Live Birth After Fresh Embryo Transfer Vs Frozen-thawed Embryo Transfer in Women With Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of childbearing age. However, the optimal infertility treatment for PCOS patients is still a matter of controversy. Despite producing more follicles and more oocytes than other women undergoing controlled ovarian hyperstimulation during an IVF cycle, women with PCOS have comparable or lower pregnancy rates. Additionally women with PCOS patients undergoing IVF have a higher risk of developing ovarian hyperstimulation syndrome (OHSS), which may be aggravated by pregnancy after an embryo transfer in a fresh cycle. Further women with PCOS are thought to have higher rates of later pregnancy complications including spontaneous abortion, pre-eclampsia, and preterm labor that may be related to impaired implantation in the superovulated endometrium. We propose a randomized clinical trial of elective embryo cryopreservation followed by a programmed cycle of endometrial preparation and frozen embryo transfer (FET) compared to fresh embryo transfer in women with PCOS undergoing in vitro fertilization (IVF).

Sex

Female

Minimum age

20 Years

Maximum age

34 Years

Inclusion Criteria:

* Women diagnosed as PCOS according to Chinese PCOS diagnosis criteria;
* Women who have ≥1 years history of infertility;
* Women aged ≥20 and \<35 years old;
* Women with body weight ≥40kg;
* Women who have at least one of the following indications for IVF or ICSI:

  1. Ovulation dysfunction and failed to become pregnant from ovulation induction treatment;
  2. Tubal factors: unilateral or bilateral tubal obstruction, adhesion, unilateral or bilateral Salpingectomy or tubal ligation;
  3. Male factors: oligoasthenozoospermia, obstructive azoospermia;
* Women who are undergoing their first cycle of IVF or ICSI;
* Women who retrieved oocytes number \> 3;
* Women who are capable of giving informed consent.

Exclusion Criteria:

* Women who underwent unilateral ovariectomy;
* Women diagnosed as uterus abnormality: malformed uterus (uterus unicorns, septate uterus, duplex uterus, uterus bicomis), adenomyosis, submucous myoma, intrauterine adhesion;
* Women or their partner with abnormal chromosome karyotype including chromosome polymorphism;
* Women who have experienced recurrent spontaneous abortion (including biochemical pregnancy abortion) more than 2 times;
* Women with medical condition that represent contraindication to assisted reproductive technology and/or pregnancy;
* Women who has developed severe OHSS before oocyte pick-up day;
* Women with retrieved oocytes number ≤3;
* Women who are unable to comply with the study procedures.

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• DERIVEDZaat T, Zagers M, Mol F, Goddijn M, van Wely M, Mastenbroek S. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database Syst Rev. 2021 Feb 4;2(2):CD011184. doi: 10.1002/14651858.CD011184.pub3. PMID 33539543
• DERIVEDWei D, Yu Y, Sun M, Shi Y, Sun Y, Deng X, Li J, Wang Z, Zhao S, Zhang H, Legro RS, Chen ZJ. The Effect of Supraphysiological Estradiol on Pregnancy Outcomes Differs Between Women With PCOS and Ovulatory Women. J Clin Endocrinol Metab. 2018 Jul 1;103(7):2735-2742. doi: 10.1210/jc.2018-00613. PMID 29718297
• DERIVEDZhang B, Wei D, Legro RS, Shi Y, Li J, Zhang L, Hong Y, Sun G, Zhang T, Li W, Chen ZJ. Obstetric complications after frozen versus fresh embryo transfer in women with polycystic ovary syndrome: results from a randomized trial. Fertil Steril. 2018 Feb;109(2):324-329. doi: 10.1016/j.fertnstert.2017.10.020. Epub 2018 Jan 17.