Introduction: The use of gonadotropin-releasing hormone analoge (GHRH-a) to induce ovarian suppression is with ovarian cyst formation. The impact of these cysts on the outcome of IVF is still controversial. While some studies suggest poor ovarian response in the presence of cyst, some others show no adverse effect of it. Interestingly, the finding of there studies reporting high pregnancy rate in groups of patients with ovarian cyst. The purpose of this study was to determine the effect of these cysts on the outcome of IVF cycles.
Material and Methods: We evaluated 81 IVF or ICSI cycles vetween May 2001 to Oct 2002. patints who had endometriosis, FSH³15 and ovarian surgery were excluded. All patients received Buserelin acetate (1mg SC daily) from 21th day of the cycle after exclusion of any ovarian pathology by transvaginal ultrasound. After two weeks, ovarian suppression was assessed using plasma estradiol, progesterone and LH levels and ultrasound. Cystic structures ³ 20mm in the ovary defined as follicle cysts (39 patients=group I). Similar patients without cyst have been chosen as control group simultaneously (42 patients=group II). When suppression, was achieved as defined by Endometrial thickness <6mm and Est <50pg/ml. COH was begun without, considering ovarian cyst and IVF-ET program was carried out in all patients. Stimulation days, E2 on HCG day, lead follicles, retrieved oocytes and fertilization rate were compared between the two groups using T-test, c2 and paired T-test.
Results: There were no significance differences between the two groups in mean age, hormonal values in suppression phase, total number of HMG ampoules, stimulation days and number of lead follicles. Total number of oocyte (9.6±7.3 in group 1 vs 5.7±4.1 in group II) number of good quality oocyte in group I vs 3.4±2.5 in group II) and total number of embryo (5.4±4.1 in group I vs 3.4±2.5 in group II) increased significantly in group I compared to group II. Comparison between two ovaries in patients with cyst indicated that the ovary including cyst has much more oocyte (5.2±4.6) than the opposite side (3.8±3.9) (P=0.05).
Conclusion: Our study revealed that GnRH-a cyst has no effect on side the folliculogenesis. Therefore it is no need to aspirate them or cancel the cycle. One noticeable point is significant increasing, in total number of oocyte in case with cycst. Interestingly, this study showed that the ovary with cyst has much more occytes than the other one. Whether ovarian blood flow or some other profile are different in two ovaries remains to be evaluated in future studies applying color Doppler and some other marker assays.