South Asian women with polycystic ovary syndrome exhibit greater sensitivity to gonadotropin stimulation with reduced fertilization and ongoing pregnancy rates than their Caucasian counterparts

• Published in: European journal of obstetrics & gynecology and reproductive biology 2007-10, Vol.134 (2), p.202-207
• Main Authors: Palep-Singh, M, Picton, H.M, Vrotsou, K, Maruthini, D, Balen, A.H
• Format: Article
• Language: English
• Subjects: Adult; Asian Continental Ancestry Group; Biological and medical sciences; Caucasians; Dose-Response Relationship, Drug; Drug Therapy, Combination; European Continental Ancestry Group; Female; Female genital diseases; Gonadotropins; Gonadotropins - administration & dosage; Gynecology. Andrology. Obstetrics; Humans; ICSI; Infertility, Female - drug therapy; Infertility, Female - ethnology; Infertility, Female - etiology; IVF; Medical sciences; Non tumoral diseases; Obstetrics and Gynecology; Ovulation Induction - methods; Polycystic ovary syndrome (PCOS); Polycystic Ovary Syndrome - complications; Polycystic Ovary Syndrome - ethnology; Pregnancy; Pregnancy Outcome - ethnology; Pregnancy Rate - ethnology; South Asians; Sperm Injections, Intracytoplasmic; United Kingdom
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2007.02.005

Abstract Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome. In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) is required for PCOS cases that are refractory to standard ovulation induction or have co-existing infertility factors in women with PCOS and Tubal factor subfertility. Objectives Assess ethnic variations in response to IVF/ICSI treatment. Study design Observational Comparative study in a University hospital fertility clinic in women with PCOS and Tubal factor subfertility. Women with PCOS (Asians: AP = 104; Caucasians: CP = 220) and those with tubal factor infertility seeking fertility treatment were assessed (Asians: AC = 84; Caucasians: CC = 200). Six hundred and eight fresh IVF or ICSI cycles using long protocol of GnRHa suppression and resulting in a fresh embryo transfer were compared. The primary endpoint was to assess the dose of gonadotropins used in the cycles. The secondary outcomes were: total number of oocytes retrieved, fertilization and ongoing clinical pregnancy rates. Results We found that the South Asian women presented at a younger age for the management of sub-fertility. An extended stimulation phase and Caucasian ethnicity showed an inverse correlation with the number of oocytes retrieved in the PCOS subgroup. Caucasian ethnicity was associated with a higher fertilization rate however increase in body mass index (BMI) and the laboratory technique of IVF appeared to have a negative impact on fertilization rates in the PCOS subgroup. Commencing down regulation on day 1 of the cycles was negatively associated with fertilization rates in the tubal group. In terms of clinical pregnancy rates, the Caucasian PCOS had a 2.5 times (95% CI: 1.25–5) higher chance of an ongoing clinical pregnancy as compared with their Asian counterpart. Also, a unit increase in the basal FSH concentration reduced the odds of pregnancy by 18.6% (95% CI: 1.8–32.6%) in the PCOS group. Conclusions The Asian PCOS have a greater sensitivity to gonadotropin stimulation with lower fertilization and ongoing clinical pregnancy rates as compared with their Caucasian counterparts.