Transvaginal Ovarian Drilling Prior to In Vitro Fertilization Markedly Increases the Percent and Yield of Euploid Blastocysts in Patients With Polycystic Ovarian Syndrome

Author Type(s)

Faculty, Student

Document Type

Abstract

Publication Date

10-2023

Journal Title

Fertility and Sterility

Department

Obstetrics and Gynecology

Abstract

OBJECTIVE: The purpose of this study was to assess the impact of transvaginal ovarian drilling (TVOD) on blastocyst euploidy rates in the in vitro fertilization (IVF) treatment of clomiphene citrate (CC) resistant polycystic ovarian syndrome (PCOS). MATERIALS AND METHODS: This was a retrospective time series trial. The electronic medical record was reviewed for all patients between Jan 2017 to Dec 2022 with ages between 18 and 42 years and a diagnosis of PCOS based on Rotterdam criteria and failure to ovulate or conceive with metformin and CC or letrozole stimulation. All subjects included had 2 IVF cycles with aneuploidy screening within a 3-month period, with TVOD prior to the second cycle. TVOD was performed with propofol anesthesia and transvaginal ultrasound guidance 2-7 days before stimulation. A 17-gauge needle punctured each ovary once and penetrated the stroma 20-50 times. Continuous data were compared with the paired t-test. Statistical significance was defined as P%0.01 due to small sample size and multiple significance testing. RESULTS: 12 subjects were identified. Mean age and initial AMH were 36.0 4.2 and 5.7 2.6 respectively. There were no significant differences in yield of oocytes, aneuploid blasts, or mosaic blasts. TVOD was associated with a 7-foldincreaseinthe yield of and 4-foldincreaseinthe percent of euploid blasts, and a halving of the percent of aneuploid blasts. There was a trend toward improvement in the number and percent of blastulation post TVOD. CONCLUSIONS: In this retrospective time series trial, TVOD markedly improved the number and percent of euploid blasts yielded in patients with CC resistant PCOS.

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