Cumulative live-birth rate in women with polycystic ovary syndrome or isolated polycystic ovaries undergoing in-vitro fertilisation treatment

Abstract

Purpose This retrospective cohort study evaluated the cumulative live birth rate in women with polycystic ovary syndrome (PCOS) and isolated polycystic ovaries (PCO) undergoing in-vitro fertilisation (IVF) treatment. Methods We studied 104 women with PCOS, 184 with PCO and 576 age-matched controls undergoing the first IVF treatment cycle between 2002 and 2009. The main outcome measure was cumulative live birth in the fresh plus all the frozen embryo transfers combined after the same stimulation cycle. Results Women in both the PCOS (n =104) and isolated PCO groups (n =184) had higher ovarian response parameters compared to age-matched controls (n =576), and higher rates of withholding fresh embryo transfer for risk of ovarian hyperstimulation syndrome (OHSS). The actual incidence of moderate to severe OHSS was significantly higher in the PCOS (11.5 %) but not the isolated PCO group (8.2 %) compared to controls (4.9 %). The live birth rates in the fresh cycle were comparable among the 3 groups, but the PCOS group had a significantly higher miscarriage rate compared to the other 2 groups. Cumulative live birth rate was significantly higher in the isolated PCO group (60.3 %), but not the PCOS group (50.0 %), compared to controls (47.5 %).Conclusions Women in the isolated PCO group, but not the PCOS group, had a significantly higher cumulative live birth rate compared to controls. This could be explained by the quantitative effect of the higher number of transferable embryos obtained per stimulation cycle, which is uncompromised by the unfavourable embryo competence otherwise observed in PCOS.

Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—A systematic review, meta‐analysis, and meta‐regression

“…Outcomes of interest were reported in a total of n = 224 136 pregnant women comprising 39 retrospective 23,31,[33][34][35][36][37][38][39][40][42][43][44][47][48][49]51,53,54,56,57,59,61,62,65,67,69,70,73,74,78,79,81,84,85,87,[89][90][91] (n = 157 899) and 24 prospective 30,32,41,45,46,50,52,55,58,60,63,64,66,…”

Polycystic ovary syndrome and adverse pregnancy outcomes: Current state of knowledge, challenges and potential implications for practice

“…Key challenges include confounding effects of BMI and assisted reproduction treatments (ART), both of which can increase miscarriage and are not consistently corrected for in statistical analysis and or design . Prospective and retrospective cohort studies have mostly shown a higher risk (twofold to fourfold) for miscarriage, while retrospective studies demonstrate a similar risk for women with and without PCOS . Hyperinsulinemia in conjunction with hyperandrogenism in women with PCOS may contribute to pregnancy loss through interfering with normal placental implantation .…”

“…This study did not find any significant difference in adverse pregnancy outcomes between groups including GDM, GH, PE and PTB, suggesting that women with PCOS may not have higher risk of adverse pregnancy outcomes when there are no significant differences in age and BMI. The rate of miscarriage has been also shown to be increased by BMI in women with and without PCOS …”

“…The rate of miscarriage has been also shown to be increased by BMI in women with and without PCOS. 19,20 Studies show inconsistent findings of gestational weight gain…”

Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention

“…Although OHSS may occasionally occur spontaneously, the great majority of cases are due to COS in women undergoing ART. The moderate and severe forms may occur in 3% to 10% of all ART cycles, and the incidence may reach 20% among high‐risk women. The main characteristics of OHSS are increased vascular permeability and ovarian enlargement.…”