In vitro fertilization (IVF) is an important treatment option for infertility in patients with polycystic ovary syndrome (PCOS). However, women with PCOS are at higher risk of adverse pregnancy outcomes and complications such as ovarian hyperstimulation syndrome (OHSS), gestational diabetes mellitus (GDM), and preterm birth. Factors influencing pregnancy outcome in patients with PCOS are still unclear and require further study.

OBJECTIVE

To identify features of the course of pregnancy and perinatal outcomes in patients with PCOS after transfer of thawed embryos in a cycle of hormone replacement therapy, depending on the type of gestagen.

MATERIAL AND METHODS

A retrospective study was conducted that included 105 patients who gave birth at 37—42 weeks of pregnancy, who became pregnant after transfer of cryopreserved embryos in ART programs. Inclusion criteria for patients: age from 20 to 45 years; anovulatory infertility (N97.0); presence of PCOS in accordance with the Rotterdam criteria; taking micronized progesterone or dydrogesterone to achieve secretory transformation and as luteal phase support (LPS). All patients were divided into two groups: Group 1 — 53 patients treated with micronized vaginal progesterone 600 mg/day; Group 2 — 52 patients treated with dydrogesterone 30 mg/day orally. The main outcome pregnancy measures were: live birth, obstetric complications: frequency of miscarriage, premature birth, GDM, preeclampsia, fetal growth retardation. Statistical analysis was performed using the χ-square and Mann-Whitney criteria, odds ratio. Differences were considered significant at p<0.05.

RESULTS

The obtained data on perinatal outcomes, including anthropometric characteristics of newborns, were comparable in both groups. The highest incidence of GDM was recorded in the second half of pregnancy in both groups. Pregnancy in women with PCOS after transfer of thawed embryos was complicated by GDM in 98 and 88% of cases (p=0.048), placental insufficiency in 21 and 12% of cases, fetal growth retardation in 4 and 12% of cases, gestational hypertension in 4 and 12% of cases, with an outcome in preeclampsia in 0 and 4% of cases in the micronized progesterone and dydrogesterone groups, respectively (p≥0.05). Patients with polycystic ovary syndrome after thawed embryo transfer who take micronized progesterone as a post-transfer support drug compared to dydrogesterone have a higher risk of GDM and insulin therapy OR=0.143 [CI:0.017—1.209] (p=0.042).

CONCLUSION

In patients with PCOS during thawed embryo transfer in the HRT cycle, it is worth considering the advisability of using dydrogesterone to reduce the risk of GDM.