quality of the embryo was lower than that of the control group, ‎which increased the number of transmitted embryos to achieve more fertility [17]. These findings are ‎consistent with the results of our studies. There was a significant difference in the number of ‎transmitted embryos in relation to the severity of OHSS. Women with OHSS should be more likely to ‎produce ovules and increase oocytes compared to other women, and therefore it is unreasonable that ‎they are more likely to have fertility and pregnancy. Depending on the severity of OHSS and oocyte ‎stimulation, since the number of oocytes is more and results in a greater number of embryos [18], it is ‎expected that in the mild OHSS, more embryos be transferred compared to the moderate OHSS, so that ‎the success rate increases.‎
Suggestions
It is suggested that a cohort study be designed in the future to make a more accurate and reliable ‎conclusion.
Limitations
A retrospective and cross-sectional design of this research was one of the limitations of this study.
Conclusions
The success rate of ICSI / IVF fertility in people with OHSS is lower than usual, and necessarily the ‎presence of PCO in individuals with OHSS, although it can somewhat reduce the outcomes and success ‎of pregnancy, is not a decisive factor in the success rate of pregnancy. With the longer duration of OHSS ‎treatment and the number of more embryos transmitted (on average, one more fetus), almost the same ‎success rate can be achieved in individuals with a PCO background
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