Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-rg895 Total loading time: 0 Render date: 2025-05-05T09:04:54.563Z Has data issue: false hasContentIssue false

12 - In vitro fertilization and the patient with polycystic ovaries or polycystic ovary syndrome

Published online by Cambridge University Press:  29 September 2009

By
Adam H. Balen
Edited by
Gabor T. Kovacs  and
Robert Norman
Adam H. Balen
Affiliation:
Leeds General Infirmary, Leeds
Gabor T. Kovacs
Affiliation:
Monash University, Victoria
Robert Norman
Affiliation:
University of Adelaide
Get access

Summary

Introduction

In vitro fertilization (IVF) is not the first-line treatment for polycystic ovary syndrome (PCOS), but many patients with the syndrome may be referred for IVF, either because there is another reason for their infertility or because they fail to conceive despite ovulating (whether spontaneously or with assistance) – that is their infertility remains unexplained. Furthermore, approximately 30% of women have polycystic ovaries as detected by ultrasound scan. Many will have little in the way of symptoms and may present for assisted conception treatment because of other reasons (for example tubal factor or male factor). When stimulated these women with asymptomatic polycystic ovaries have a tendency to respond sensitively and are at increased risk of developing the ovarian hyperstimulation syndrome (OHSS). An understanding of the management of such patients is therefore important to specialists involved in IVF.

The association of enlarged, sclerocystic ovaries with amenorrhea, infertility, and hirsutism, as described by Stein and Leventhal (1935), is now described as the polycystic ovary syndrome (PCOS). In recent years it has become apparent that polycystic ovaries may be present in women who are not hirsute and who have a regular menstrual cycle. Thus, a clinical spectrum exists between the typical Stein–Leventhal picture (PCOS) and the symptomless women with polycystic ovaries. Even the clinical picture of patients with PCOS exhibits considerable heterogeneity (Balen et al. 1995). This heterogeneous disorder may present, at one end of the spectrum, with the single finding of polycystic ovarian morphology as detected by pelvic ultrasound.

Type
Chapter
Information
Polycystic Ovary Syndrome , pp. 177 - 203
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Adams, J., Polson, D. W., Abdulwahid, N., et al. (1985) Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotrophin releasing hormone. Lancet ii:1375–1378.CrossRefGoogle Scholar
Adams, J., Polson, D. W., and Franks, S. (1986) Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br. Med. J. 293:355–358.CrossRefGoogle ScholarPubMed
Adashi, E. Y., Resnick, C. E., D'Ercole, A. J., Svoboda, M. E., and Wyk, J. J. (1985) Insulin-like growth factors as intraovarian regulators of granulosa cell growth and function. Endocr. Rev. 6:400–420.CrossRefGoogle ScholarPubMed
Agrawal, R., Sladkevicius, P., Engman, L., et al. (1998) Serum vascular endothelial growth factor concentrations and ovarian stromal blood flow are increased in women with polycystic ovaries. Hum. Reprod. 13:651–655.CrossRefGoogle ScholarPubMed
Agrawal, R., Holmes, J., and Jacobs, H. S. (2000) Follicle-stimulating hormone or human menopausal gonadotropin for ovarian stimulation in in vitro fertilization cycles: a meta-analysis. Fertil. Steril. 73:338–343.CrossRefGoogle ScholarPubMed
Ahlgren, M., Kallen, B., and Rannevik, G. (1976) Outcome of pregnancy after clomiphene therapy. Acta Obstet. Gynaecol. Scand. 55:371–375.CrossRefGoogle ScholarPubMed
Al-Inany H. and Aboulghar M. (2002) Gonadotrophin releasing hormone antagonist for assisted conception (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford, UK.
Baird, D. T., Corker, C. S., and Davidson, D. W. (1977) Pituitary–ovarian relationships in polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 45:798–809.CrossRefGoogle ScholarPubMed
Balen, A. H., Tan, S. L., MacDougall, J., and Jacobs, H. S. (1993a) Miscarriage rates following in-vitro fertilization are increased in women with polycystic ovaries and reduced by pituitary desensitization with buserelin. Hum. Reprod. 8:959–964.CrossRefGoogle Scholar
Balen, A. H., Tan, S. L., and Jacobs, H. S. (1993b) Hypersecretion of luteinising hormone: a significant cause of infertility and miscarriage. Br. J. Obstet. Gynaecol. 100:1082–1089.CrossRefGoogle Scholar
Balen, A. H., Braat, D. D. M., West, C., Patel, A., and Jacobs, H. S. (1994) Cumulative conception and live birth rates after the treatment of anovulatory infertility: an analysis of the safety and efficacy of ovulation induction in 200 patients. Hum. Reprod. 9:1563–1570.CrossRefGoogle ScholarPubMed
Balen, A. H., Conway, G. S., Kaltsas, G., et al. (1995) Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum. Reprod. 8:2107–2111.Google Scholar
Balen, A. H., Laven, J. S. E., Tan, S. L., and Dewailly, D. (2003) Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum. Reprod. Update 9:505–514.CrossRefGoogle ScholarPubMed
Bentick, B., Shaw, R. W., Iffland, C. A., Burford, G., and Bernard, A. (1988) A randomized comparative study of purified follicle stimulating hormone and human menopausal gonadotropin after pituitary desensitisation with buserelin for superovulation and in-vitro fertilization. Fertil. Steril. 50:79–84.CrossRefGoogle Scholar
Beral, V., Doyle, P., Tan, S. L., Mason, B. A., and Campbell, S. (1990) Outcome of pregnancies resulting from assisted conception. Br. Med. Bull. 46:753–768.CrossRefGoogle ScholarPubMed
Charbonnel, B., Krempf, M., Blanchard, P., Dano, F., and Delage, C. (1987) Induction of ovulation in polycystic ovary syndrome with a combination of a luteinizing hormone-releasing hormone analog and exogenous gonadotropins. Fertil. Steril. 47:920–924.CrossRefGoogle ScholarPubMed
Chian, R. C., Buckett, W. M., Tulandi, T., and Tan, S. L. (2000) Prospective randomized study of human chorionic gonadotrophin priming before immature oocyte retrieval from unstimulated women with PCOS. Hum. Reprod. 15:165-170.CrossRefGoogle Scholar
Child, T., Abdul-Jalil, A., Gulekli, B., and Tan, S. (2001) In vitro maturation and fertilization of oocytes from unstimulated normal ovaries, polycystic ovaries, and women with polycystic ovary syndrome. Fertil. Steril. 76:936.CrossRefGoogle ScholarPubMed
Child, T., Phillips, S., Abdul-Jalil, A., Gulekli, B., and Tan, S. (2002) A comparison of in vitro maturation and in vitro fertilization for women with polycystic ovaries. Am. J. Obstet. Gynecol. 100:665.Google ScholarPubMed
Clark, A. M., Ledger, W., Galletly, C., et al. (1995) Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum. Reprod. 10:2705–2712.CrossRefGoogle ScholarPubMed
Clayton, R. N., Ogden, V., Hodgekinson, J., et al. (1992) How common are polycystic ovaries in normal women and what is their significance for the fertility of the population?Clin. Endocrinol. (Oxf.) 37:127–134.CrossRefGoogle ScholarPubMed
Coelingh Bennink, H., Fauser, B., and Out, H. (1998) Recombinant FSH (Puregon) is more efficient than urinary FSH (Metrodin) in clomiphene-resistant normogonadotropic chronic anovulatory women: a prospective multicentre, assessor-blend, randomized, clinical trial. Fertil. Steril. 69:19–25.CrossRefGoogle Scholar
Conway, G. S. (1991) Insulin resistance and the polycystic ovary syndrome. Contemp. Rev. Obstet. Gynaecol. 2:34–39.Google Scholar
Couzinet, B., Lestrat, N., Brailly, S., Forest, M., and Schaison, G. (1988) Stimulation of ovarian follicular maturation with pure follicle stimulating hormone in women with gonadotropin deficiency. J. Clin. Endocrinol. Metab. 66:552–556.CrossRefGoogle ScholarPubMed
Dale, P., Tanbo, T., Haug, E., and Abyholm, T. (1998) The impact of insulin resistance on the outcome of ovulation induction with low-dose follicle stimulating hormone in women with polycystic ovary syndrome. Hum. Reprod. 13:567–570.CrossRefGoogle ScholarPubMed
Devroey, P., Tournaye, H., Hendrix, P., and Out, H. (1998) The use of a 100 IU starting dose of recombinant follicle stimulating hormone (Puregon) in in-vitro fertilisation. Hum. Reprod. 13:565–566.CrossRefGoogle Scholar
Diamant, Y. Z., Rimon, E., and Evron, S. (1982) High incidence of pre-eclamptic toxemia in patients with polycystic disease. Eur. J. Obstet. Gynecol. Reprod. Biol. 14:199–204.CrossRefGoogle Scholar
Dor, J., Shulman, A., Levran, D., et al. (1990) The treatment of patients with polycystic ovary syndrome by in-vitro fertilization: a comparison of results with those patients with tubal infertility. Hum. Reprod. 5:816–818.CrossRefGoogle ScholarPubMed
Erickson, G. F., Magoffin, D. A., Dyer, C. A., and Hofeditz, C. (1985) The ovarian androgen producing cells: a review of structure/function relationships. Endocr. Rev. 6:371–399.CrossRefGoogle ScholarPubMed
European and Middle East Orgalutran Study Group (2001) Comparable clinical outcome using the GnRH antagonist ganirelix or a long protocol of the GnRH agonist triptorelin for the prevention of premature LH surges in women undergoing ovarian stimulation. Hum. Reprod. 16:644–651.
European Orgalutran Study Group, Borm G., and Mannaerts B. (2000) Treatment with the gonadotrophin-releasing hormone antagonist ganirelix in women undergoing controlled ovarian hyperstimulation with recombinant follicle stimulating hormone is effective, safe and convenient: results of a controlled, randomized, multicentre trial. Hum. Reprod. 15:1490–1498.
European Recombinant LH Study Group (2001) Recombinant human LH is as effective as, but safer than, urinary human chorionic gonadotrophin in inducing final follicular maturation and ovulation in in vitro fertilisation: results of a multicentre double-blind study. J. Clin. Endocrinol. Metab. 86:2607.
Farquhar, C. M., Birdsall, M., Manning, P., and Mitchell, J. M. (1994) Transabdominal versus transvaginal ultrasound in the diagnosis of polycystic ovaries on ultrasound scanning in a population of randomly selected women. Ultrasound Obstet. Gynecol. 4:54–59.CrossRefGoogle Scholar
Fauser, B., Jong, D., Olivennes, F., et al. (2002) Endocrine profile after triggering of final oocytes maturation with GnRH agonist after co-treatment with the GnRH antagonist ganirelix during ovarian hyperstimulation for IVF. J. Clin. Endocrinol. Metab. 87:709–715.CrossRefGoogle Scholar
Fedorcsak, P., Dale, P., Storeng, R., Tanbo, T., and Abyholm, T. (2001) The impact of obesity and insulin resistance on the outcome of IVF or ICSI in women with polycystic ovarian syndrome. Hum. Reprod. 16:1086–1091.CrossRefGoogle ScholarPubMed
Ferrara, N., Chen, H., Davis-Smyth, T., et al. (1998) Vascular endothelial growth factor is essential for corpus luteum angiogenesis. Nat. Med. 4:336–340.CrossRefGoogle ScholarPubMed
Fleming, R. and Coutts, J. R. T. (1988) Luteinising hormone releasing hormone analogues for ovulation induction, with particular reference to polycystic ovary syndrome. Baillière's Clin. Obstet. Gynaecol. 2:677–688.CrossRefGoogle ScholarPubMed
Fleming, R. and Coutts, J. R. T. (1990) Induction of multiple follicular development for in-vitro fertilisation. Br. Med. Bull. 46:596–615.CrossRefGoogle Scholar
Fleming, R., Haxton, M. J., Hamilton, M. P. R., et al. (1985) Successful treatment of infertile women with oligomenorrhoea using a combination of a luteinising hormone releasing hormone agonist and exogenous gonadotrophins. Br. J. Obstet. Gynaecol. 92:369–374.CrossRefGoogle ScholarPubMed
Fox, R. and Wardle, P. G. (1990) Maturity onset diabetes mellitus in association with polycystic ovarian disease. J. Obstet. Gynaecol. 10:555–556.CrossRefGoogle Scholar
Franks, S. (1989) Polycystic ovary syndrome: a changing perspective. Clin. Endocrinol. (Oxf.) 31:87–120.CrossRefGoogle ScholarPubMed
Franks, S., Adams, J., Mason, H., and Polson, D. (1985) Ovulatory disorders in women with polycystic ovary syndrome. Clin. Obstet. Gynaecol. 12:605–632.Google ScholarPubMed
Franks, S., Ghasani, N., Waterworth, D., et al. (1997) The genetic basis of polycystic ovary syndrome. Hum. Reprod. 12:2641–2648.CrossRefGoogle ScholarPubMed
Friedman, C. I., Schmidt, G. E., Chang, F. E., and Kim, M. H. (1984) Severe ovarian hyperstimulation following follicular aspiration. Am. J. Obstet. Gynecol. 150:436–437.CrossRefGoogle ScholarPubMed
Frydman, R., Belaisch-Allart, J., Parneix, I., et al. (1988) Comparison between flare up and down regulation of luteinizing hormone releasing hormone agonists in an in-vitro fertilization program. Fertil. Steril. 50:471–475.CrossRefGoogle Scholar
Fulghesu, A. M., Ciampelli, M., Belosi, C., et al. (2001) A new ultrasound criterion for the diagnosis of polycystic ovary syndrome: the ovarian stroma/total area ratio. Fertil. Steril. 76:326–331.CrossRefGoogle Scholar
Gemzell, C. A., Kemman, E., and Jones, J. R. (1978) Premature ovulation during administration of human menopausal gonadotrophins in non-ovulatory women. Infertility 1:1–10.Google Scholar
Gjoanness, H. (1989) The course and outcome of pregnancy after ovarian electrocautery in women with polycystic ovarian syndrome: the influence of body weight. Br. J. Obstet. Gynaecol. 96:714–719.CrossRefGoogle Scholar
Golan, A., Ron-el, R., Herman, A., et al. (1989) Ovarian hyperstimulation syndrome: an update review. Obstet. Gynecol. Surv. 44:430–435.CrossRefGoogle Scholar
Goldzieher, J. W., and Green, J. A. (1962) The polycystic ovary. I. Clinical and histological features. J. Clin. Endocrinol. Metab. 22:325–338.CrossRefGoogle Scholar
Homburg, R. (1996) Polycystic ovary syndrome: from gynecological curiosity to multisystem endocrinopathy. Hum. Reprod. 11:29–39.CrossRefGoogle Scholar
Homburg, R., Armar, N. A., Eshel, A., Adams, J., and Jacobs, H. S. (1988) Influence of serum luteinising hormone concentrations on ovulation, conception and early pregnancy loss in polycystic ovary syndrome. Br. Med. J. 297:1024–1026.CrossRefGoogle ScholarPubMed
Homburg, R., Berkowitz, D., Levy, T., et al. (1993a) In-vitro fertilization and embryo transfer for the treatment of infertility associated with polycystic ovary syndrome. Fertil. Steril. 60:858–863.CrossRefGoogle Scholar
Homburg, R., Levy, T., Berkovitz, D., et al. (1993b) Gonadotropin releasing hormone agonist reduces the miscarriage rate for pregnancies achieved in women with polycystic ovaries. Fertil. Steril. 59:527–531.CrossRefGoogle Scholar
Insler, V. and Lunenfeld, B. (1991) Pathophysiology of polycystic ovarian disease: new insights. Hum. Reprod. 6:1025–1029.CrossRefGoogle ScholarPubMed
, Itskovitz-Eldor J., Kol, S., and Mannaerts, B. (2000) Use of a single bolus of GnRH agonist triptorelin to trigger ovulation after GnRH antagonist ganirelix treatment in women undergoing ovarian stimulation for assisted reproduction, with special reference to the prevention of OHSS: preliminary report. Hum. Reprod. 15:1965–1968.Google Scholar
Jacobs H. S., Porter R., Eshel A., and Craft I. (1987) Profertility uses of luteinising hormone releasing hormone agonist analogues. In Vickery, B. H. and Nestor, J. J. (eds.) LHRH and its Analogs, pp.303–322. Lancaster, PA: MTP Press.CrossRefGoogle Scholar
Jones, G. S., Garcia, J. E., and Rosenwaks, Z. (1984) The role of pituitary gonadotropins in follicular stimulation and oocyte maturation in the human. J. Clin. Endocrinol. Metab. 59:178–183.CrossRefGoogle ScholarPubMed
Kamat, B. R., Brown, L. F., and Manseau, E. J. (1995) Expression of vascular endothelial growth factor vascular permeability factor by human granulosa and theca lutein cells: role in corpus luteum development. Am. J. Pathol. 146:157–165.Google ScholarPubMed
Kiddy, D. S., Hamilton-Fairley, D., Bush, A., et al. (1992) Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 36:105–111.CrossRefGoogle ScholarPubMed
Kocak, M., Caliskan, E., Simsir, C., and Haberal, A. (2002) Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome. Fertil. Steril. 77:101.CrossRefGoogle ScholarPubMed
Kodama, H., Fakuda, J., Karube, H., et al. (1995) High incidence of embryo transfer cancellations in patients with polycystic ovarian syndrome. Hum. Reprod. 10:1962–1967.Google ScholarPubMed
Kyei-Mensah, A. A., Lin Tan, S., Zaidi, J., and Jacobs, H. S. (1998) Relationship of ovarian stromal volume to serum androgen concentrations in patients with polycystic ovary syndrome. Hum. Reprod. 13:1437–1441.CrossRefGoogle ScholarPubMed
Larsen, T. (1990) Comparison of urinary human follicle stimulating hormone and HMG for ovarian stimulation in polycystic ovary syndrome. Fertil. Steril. 53:426CrossRefGoogle Scholar
Lord, J. M., Flight, I. H. K., and Norman, R. J. (2003) Metformin in polycystic ovary syndrome: systematic review and meta-analysis. Br. Med. J. 327:951–955.CrossRefGoogle ScholarPubMed
MacDougall, M. J., Tan, S. L., and Jacobs, H. S. (1992) In-vitro fertilization and the ovarian hyperstimulation syndrome. Hum. Reprod. 7:597–600.CrossRefGoogle ScholarPubMed
MacDougall, J. M., Tan, S. L., Balen, A. H., and Jacobs, H. S. (1993) A controlled study comparing patients with and without polycystic ovaries undergoing in-vitro fertilization and the ovarian hyperstimulation syndrome. Hum. Reprod. 8:233–237.CrossRefGoogle Scholar
Marci, R., Senn, A., Dessole, S., Chanson, A., and Loumaye, E. (2001) A low-dose stimulation protocol using highly purified follicle-stimulating hormone can lead to high pregnancy rates in in vitro fertilization patients with polycystic ovaries who are at risk of a high ovarian response to gonadotrophins. Fertil. Steril. 75:1131.CrossRefGoogle Scholar
Medical Research Council (1990) Births in Great Britain resulting from assisted conception, 1978–87. Br. Med. J. 330:1229–1233.
Messinis, I. E., Templeton, A. A., and Baird, D. T. (1986) Comparison between clomiphene plus human menopausal gonadotropin and clomiphene plus pulsatile follicle stimulating hormone in induction of multiple follicular development in women. Hum. Reprod. 4:223–226.CrossRefGoogle Scholar
Michelmore, K. F., Balen, A. H., Dunger, D. B., and Vessey, M. P. (1999) Polycystic ovaries and associated clinical and biochemical features in young women. Clin. Endocrinol. (Oxf.) 51:779–786.CrossRefGoogle ScholarPubMed
Nestler, J., Jakubowicz, D., Evans, W., and Pasquali, R. (1998) Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N. Engl. J. Med. 338:1876–1880.CrossRefGoogle ScholarPubMed
North American Ganirelix Study Group (2001) Efficacy and safety of ganirelix acetate versus leuprolide acetate in women undergoing controlled ovarian hyperstimulation. Fertil. Steril. 75:35–45.
Olivennes, F., Taieb, J., Frydman, R., and Bouchard, P. (1996) Triggering of ovulation by a gonadotrophin releasing hormone agonist in patients pretreated with a GnRH antagonist. Fertil. Steril. 66:151–153.CrossRefGoogle ScholarPubMed
Out, H., Mannaerts, B., Driessen, S., and Coelingh Bennink, H. (1995) A prospective, assessor-blinded, multicentre study comparing recombinant and urinary follicle stimulating hormone (Puregon vs. Metrodin) in in-vitro fertilisation. Hum. Reprod. 10:2534–2540.CrossRefGoogle Scholar
Owen, E. J., Shoham, Z., Mason, B. A., Ostergaard, H., and Jacobs, H. S. (1991) Cotreatment with growth hormone after pituitary suppression for ovarian stimulation in IVF: a randomized double-blind placebo-control trial. Fertil. Steril. 56:1104–1110.CrossRefGoogle ScholarPubMed
Polson, D. W., Wadsworth, J., Adams, J., and Franks, S. (1988) Polycystic ovaries: a common finding in normal women. Lancet ii:870–872.CrossRefGoogle Scholar
Regan, L., Owen, E. J., and Jacobs, H. S. (1990) Hypersecretion of luteinising hormone, infertility and miscarriage. Lancet 336:1141–1144.CrossRefGoogle ScholarPubMed
Sagle, M., Bishop, K., Alexander, F. M., et al. (1988) Recurrent early miscarriage and polycystic ovaries. Br. Med. J. 297:1027–1028.CrossRefGoogle ScholarPubMed
Salat-Baroux, J. and Antoine, J. M. (1990) Accidental hyperstimulation during ovulation induction. Baillière's Clin. Obstet. Gynaecol. 4:627–637.CrossRefGoogle ScholarPubMed
Salat-Baroux, J., Alvarez, S., Antoine, J. M., et al. (1988a) Results of in-vitro fertilization in the treatment of polycystic ovary disease. Hum. Reprod. 3:331–335.CrossRefGoogle Scholar
Salat-Baroux, J., Alvarez, S., Antoine, J. M., et al. (1988b) Comparison between long and short protocols of luteinising hormone releasing hormone agonist in the treatment of PCOD by in-vitro fertilization. Hum. Reprod. 3:535–539.CrossRefGoogle Scholar
Saxton, D. W., Farquhar, C. M., Rae, T., et al. (1990) Accuracy of ultrasound measurements of female pelvic organs. Br. J. Obstet. Gynaecol. 97:695–699.CrossRefGoogle ScholarPubMed
Schenker, J. G. and Weinstein, D. (1978) Ovarian hyperstimulation syndrome: a current survey. Fertil. Steril. 30:255Google ScholarPubMed
Sharma, V., Riddle, A., Mason, B. A., Pampiglione, J., and Campbell, S. (1988) An analysis of factors influencing the establishment of a clinical pregnancy in an ultrasound-based ambulatory in-vitro fertilization program. Fertil. Steril. 49:468–478.CrossRefGoogle Scholar
Shoham, Z., Borenstein, R., Lunenfeld, B., and Pariente, C. (1990) Hormonal profiles following clomiphene citrate therapy in conception and nonconception cycles. Clin. Endocrinol. (Oxf.) 33:271–278.Google ScholarPubMed
Shoham, Z., Balen, A. H., Patel, A., and Jacobs, H. S. (1991) Results of ovulation induction using hMG or purified FSH in hypogonadotropic hypogonadism patients. Fertil. Steril. 56:1048–1053.CrossRefGoogle ScholarPubMed
Smitz, J., Camus, M., Devroey, P., et al. (1991) Incidence of severe ovarian hyperstimulation syndrome after gonadotropin releasing hormone agonist/HMG superovulation for in-vitro fertilization. Hum. Reprod. 6:933–950.Google Scholar
Stadtmauer, L., Toma, S., Riehl, R., and Talbert, L. (2001) Metformin treatment of patients with polycystic ovary syndrome undergoing in vitro fertilization improves outcomes and is associated with modulation of the insulin-like growth factors. Fertil. Steril. 75:505.CrossRefGoogle ScholarPubMed
Stanger, J. D. and Yovich, J. L. (1985) Reduced in-vitro fertilisation of human oocyte from patients with raised basal luteinising hormone levels during the follicular phase. Br. J. Obstet. Gynaecol. 92:385–393.CrossRefGoogle ScholarPubMed
Stein, I. F. and Leventhal, M. L. (1935) Amenorrhea associated with bilateral polycystic ovaries. Am. J. Obstet. Gynecol. 29:181–191.CrossRefGoogle Scholar
Takahashi, K., Eda, Y., Okada, S., et al. (1993) Morphological assessment of polycystic ovaries using transvaginal ultrasound. Hum. Reprod. 6:844–849.CrossRefGoogle Scholar
Tan, S. L., Balen, A. H., Hussein, E. H., et al. (1992) A prospective randomized study of the optimum timing of human chorionic gonadotropin administration after pituitary desensitization in vitro fertilization. Fertil. Steril. 157:1259–1264.CrossRefGoogle Scholar
Tanbo, T., Dale, P. O., Kjekshus, E., Haug, E., and Abyholm, T. (1990) Stimulation with HMG versus follicle stimulating hormone after pituitary suppression in polycystic ovary syndrome. Fertil. Steril. 53:798–803.CrossRefGoogle Scholar
Teissier, M., Chable, H., Paulhac, S., and Aubard, Y. (1999) Recombinant human follicle stimulating hormone versus human menopausal gonadotrophin induction: effects in mature follicle endocrinology. Hum. Reprod. 14:2236–2241.CrossRefGoogle ScholarPubMed
Teissier, M., Chable, H., Paulhac, S., and Aubard, Y. (2000) Comparison of follicle steroidogenesis from normal and polycystic ovaries in women undergoing IVF: relationship between steroid concentrations, follicle size, oocyte quality and fecundability. Hum. Reprod. 15:2471–2477.CrossRefGoogle ScholarPubMed
The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum. Reprod. 19:41–47.
Thomas, A., Okamoto, S., O'Shea, F., et al. (1989) Do raised serum luteinising hormone levels during stimulation for in-vitro fertilisation predict outcome?Br. J. Obstet. Gynaecol. 96:1328–1332.CrossRefGoogle ScholarPubMed
Trounson, A., Wood, C., and Kausche, A. (1994) In vitro maturation and the fertilisation and development competence of oocytes recovered from untreated polycystic ovarian patients. Fertil. Steril. 62:353–361.CrossRefGoogle ScholarPubMed
Vandermolen, D., Ratts, V., Evans, W., Stovall, D., and Kauma, S. (2001) Metformin increases the ovulatory rate and pregnancy rate from clomiphene citrate in patients with polycystic ovary syndrome who are resistant to clomiphene citrate alone. Fertil. Steril. 75:310.CrossRefGoogle ScholarPubMed
Wass, P. and Rossner, S. (1997) An android body fat distribution in women impairs the pregnancy rates of in vitro fertilisation and embryo transfer. Hum. Reprod. 12:2057–2060.CrossRefGoogle Scholar
Zaidi, J., Campbell, S., Pittrof, R., et al. (1995) Ovarian stromal blood flow in women with polycystic ovaries: a possible new marker for diagnosis. Hum. Reprod. 10:1992–1996.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×