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

TL;DR

Transvaginal ovarian drilling before a second IVF cycle may increase the number of healthy embryos in women with PCOS.

Contribution

TVOD significantly improves euploid embryo yield in PCOS patients compared to controls in repeat IVF cycles.

Findings

TVOD was associated with a sixfold increase in euploid blast yield.

TVOD resulted in a fourfold decrease in aneuploid blast percentage.

TVOD improved transferable embryo yield from +1.5 to +3.9.

Abstract

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).

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.

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).

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.

The online version contains supplementary material available at 10.1007/s10815-025-03778-x.