Transvaginal ovarian drilling prior to a second IVF cycle may improve the rate of euploidy in patients with polycystic ovarian syndrome when compared to controls.

Abstract

Purpose: To assess the impact of transvaginal ovarian drilling (TVOD) on euploidy rates following repeat in vitro fertilization (IVF) in subjects with polycystic ovarian syndrome (PCOS).

Materials and methods: A single institution retrospective cohort study between January 2017 and December 2024, all patients with PCOS, as confirmed by Rotterdam criteria, who had TVOD performed prior to a repeat IVF cycle and underwent PGT-A in both the prior and repeat cycles were included and compared to a well-matched control. The primary outcome was the number of transferable embryos per cycle. Secondary outcomes included: blastocyst yield, euploid yield, and rates of aneuploidy.

Results: Eighteen subjects met criteria in our study time frame and were compared to 57 control subjects. The mean age for the TVOD and control groups was 35.3 ± 4.6 and 36.5 ± 4.4 respectively (p = 0.34). TVOD was associated with a doubling of blastocyst yield, a sixfold increase in the yield of euploid blasts, and a nearly fourfold decrease in the percentage of aneuploid blasts. When compared to controls, TVOD resulted in a significant improvement in the yield of euploid embryos, from + 1.3 to + 2.4 (p = 0.01), and transferable embryos from + 1.5 to + 3.9 (p = 0.001). TVOD also resulted in a decrease in the percentage of aneuploid embryos from - 8.5 to - 49% (p < 0.001).

Conclusion: TVOD appears to have positively impacted the yield of transferable embryos and euploid embryos in patients with PCOS when compared to a well-matched control.