Outcomes of subsequent IVF cycles among women with PCOS after the first unstimulated IVM treatment: a single-center matched retrospective case-control study

Objective: In-vitro maturation (IVM) is an advanced technique and an alternative to conventional in-vitro fertilization (IVF). It is safe, effective, and cost-effective in patients with polycystic ovary syndrome (PCOS). However, no clinical guidelines state that IVM could work without compromised pregnancy outcomes in patients with PCOS. The purpose of this study was to identify whether previous unstimulated IVM improved the clinical outcomes of women with PCOS in the subsequent IVF cycle. Methods: In this matched retrospective case-control study, we compared the results of IVF treatment in two groups of women with PCOS between January 2008 and December 2017. The study group comprised 79 women who underwent a subsequent IVF treatment after IVM failure (IVM-IVF group). Considering the year, age, and BMI, a 1:3 matched control group of 237 women with PCOS who received their first IVF cycle was established (IVF group). Results: Compared with the IVF group, the IVM-IVF group had a significantly lower initial gonadotropin dose [112.5 IU (112.5-150 IU) vs. 150 IU (150-200 IU), p < 0.001] and total gonadotropin dose [1350 IU (1125-2162.5 IU) vs. 1875 IU (1425.00-2643.75 IU), p < 0.001]. The live birth rate, clinical pregnancy, and miscarriage rates were comparable between the IVM-IVF and IVF groups at 12 months [55.6% vs. 48.6%, (adjusted p = 0.923), 68.1% vs. 59% (adjusted p = 0.677), and 18.8% vs. 17.7% (adjusted p = 0.645), respectively] and the first transfer cycle [36.1% vs. 34.2% (adjusted p = 0.560), 55.6% vs. 41.9% (adjusted p = 0.177), and 35% vs. 18.3% (adjusted p = 0.396), respectively]. The occurrence of moderate/severe OHSS did not significantly differ between the groups [5.1% vs. 7.6% (adjusted p = 0.698)]. Notably, LH levels, the LH/FSH ratio, and androstenedione levels were significantly reduced in the IVM-IVF group after the IVM treatment. Conclusion: Alternatives to IVF are underappreciated in clinical practice and research because of the lack of evidence on the efficacy of IVM in certain populations. IVF treatment given during a follow-up visit after an unstimulated IVM can achieve pregnancy outcomes comparable to those of a first IVF cycle without adversely affecting the subsequent pregnancy outcome.