Reading through the table of contents from yesterday’s issue of The New England Journal of Medicine, I was interested to find an article entitled “Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome.” Having many patients with PCOS, I was of course interested to see whether this large study of over 1500 women diagnosed with PCOS would validate my prior assumptions.
In this study, pregnancy rates were higher (49% vs 42%) and miscarriage rates lower (22% vs 33%). Women with PCOS experience a metabolic and hormonal imbalance that results in irregular or no menstrual cycles. We know that these women respond well to fertility medications at the time of in-vitro fertilization (IVF). In fact, many of them respond too well. It is not unusual for a PCOS patient to develop 20 or 30 eggs during a typical IVF cycle. Importantly, quantity and quality do not always go together so PCOS patients can be some of our toughest cases. Due to their high response and accompanying high estrogen levels, these women are at risk of Ovarian Hyperstimulation Syndrome (OHSS) which can be a serious complication. Hormonal fluctuations can also change the responsiveness of the uterus for implantation and often the uterus and embryos fall out of sync with each other.
We have known for years that these patients are not as successful when embryos are transferred fresh. Waiting a few weeks for hormone levels to return to normal and using a frozen embryo transfer cycle to prepare the uterus and ensure proper timing for implantation has been a cornerstone of the RMANJ approach to IVF. Our approach to patient care has always been using evidence based medicine to deliver the best patient care. I am glad to see that the finds from this case study further supports our belief that controlling the timing of an embryo transfer improves successful outcomes for some of our toughest patients.
Repose to recent article: Frozen Embryos Could Be More Successful for PCOS