Influence of ovarian cysts during controlled ovarian hyperstimulation

BACKGROUND: The use of gonadotrophin-releasing hormone agonist and purified follicular stimulating hormone increases the incidence of ovarian cysts during in vitro fertilization-embryo transfer cycles. The aetiopathogenesis and the effects of ovarian cysts on controlled ovarian hyperstimulation is unclear; most authors observed no-detrimental influence of ovarian cysts in controlled ovarian hyperstimulation cycles for IVF. The aim of this study was the evaluation of the real incidence and effects of ovarian cysts during in vitro fertilization-embryo transfer cycles. DESIGN: retrospective study. SETTING: reproductive medicine units. PATIENTS: 130 women. INTERVENTIONS: r-FSH--225 U.I. was administered to 130 women i.m. after a long protocol of down regulation with GnRH-a (Triptoreline 3.75). The drug administration was personalized on the basis of: pre-existent patients pathologies; E2 blood levels; ultrasound evaluation of the follicular development. MAIN OUTCOME MEASURES: E2 levels, number and quality of oocytes retrieved, fertilization rate, number of embryos developed, pregnancy rate. RESULTS: At the end of stimulation ovarian cyst was observed in eighteen cases. There was no difference, between the cycles with or without cysts, in the follicular development, number and quality of eggs retrieved, fertilization rate, number and quality of the transferred embryos, pregnancy and miscarriage rate. CONCLUSIONS: The conclusion is drawn that the incidence of ovarian cysts during COH can be reduced observing some simple rules like: to exclude from the stimulation protocols patients with follicles of more than 12 mm diameters as observed at the preliminary ultrasound control; to personalize the therapeutic regime with the pre-existent patients pathologies; ultrasound evaluation of the follicular development; determination of the E2 serum levels, every two days.