In performing in vitro fertilization and embryo transfer(IVF-ET) program, we have identified multifollicular ovarian pattern which can be distinguished from polycystic ovaries(PCO) by transvaginal ultrasonography. Multifollicular ovaries(MFO) are
normal
in size or slightly enlarged, and filled with six or more cysts 4∼10 mm in diameter : in contrast to PCO, ovarian stroma is not increased. Women with MFO have the characteristic clinical and endocrine features which are distinct from those
associated
with PCO.
The objective of this retrospective clinical study was to evaluate the outcomes of controlled ovarian hyperstimulation(COH) in infertile patients with MFO, and to compare the pregnancy 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 gonadotropins in 61 MFO patients(68 cycles), 9 PCO patients(11 cycles), and 188 patients (296 cycles) with tubal 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 duration of infertility, and the cancellation rate of COH among three groups. Although patients with MFO or PCO needed less amount of gonadotropins, they showed
higher
peak
serum E2 level 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 embryos transferred, and the cumulative embryo score(CES) among three
groups. The clinical pregnancy rate(PR) per ET and the implantation rate per embryo were 33.3%(22/66) and 10.1%(36/358), respectively, in MFO, k40.0%(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 although patients with MFO or PCO have the different clinical and endocrine features, the outcomes of IVF-ET using midluteal GnRH agonist and gonadotropins are similar each other. However, as patients with MFO pattern in
transvaginal ultrasonography have a higher incidence of OHSS than tubal factor patients, more careful monitoring of COH for IVF-ET is required.
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