ICSI and PGT-A in PCOS phenotype-D patients: a matched case–control study versus idiopathic infertile women

• Published in: Journal of assisted reproduction and genetics 2024-12, Vol.41 (12), p.3423-3432
• Main Authors: Vaiarelli, Alberto, Cimadomo, Danilo, Rucci, Cecilia, Innocenti, Federica, Taggi, Marilena, Pittana, Erika, Fiorentino, Giulia, Petrone, Pasquale, Soscia, Daria Maria, Fabozzi, Gemma, Mazzilli, Rossella, Rienzi, Laura, Ubaldi, Filippo Maria, Nappi, Rossella Elena, Gennarelli, Gianluca
• Format: Article
• Language: English
• Subjects: Adult; Assisted Reproduction Technologies; Blastocyst; Blastocysts; Case-Control Studies; Embryo Transfer - methods; Female; Fertilization; Fertilization in Vitro - methods; Genotype & phenotype; Gynecology; Human Genetics; Humans; Infertility; Infertility, Female - pathology; Infertility, Female - therapy; Male; Medicine; Medicine & Public Health; Oligomenorrhea; Oocytes; Oocytes - growth & development; Oocytes - pathology; Phenotype; Phenotypes; Polycystic Ovary Syndrome - pathology; Polycystic Ovary Syndrome - therapy; Pregnancy; Pregnancy Rate; Preimplantation Diagnosis; Reproductive Medicine; Retrospective Studies; Sperm; Sperm Injections, Intracytoplasmic - methods; Zygotes
• ISSN: 1058-0468; 1573-7330; 1573-7330
• DOI: 10.1007/s10815-024-03299-z

Purpose To assess oocyte competence and embryo chromosomal constitution in phenotype-D PCOS women undergoing ICSI for PGT-A at the blastocyst stage. Methods Retrospective study at a private IVF center. In the period 2013–2021, 58 naïve phenotype-D PCOS women (i.e., oligomenorrhea, ovarian PCO-morphology, and absence of hyperandrogenism) underwent ICSI with ejaculated sperm for PGT-A. These cases were matched to 58 controls selected from 2211 naïve women with idiopathic infertility planned for the same treatment in the same period. The matching variables were age (≈ 36 years), BMI (≈ 22), cumulus oocyte complexes (COCs) retrieved (≈ 21–23), and sperm quality (≈ 43–45% men with all sperm parameters > 5th percentile). The primary outcome was euploid blastocyst rate (EBR) per cohort of inseminated oocytes. Results Maturation rates per COCs and euploidy per biopsied blastocysts were similar. PCOS patients with phenotype-D showed higher fertilization per inseminated oocytes and higher blastulation per zygotes. This resulted into a higher EBR per inseminated oocytes and more euploid blastocysts available for transfer, although these differences adjusted for confounders were not significant. The live birth rate per first euploid transfers was comparable, so were all other outcomes considered. Conclusions Oocyte competence was not compromised in phenotype-D PCOS women, while good prognosis idiopathic infertile women might have unknown oocyte issues. In case of repeated failures after intrauterine insemination, a timely referral to IVF might represent an efficient strategy, in line with the “one-and-done” approach fulfilling a family planning perspective. Indeed, 22% of the phenotype-D PCOS women had 2 singleton LBs and 76% had surplus oocytes/euploid blastocysts after achieving ≥ 1 live birth.