Ovarian Cyst Formation Following Gonadotropin-Releasing Hormone-Agonist Administration Decreases the Oocyte Quality in IVF Cycles

Abstract

Objective: The gonadotropin-releasing hormone-agonist (GnRH-a) treatment during in vitro fertilization (IVF) sometimes causes a functional ovarian cyst during the administration period before gonadotropin stimulation, as an undesired event. The aim of this study was to analyze the effect of these cysts on the IVF outcomes. Materials and Methods: Out of 981 IVF cycles, 78 with ovarian cysts were retrospectively analyzed with respect to the demographic characteristics, hormonal outcomes, and fertilization, implantation and clinical pregnancy rates. Results: The metaphase II oocyte ratio, fertilization rate and percentage of high quality embryos (grade 1) were significantly higher in the cyst-negative group (p<0.0001; p<0.0001; p≤0.05). These same three parameters were also significantly higher in the cyst-aspirated group (p<0.01; p<0.05; p<0.05). Cyst diameters of the aspiration group were significantly higher (p<0.05). No statistically significant differences in implantation and clinical pregnancy rates were determined between the groups. Conclusion: An ovarian cyst formation during the GnRH-a suppression period negatively affects oocyte quality. Cyst aspiration before gonadotropin stimulation does not improve the IVF outcome. Turkish Başlık: IVF Sikluslarında GnRH Agonist Tedavisi Sonrası Oluşan Over Kistleri Oosit Kalitesini Düşürür Anahtar Kelimeler: Over kisti,IVF,GnRH agonisti Amaç: In vitro fertilizasyon (IVF) sürecinde, kontrollü ovaryen stimülasyon öncesinde kullanılan gonadotropin-releasing hormone-agonist (GnRH-a) tedavisi, zaman zaman, istenmeyen bir etki olarak, ovaryen kist oluşumuna neden olabilir. Bu çalışmamızda, GnRH-a oluşan bu kistlerin, IVF sonuçlarına etkisini araştırdık. Gereç ve Yöntemler: Toplam 931 IVF siklusu içinde, GnRH-a sonrası kistespit edilen 78 hasta, demografik özellikler, hormonal sonuçlar, fertilizasyon, implantasyon ve gebelik hızları açısından, retrospektif olarak analiz edilidi. Bulgular: Metafaz II oosit oranı, fertilizasyon hızı ve yüksek kalitedeki embiryo yüzdesi, kist olmayan hasta grubunda, anlamlı olarak daha yüksek tespit edildi (p<0.0001; p<0.0001; p≤0.05). Ayrıca, bu üç parametre, kist aspirasyonu yapılan grupta, aspirasyon işlemi yapılmayan gruba oranla, anlamlı olarak daha yüksek belirlendi (p<0.01; p<0.05; p<0.05). Kist çapı, aspirasyon yapılan grupta, anlamlı olarak daha yüksekti (p<0.05). İmplantasyon ve klinik gebelik hızları açısından, gruplar arasında herhangi bir fark tespit edilemedi. Sonuç: GnRH-a süpresyon periyodu sonrası oluşan ovaryen kistler, oosit kalitesini kötü yönde etkileyebilir. Gonadotropin stimülasyonu öncesi kistin aspire edilmesinin, IVF başarısına bir katkı sağlamaz.

Keywords

• Ovarian cyst, in vitro fertilization (IVF), gonadotropin-releasing hormone agonist

Ovarian Cyst Formation Following Gonadotropin-Releasing Hormone-Agonist Administration Decreases the Oocyte Quality in IVF Cycles

Abstract

References

1. Fiszbajn GE, Lipowicz RB, Elberger L, Grabia A, Papier SD, Olmedo SBP, et al. Conservative management versus aspiration of functional ovarian cysts before ovarian stimulation for assisted reproduction. J Assist Reprod Genet 2000;17:260-3.
2. Feldberg D, Goldman J, Ashkenazi J, Shelef M, Dicker D, Hart J. Ovarian cyst aspiration during induction of ovulation for IVF. Hum Reprod 1987;2:115.
3. Segal S, Schifren JL, Isaacson KB, Leykin L, Chang Y, Pal L, et al. Effects of a baseline ovarian cyst on the outcomes of in vitro fertilization-embryo transfer. Fertil Steril. 1999;71:274-7.
4. Qublan HS, Amarin Z, Tahat YA, Smadi AZ, Kilani M. Ovarian cyst formation following GnRH agonist administration in IVF cycles: incidence and impact. Hum Reprod 2006;21:640-4.
5. Feldberg D, Ashkenazi J, Dicker D, Yeshaya A, Goldman GA, Goldman JA. Ovarian cyst formation: a complication of gonadotropinreleasing hormone agonist therapy. Fertil Steril 1989;51:42-5.
6. Herman A, Ron-El R, Golan A, Nahum H, Soffer Y, Caspi E. Follicle cysts after menstrual versus midluteal administration of gonadotropin-releasing hormone analog in in vitro fertilization. Fertil Steril 1990;53:854-8.
7. Jenkins JM, Davies DW, Anthony F, Wood P, Gadd SG, Watson RH, et al. The detrimental influence of functional ovarian cysts during in-vitro fertilization cycles. Hum Reprod 1992;7:776-80.
8. Ron-El R, Herman A, Golan A, Raziel A, Soffer Y, Caspi E. Follicle cyst formation following long acting gonadotropin-releasing hormone analog administration. Fertil Steril 1989;52:1063-6.

9. Tarlatzis BC, Bili H, Bontis J, Lagos S, Vatev I, Mantalenakis S. Follicle cyst formation after administration of different gonadotropinreleasing hormone analogues for assisted reproduction. Hum Reprod 1994;9:1983-6.
10. Biljan MM, Lapensee L, Mahutte NG, Bissonnette F, Hemmings R, Tan SL. Effects of functional ovarian cysts detected on the 7th day of gonadotropin-releasing hormone analog administration on the outcome of IVF treatment. Fertil Steril 2000;74:941-5.
11. Hornstein MD, Barbieri RL, Ravnikar VA, McShane PM. The effects of baseline ovarian cysts on the clinical response to controlled ovarian hyperstimulation in an in vitro fertilization program. Fertil Steril 1989;52:437-40.
12. Keltz MD, Jones EE, Duleba AJ. Baseline cyst formation after luteal phase gonadotropin releasing hormone agonist administration is linked to poor in vitro fertilization outcome. Fertil Steril 1995;64:568-72.
13. Thatcher SS, Jones E, DeCharney AH. Ovarian cysts decrease the success of controlled ovarian stimulation and in vitro fertilization. Fertil Steril 1989;52:812-6.
14. Firouzabadi RD, Sekhavat L, Javedani M. The effect of ovarian cyst aspiration on IVF treatment with GnRH. Arch Gynecol Obstet 2010;281:545-9.
15. Levi R, Özçakir HT, Adakan S, Göker TEN, Tavmergen E. Effect of ovarian cysts detected on the beginning day of ovulation induction to the success rates in ART cycles. J Obstet Gynecol Res 2003;29:257-61.
16. Kumbak B, Kahraman S. Management of prestimulation ovarian cysts during assisted reproductive treatments: impact of aspiration on the outcome. Arch Gynecol Obstet 2009;279:875-80.