| Purpose.The main cause of infertility in PCOS patients is anovulation or oligo-ovulation.Timed intercourse(TI) or intrauterine insemination(IUI) after ovulation induction(OI) is the principal management for PCOS.The clinical characteristics of PCOS are ovary recuitment encrement and selection obstacle.The situations usually seen in ovulation induction(OI) of PCOS patients were insensitivity to the ovulation induction medicine and the hypersensitivity to the ovulation induction medicine,i.e.,hyper-responsiveness and causing ovary hyperstimulation syndrome(OHSS),even threatening the patients' life.To select a safe and effective OI protocol was one of the aims of this study.Meanwhile,if 6 cycles of TI/IUI failed or PCOS combined with other causes of infertility,i.e.,tubal factor,controlled ovary hyperstimulation(COH)+IVF/ICSI would be used.The immenence of in vitro maturation(IVM) is theoretically more convenient and safer choice for PCOS than conventional IVF/ICSI.The other purpoae of the study was to investigate the effectiveness of IVM by means of retrospective comparison of outcomes between IVM and conventional IVF/ICSI in our Hospital. Objectives and Methods:(1) 205 PCOS patients who underwent IUI or timed intercourse(TI) in our Hospital from January,2006 to December, 2007 were retrospectively analyzed.The diagnostic criteria used in the study is the 2005 ASRM/ESHRE Rotterdam Criteria for PCOS.Other causes for infertility were excluded.The patients were divided into three groups according to their ovulation induction(OI) protocols,i.e.,CC group(Citrate Clomiphene was used for OI),LE group(Letrozole was used for OI) and HMG group(HMG was used for OI).The endometrum thickness on HCG day,cervical mucus score,number of oocytes,ovulation rate,clinical pregnancy rate,OHSS rate and multiple pregnancy rate were compared among the three groups.Chi-square and t-test were used for statistical analysis.(2) PCOS patients who underwent IVM or IVF in our Hospital from July,2006 to December,2006 were analyzed retrospectively.The diagnostic criteria used in the study is the 2005 ASRM/ESHRE Rotterdam Criteria for PCOS.Totally,20 patients underwent IVM(20 cycles) and 36 patients underwent IVF/ICSI(45 cycles).The number of oocytes retrieved,fertilization rate,cleavage rate,rate of good quality embryos,endometrium thickness on implantation day,clinical pregnancy rate,abortion rate OHSS rate,multipregnancy rate and the dosage of FSH were compared between the IVM and IVF/ICSI group. Results:(1)The age,duration of infertility BMI and IUI/TI ratio were not statistically different in three groups(P＞0.05).The ovulation rate,cervical mucus score,endometrium thickness and clinical pregnancy rate of HMG and LE group were higher than those in CC group(P＜0.05). The number of oocytes in HMG group was higher than that of LE group and CC group and the OHSS rate in HMG group was also higher than that of LE and CC group(P＜0.05).The multiple pregnancy rate were not statistically different.(2) The age,duration of infertility,BMI and etiological constitute were not significantly different between the IVM and IVF/ICSI group(P＞0.05).There were no statistical difference between the two groups in the fertilization rate,cleavage rate,clinical pregnancy rate and abortion rate(P＞0.05).The endometrium thickness on implantation day and the rate of good quality embryo in IVM group were significantly lower than those of IVF/ICSIgroup,whereas,the OHSS rate and dosage of FSH in IVF/ICSI group were significantly higher than those of IVM group.Conclusions:(1) Letrozole could be used of first-line choice for PCOS patients instead ifCitrate Clomiphene and HMG might be used as second-line medication for OI in PCOS.(2)Compared with conventional IVF/ICSI,IVM is a relatively more economic,convennient and safe ART and it would reduce the risk of OHSS.IVM might be suggested as the first choice for PCOS patients who would undertake IVF.
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