الفهرس 
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Abstract
This prospective and retrospective study was done in three parts:
Part 1: Fresh versus Frozen-Thawed Embryo Transfer (ET) in Women with PCOS Undergoing Autologous IVF Cycles
The aim of this part of the study to compare between the fresh and frozen-thawed ET in the women with PCOS in terms of IVF outcomes.
It is a retrospective and prospective study. All the women underwent IVF cycles in a private university center during the years 2010 through 2015 were examined. We included women with PCOS under the age of 40 years who underwent autologous fresh or frozen-thawed ET. Cleavage stage embryos (day 2 or 3) were only included in the analysis. Cycles were divided into 2 groups: Fresh ET and Frozen-thawed ET. The main outcome measures were clinical pregnancy rate, live birth rate and abortion rate. SAS was used for statistical analysis. Statistical analysis tests included chi square and student t test.
121 cycles were included in the study, 62 fresh ET cycles and 59 frozen- thawed ET cycles. Both groups were comparable in terms of age, basal follicular stimulating hormone (FSH), Antimullarian hormone (AMH) and antral follicle count (AFC). We recorded significant increased estradiol level just before ET in fresh ET cycles. The fresh ET cycles showed significant increase in clinical pregnancy rate and live birth rate. The miscarriage rate was lower in the fresh ET cycles.
Our study suggests that wise tailored COH in the prospective high responders such as PCOS results in optimized E2 levels which can be associated with better endometrial receptivity in IVF cycles.
Part 2: IVF versus ICSI for Couples with PCOS and Normozoospermic Semen: An Analysis of 4679 Cycles from SART
The objective of this study was to determine whether patients with PCOS have better pregnancy outcomes following ICSI versus IVF.
Data from the 2011-2012 SART registry was were analyzed. First fresh autologous cycles in women under 40 with the diagnosis of PCOS were included in the study. All other diagnostic indications for IVF were excluded from this study including male factor.
Groups were further stratified based on the insemination technique: conventional IVF or ICSI. Cycles using split IVF/ICSI were excluded. Cycles were divided into two groups: cleavage stage embryo transfer (ET) and blastocyst stage ET. Main outcomes measured were the number of two pronuclear (2PN) embryos, LBR, and miscarriage rate. Secondary outcomes included implantation rate (IR), CPR and the percentage of cycles that did not result in 2PN embryos. Data were analyzed using two-sided Welch’s t-test.
2217 cycles reported use of conventional IVF and 2462 cycles reported use of ICSI. In the IVF group, the number of 2 PN oocytes, CPR, and LBR were statistically higher in both cleavage stage and blastocyst stage transfer cycles compared to the ICSI group. Miscarriage rate was lower in patients undergoing ICSI with blastocyst ET but higher in those with cleavage ET compared to the IVF group. The percentage of cycles with no 2PN oocytes was statistically lower in the ICSI group with blastocyst ET only (Table). Although statistical significance was found between these two groups, the differences were not clinically significant.
Contrary to previous studies, ICSI does not offer an advantage over conventional IVF in terms of number of oocytes fertilized, CPR, or LBR.
Part 3: Impact of Metformin on in vitro fertilization (IVF) Outcomes in Overweight and Obese Women with Polycystic Ovary Syndrome (PCOS)
The aim of this study was to determine if metformin therapy improves in vitro fertilization (IVF) outcomes in overweight and obese polycystic ovarian syndrome (PCOS) subjects.
This is a prospective non randomized and retrospective study that took place in a University IVF Center in association with Duke Fertility Center. The study included 102 overweight and obese women (BMI>24) with PCOS underwent their first fresh autologous IVF-embryo transfer cycle with intracytoplasmic sperm injection (ICSI). We divided the study population into two groups according to the administration of metformin before the start of the IVF cycle treatment (51 patients were randomly assigned to each group). The metformin-treated group received metformin (1000 to 1500 mg per day) with the start of controlled ovarian stimulation (COH) and continued to be discontinued on the day of the pregnancy check, and if the test was positive, the patient was instructed to keep having the study medicine till the end of first 12 weeks of gestation. The primary outcome measures were the total number of retrieved oocytes, the total number of the fertilized oocytes (two pn oocytes), fertilization rate, implantation rate, pregnancy and miscarriage rates.
Metformin-treated group versus the non-metformin-treated group demonstrated a significant decrease in the mean number of the retrieved oocytes and the 2pn oocytes (p < 0.01). We did not find a significant difference between the two comparable groups regarding the fertilization rate, implantation rate, multiple pregnancy rates, miscarriage rate or life birth rate. We did not record any case of ovarian hyperstimulation syndrome (OHSS) in both groups. Also, we did not record any fetal malformation in both groups.
The prospective hyperresponder overweight and obese PCOS subjects will not benefit from short-term Metformin administration regarding the IVF outcomes.