A Meta-Analysis of Oocyte Quality and Clinical Outcome of Intracytoplasmic Sperm Injection Cycles in Patients with Polycystic Ovary Syndrome

Whether treatment outcomes in intracytoplasmic sperm injection (ICSI) cycles differ between polycystic ovary syndrome (PCOS) and non-PCOS patients remains inconclusive. The aim of this meta-analysis is to compare oocyte quality and clinical outcomes in PCOS patients and non-PCOS patients undergoing ICSI procedure. Methods: Databases including Medline, Embase and the Cochrane Library were searched for studies published up to 18 January 2018. All articles searched were independently reviewed and selected by two evaluators according to predetermined inclusion and exclusion criteria. Results: Eight studies were selected for inclusion, and a total of 474 PCOS patients (627 cycles) were compared to age-matched controls (962 patients, 992 cycles). The total gonadotropin usage was significant less in PCOS group, and the MD was -481.72 IU [95% CI: -603.76-359.68, P < 0.00001]. A significantly higher mean number of oocytes, metaphase II (MII) oocytes and 2-pronucleated (2PN) oocytes per cycle were observed in the PCOS group than in the non-PCOS group (P < 0.005), the total MDs were 4.20 [95% CI: 2.50-5.90], 1.52 [95% CI: 0.84-2.20] and 1.71 [95% CI: 0.73-2.69], respectively. The fertilization rate was comparable. The clinical pregnancy rate per transfer cycle was higher in the PCOS group, the odd ratio (OR) was 1.59 [95% CI: 1.23-2.05, P < 0.005] and the live birth rate was comparable. A higher miscarriage rate was observed in the PCOS group, but this did not reach statistical significance. The risk of ovarian hyperstimulation syndrome (OHSS) was significantly higher in the PCOS group [OR: 3.01, 95% CI: 1.16-7.82, P < 0.05]. Conclusions: This meta-analysis demonstrated that PCOS patients may have more favourable ICSI outcomes than non-PCOS patients. Our findings should be evaluated in further prospective cohort studies.