In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction

Background Polycystic ovarian syndrome (PCOS) occurs in 4% to 7% of all women of reproductive age and 20% of women presenting with subfertility. A significant proportion of these women will ultimately need assisted reproductive technology (ART). In women with PCOS, the supra‐physiological doses of gonadotrophins used for controlled ovarian hyperstimulation (COH) often result in an exaggerated ovarian response characterised by the development of a large cohort of follicles of uneven quality, retrieval of immature oocytes, and increased risk of ovarian hyperstimulation syndrome. A potentially useful intervention for women with PCOS‐related infertility involves earlier retrieval of immature oocytes followed by in vitro maturation. Objectives To compare live birth rates per woman following in vitro maturation (IVM) with conventional in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) for women with PCOS undergoing ART. Search methods We searched the Menstrual Disorders and Subfertility Group Specialised Register of controlled trials for any relevant trials (January 2011) identified from the title, abstract, or keyword sections. Following a search of the electronic database MEDLINE using Ovid software, in all languages, we also performed a manual search of the references of all retrieved articles; sought unpublished papers and abstracts submitted to international conferences; and contacted experts. In addition, we searched the National Institute of Clinical Excellence fertility assessment and treatment guidelines (NICE 2004) and handsearched reference lists of relevant articles (from 1970 until February 2011). Selection criteria All randomised trials on the intention to perform IVM before IVF or ICSI compared to conventional IVF or ICSI for subfertile women with PCOS. Data collection and analysis Two review authors independently assessed eligibility and quality of trials. Main results There were no trials suitable for inclusion in the review. Authors' conclusions There are no randomised controlled trials upon which to base any practice recommendations regarding IVM before IVF or ICSI for women with PCOS. There is an urgent need for randomised trials in this field.