Outcome of In Vitro Fertilization and Embryo Transfer in Patients with Multifollicular Ovarian Pattern inTransvaginal Ultrasonography

Jung, Jae Hoon; Kim, Seok Hyun; Suh, Chang Suk; Choi, Young Min; Shin, Chang Jae; Kim, Jung Gu; Moon, Shin Yong; Lee, Jin Yong

Abstract

In performing in vitro fertilization and embryo transfer(IVF-ET) program, we haveIdentified multifollicular ovarian pattern which can be distinguished from polycystic ovaries(PCO) by transvaginal ultrasonograpy. Mutifollicular ovaries(MFO) are normal in size ofslightly enlarged, and filled with six or more cysts 4~10 mm in diameter: in contrast toPCO, ovarian stroma is not increased. Women with MFO have the characteristic clinical andEndocrine features which are distinct from those associated with PCO.The objective of this retrospective clinical study was to evaluate the outcomes ofcontrolled ovarian yperstimulation(COH) in infertile patients with MFO, and to compare thepregnancy outcomes in MFO patients with those of PCO or tubal factor only patients. IVF-ET was performed using COH with midluteal GnRH agonist suppression and gonadotropinsin 61 MFO patients(68 cycles), 9 PCO patients(11 cycles), and 188 patients(296 cycles) withtubal factor infertility at Seoul National University Hospital from January, 1995 to August,1996.There were no statistically significant differences in the age of patients, the durationof infertility, and the cancellation rate of COH among three groups. Although patients withMFO of PCO needed less amount of gonadotropins, they showed higher peak serum E2Level and more oocytes were retrieved compared with tubal factor patients(p < 0.05). However,no significant differences existed in the fertilization rate, the number of embroys transferred,and the cumulative embryo score(CES) among three groups. The clinical pregnancy rate(PR) per ET and the implantation rate per embroy were 33.3%(22/66) and 10.1%(36/358),respectively, in MFO, 40.0%(4/10) and 9.4%(5/53) in PCO, and 28.7%(83/289) and 7.6%(108/1,403) in tubal factor patients, and they showed no significant differences. In addition,the ectopic PR, the abortion rate, and the multiple PR were not different among three groups.The occurrence rate of ovarian hyperstimulation syndrome(OHSS) was higher in MFO(10.3%) and PCO(18.2%) compared with tubal factor patients(2.7%,p < 0.05).These data suggest that althought patients with MFO or PCO have the different clinicaland endocrine features, the outcomes of IVF-ET using midluteal GnRH agonist andgonadotropins are similar each other. However, as patients with MFO parttern in transvaginalultrasonography have a higher incidence of OHSS than tubal factor patients, morecareful monitoring of COH for IVF-ET is required.