How Is Polycystic Ovarian Syndrome (PCOS) Managed During IVF?

PCOSIn continuing to post about some of my unique and interesting cases, this article will address my standard practice of care in the treatment of patients who are suffering from polycystic ovarian syndrome (PCOS) after undergoing in vitro fertilization (IVF).

PCOS and Conventional IVF

Before visiting New Hope Fertility Center, Olive, a 41-year-old Asian woman who has been unable to conceive for over three years, had undergone treatment for her infertility at an unnamed center in Florida:

  • Three failed fertility medication induced intrauterine inseminations (3 x IUIs)
  • Followed by two failed conventional in vitro fertilization (IVF) cycles

Case Study of Olive’s First Failed Fresh IVF Cycle

  • 26 eggs were retrieved
  • 18 mature eggs
  • 4 embryos at blastocysts stage (day 5) development
  • Unfortunately, the fresh embryo transfer on day 5 (blastocysts stage of embryo formation) resulted in a second trimester miscarriage at 19 weeks. Olive’s first IVF cycle resulted in a low yield of embryos at the blastocysts stage of development.
  • Two causes for Olive’s low yield of production of embryos at the blastocysts stage may have been:
  • Her ovulation was triggered (induced) too early, or
  • Polycystic Ovarian Syndrome (PCOS)
  • Now, a prudent fertility specialist must construct a balanced treatment plan between Olive’s egg quantity and ovarian hyper-stimulation.

Case Study of Olive’s Second Failed Fresh IVF Cycle

  • 41 eggs were retrieved
  • 3 embryos at blastocysts stage (day 5) development
  • Preimplantation Genetic Diagnosis (PGD) testing resulted in 1 normal embryo
  • Again, one (1) normal fresh embryo was transferred with no pregnancy.

In her second conventional IVF cycle, the amount of injectable fertility medication was increased. Although a total of 41 eggs were retrieved, a very low yield of blastocyst formation embryos were developed. This is a rate of less than 10 percent. A follow up frozen embryo transfer was also performed without success.

New Hope Fertility Center’s Prescribed Treatment
After undergoing two (2) mini-IVF cycles at New Hope Fertility Center, Olive achieved a successful pregnancy on her second attempt and was graduated to the care of her obstetrician at 9 weeks!
Olive’s Case Analysis Discussion by Dr. John Zhang

After the age of 40, a woman’s egg quality is significantly decreased. At age 41, Olive’s egg quality was compromised. Olive was also a good candidate for PCOS due to the increased amount of injectable medications used during her second failed conventional IVF procedure.
Polycystic Ovarian Syndrome PCOS IVF

When Olive came to New Hope Fertility Center, I recommended treating her infertility through Mini-IVF with PGD testing. After reviewing and analyzing her past IVF history, I determined that Olive had good quality and quantity of antral follicles.
Treatment Protocol
Based upon Olive’s case study, I found that Mini-IVF treatment using ultra-mini to heavy mini-ovarian follicle stimulation may be the best treatment protocol for women with PCOS.
Fertility Medications Prescribed

  • Clomid
  • Letrozole
  • Follistim
  • Ganirelix

A double ovulation trigger medication was used to help or prevent ovarian hyperstimulation syndrome (OHSS) and premature egg maturation.

  • Synarel (nasal spray)
  • Ovidrel

Successful Results
In order to increase the chance of pregnancy, a woman in her advanced maternal years should be advised to undergo multiple Mini-IVF cycles with PGD testing and single embryo transfer. This protocol is preferable to one or more conventional IVF cycles using heavy stimulation.
In Olive’s case, a blastocysts stage embryo formation rate of over 50 percent was achieved. Olive’s first Mini-IVF cycle achieved two (2) normal blastocysts stage embryos. Olive’s second Mini-IVF cycle achieved six (6) blastocysts stage embryos.
Olive’s Successful Results After 2 Mini-IVFs at New Hope Fertility Center

  • 28 blastocysts stage embryos were developed
  • Preimplantation Genetic Diagnosis (PGD) testing resulted in 8 chromosomally normal embryos in the blastocysts stage
  • After PGD testing, 8 blastocysts stage chromosomally normal embryos – a 33 percent rate of success – were developed for successful transfer and pregnancy
    Achieving 8 chromosomally normal embryos was a very good result considering Olive’s advanced maternal age of 41. Today, Olive is close to delivering a healthy baby!

Leading Fertility Specialist Managing PCOS Through Mini-IVF

Lessen your chances of PCOS by discovering the nation’s leading provider of Mini-IVF using PGD testing at New Hope Fertility Center. Please click the link below and enter your information, or simply call 212-517-7676. A fertility specialist from New Hope Fertility Center will be in touch with you shortly. Thank you for visiting my blog!

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