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. 2023 Jul 19;21(1):66.
doi: 10.1186/s12958-023-01118-1.

Risk factors for low oocyte retrieval in patients with polycystic ovarian syndrome undergoing in vitro fertilization

Hao Jin  1 , Haiyan Yang  2 , Jiujia Zheng  2 , Jiechun Zhou  2 , Rong Yu  3
Affiliations

Risk factors for low oocyte retrieval in patients with polycystic ovarian syndrome undergoing in vitro fertilization

Hao Jin et al. Reprod Biol Endocrinol. .

Abstract

Background: The number of oocytes retrieved does not always coincide with the number of follicles aspirated in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Patients with high expectation of retrieval sometimes obtain few oocytes, which may be induced by improper operation or therapeutic factors. The purpose of this study was to evaluate the distribution data of oocyte retrieval rate (ORR) and to explore the risk factors for low ORR in patients with polycystic ovary syndrome (PCOS) undergoing IVF/ICSI.

Methods: A total of 2478 patients with PCOS undergoing IVF/ICSI were involved in this retrospective case-control study from March 2016 to October 2021. The oocyte retrieval rate was calculated as the ratio of the number of obtained oocytes to the number of follicles (≥ 12 mm) on the trigger day. Patients were divided into a low ORR and a normal ORR group with the boundary of one standard deviation from the mean value of ORR. The patient characteristics, treatment protocols, serum hormone levels, and embryonic and pregnancy outcomes were analyzed.

Results: The ORR exhibited a non-normal distribution, with a median of 0.818. The incidence of complete empty follicle syndrome was 0.12% (3/2478). The proportion of patients in the low ORR group who received the progestin-primed protocol was significantly higher than that in the normal ORR group (30.30% vs. 17.69%). A logistic regression analysis showed that the serum estradiol level/follicle (≥ 12 mm) ratio (OR: 0.600 (0.545-0.661)) and progesterone level (OR: 0.783 (0.720-0.853)) on the trigger day were significant factors in the development of a low ORR, with optimal cutoff values of 172.85 pg/ml and 0.83 ng/ml, respectively, as determined by receiver operating curve. Fewer high-quality embryos (2 vs. 5) and more cycles with no available embryos (5.42% vs. 0.43%) were found in the low ORR group.

Conclusions: For patients with PCOS, low estradiol levels/follicles (≥ 12 mm) and progesterone levels on the trigger day and the use of the progestin-primed protocol could be risk factors for low ORR, which leads to a limited number of embryos and more cycle cancellations.

Keywords: In vitro fertilization; Oocyte; Polycystic ovary syndrome; Risk factor.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The non-normal distribution of the frequency of oocyte retrieval rate (ORR) values in patients with PCOS undergoing IVF/ICSI. ORR was defined as the ratio of the number of oocytes obtained to the number of follicles visualized on ultrasound with a diameter ≥ 12 mm on the trigger day
Fig. 2
Fig. 2
(a) Comparison of low ORR events occurring in conditions of different triggers with the same ovarian stimulation protocol by the χ2 test or Fisher’s exact test. (b) Comparison of low ORR events occurring in conditions of different ovarian stimulation protocols with the same trigger administration by the χ2 test or Fisher’s exact test MPA, medroxyprogesterone acetate; r-hCG, recombinant human chorionic gonadotropin; GnRH-a, gonadotrophin releasing hormone agonist
Fig. 3
Fig. 3
Receiver operating curve analyses of the ratio of the estradiol (E2)/follicle (≥ 12 mm) and progesterone (P) level on the trigger day to predicting low ORR events
See this image and copyright information in PMC

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