Does they type of insemination have an effect on reproductive outcomes in women with PCOS using in vitro maturation?

This study compared traditional in vitro fertilization (IVF) to intracytoplasmic sperm injection (ICSI) for in vitro maturation of eggs. It found that both insemination methods led to good fertilization and pregnancy outcomes for patients with polycystic ovarian syndrome (PCOS).

PCOS is a condition in which a woman has high testosterone levels and does not ovulate consistently. PCOS is a leading cause of infertility. Women with PCOS and infertility are often initially treated with ovarian stimulation (OS) medications to encourage ovulation. The next line of treatment is often IVF. IVF involves using OS and collecting the oocytes (eggs) and implanting fertilized embryo(s) in the uterus. However, the higher doses of OS used during IVF have risks and side effects including over-stimulating the ovaries. 

In vitro maturation (IVM) is another option. IVM involves collecting earlier, immature oocytes. The oocytes are cultured to mature them artificially. After that, they are inseminated and the embryos are implanted in the same way as a typical IVF cycle. IVM is an option for patients with PCOS and infertility.

The oocyte is surrounded by a protective layer (zone pellucida) which ensures that the oocyte is fertilized in the correct way by a single sperm. IVM may make this layer more difficult for a sperm to enter. Oocytes obtained through IVM can be inseminated using ejaculated sperm, similar to IVF. Alternately, ICSI is a procedure that involves injecting a single sperm into the oocyte. It is unclear which insemination method leads to better IVM outcomes for patients with PCOS.

This study included 38 patients with PCOS who underwent IVM. 828 immature oocytes were collected and artificially matured. 416 oocytes were inseminated using IVF, and 412 using ICSI. 

A similar number of oocytes matured in both the ICSI and IVF groups (72.6% vs. 78.1%). There was a trend toward more oocytes having a normal fertilization using ICSI (66.9% vs. 59.4%). Some (5.3%) of the IVF oocytes had an abnormal fertilization by two or more sperm. Also, 4.8% of the IVF oocytes were not fertilized at all, whereas this did not occur with any of the ICSI oocytes. A similar proportion of embryos formed from fertilization methods were high-quality (46.5% – ICSI vs. 40.9% – IVF).

21 embryos from each fertilization group were transferred. A single embryo was transferred to the uterus. If the lining of the uterus was thick enough (over 8 mm) this was done with a fresh embryo, otherwise, they were frozen until the following cycle. A similar number of embryos implanted for each group (10 – ICSI vs. 11 – IVF). The same number of pregnancies were observed on ultrasound for each group (9 vs. 9).

This study found that both ICSI and IVF are effective fertilization methods to use with IVM for patients with PCOS.

This study used a small number of patients. More studies are needed.