BACKGROUND Poor response patients with PCOS who are not susceptible to gonadotropin stimulation are more likely to have canceled cycles or poor clinical outcomes during IVF treatment. However, some limitations exist in the present therapies. In this study, we evaluated the effects of using the transvaginal ovarian drilling (TVOD) followed by controlled ovarian stimulation (COS) from the second day of these poor responders. METHODS During IVF, 7 poor responders with PCOS and 28 PCOS patients (14 normal and 14 high responders) were recruited. All patients received COS with the gonadotropin-releasing hormone antagonist protocol. For the poor responders, after undergoing 10 to 14 days of ovulation induction with no response, the TVOD was applied and then ovarian stimulation was performed from the next day at the same gonadotropin dose. Serum samples during COS and follicular fluid samples from the dominant follicles on the oocyte pick-up (OPU) day in all three groups were collected. Besides, follicular fluid from small follicles (diameter < 1 cm) in the normal and high responders on the OPU day and those in the poor responders on the TVOD day were gathered. Hormonal levels were examined in all samples using immunometric assays. RESULTS All the poor responders restored ovary response after receiving TVOD. There was no significant difference in the stimulation duration, total gonadotrophin dose used and the clinical outcomes among the three groups. The body mass index, serum and follicular levels of anti-Müllerian hormone (AMH) and testosterone in poor responders were higher than those in the other two groups, and the application of TVOD significantly decreased the levels of AMH and testosterone in both serum and follicular fluid. CONCLUSIONS TVOD followed by ovulation induction from the next day is effective and convenient for poor responders with PCOS. The decline of AMH and testosterone resulted from TVOD may be the main reason resulting in the recovery of ovary sensitivity to gonadotropins. The small sample size is the primary limitation of this study, future studies using a large population cohort and monitoring the long-term outcomes of this strategy will be required. TRIAL REGISTRATION ChiCTR1900023612. Registered 04 June 2019-Retrospectively registered.

中文翻译：

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一项初步研究显示，经阴道卵巢钻探，然后从第二天开始进行受控的卵巢刺激，可以改善多囊卵巢综合症的不良反应者的卵巢反应。

背景技术对促性腺激素刺激不敏感的PCOS反应较差的患者在IVF治疗期间更有可能取消周期或临床预后不良。但是，目前的疗法存在一些局限性。在这项研究中，我们评估了这些不良反应者从第二天开始使用经阴道卵巢钻孔（TVOD）继之以受控卵巢刺激（COS）的效果。方法在IVF期间，招募了7名PCOS不良反应者和28名PCOS患者（14名正常人和14名高反应者）。所有患者均接受了促性腺激素释放激素拮抗剂方案的COS。对于反应较差的人，在经历10至14天的无排卵诱导后，应用TVOD，然后从第二天开始以相同的促性腺激素剂量进行卵巢刺激。收集所有三个组在COS期间的血清样品和卵母细胞摄取（OPU）日的优势卵泡中的卵泡液样品。此外，在OPU日，正常和高反应者中的小卵泡（直径<1 cm）和TVOD较差反应者中的小卵泡中收集到卵泡液。使用免疫测定法检查所有样品中的激素水平。结果所有不良反应者均在接受TVOD后恢复了卵巢反应。三组之间的刺激持续时间，促性腺激素总剂量和临床结局无显着差异。较弱反应者的体重指数，血清和卵泡中抗苗勒氏激素（AMH）和睾丸激素水平高于其他两组，TVOD的应用显着降低了血清和卵泡液中AMH和睾丸激素的水平。结论TVOD继之于第二天的排卵诱导对于PCOS不良反应者有效且方便。TVOD导致AMH和睾丸激素的下降可能是导致卵巢对促性腺激素敏感性恢复的主要原因。样本量小是这项研究的主要局限性，将来需要使用大量的人群研究并监测该策略的长期结果。试用注册ChiCTR1900023612。注册于2019年6月4日-追溯注册。TVOD导致AMH和睾丸激素的下降可能是导致卵巢对促性腺激素敏感性恢复的主要原因。样本量小是这项研究的主要局限性，将来需要使用大量的人群研究并监测该策略的长期结果。试用注册ChiCTR1900023612。注册于2019年6月4日-追溯注册。TVOD导致AMH和睾丸激素的下降可能是导致卵巢对促性腺激素敏感性恢复的主要原因。样本量小是这项研究的主要局限性，将来需要使用大量的人群研究并监测该策略的长期结果。试用注册ChiCTR1900023612。注册于2019年6月4日-追溯注册。