Obstetric complications in women with IVF conceived pregnancies and polycystic ovarian syndrome

Abstract

Polycystic ovarian syndrome (PCOS) is often accompanied by infertility that necessitates ovulation induction using clomiphene citrate, gonadotropins or even in vitro fertilization (IVF). These treatment methods are known to increase the incidence of multiple pregnancies as well as some negative consequences, including a rise in the risk for gestational diabetes mellitus, pre-eclampsia, etc., Furthermore, pregnancies established after IVF carry an increased risk for maternal complications. However, the increased risk of developing adverse obstetric complications has been suggested to occur independently of obesity as well as in populations without assisted reproductive techniques. Many studies have been performed to study the effect of PCOS on pregnancy and the effect of pregnancy on PCOS. The hormonal milieu that is exaggerated in PCOS women is quite well understood at the biochemical and genetic levels. The maternal and neonatal outcomes of PCOS women who have undergone in vitro fertilization-embryo transfer (IVF-ET) have not been widely studied till date. This review aims to evaluate the current evidence regarding adverse obstetric outcomes of PCOS women undergoing IVF-ET. The rationale of this review is to study whether the adverse obstetric outcomes are increased in PCOS women in general, or particularly in those PCOS women who are undergoing IVF-ET. It is also important to analyze via a literature review whether the increased adverse outcomes are due to infertility in general or PCOS per se. An attempt has been made to give evidence regarding preventive strategies for obstetric complications in PCOS women who have undergone IVF-ET.

Haplosufficient Genomic Androgen Receptor Signaling Is Adequate to Protect Female Mice From Induction of Polycystic Ovary Syndrome Features by Prenatal Hyperandrogenization

“…Ovulatory dysfunction is a key cause of the reduced fertility observed in PCOS patients (56). This PCOS trait was reproduced in the present study, whereby prenatally DHT-treated WT (ARϩ/ϩ) females displayed fewer corpora lutea and reduced serum P4 levels consistent with our and other previous studies (36,54).…”

Role of androgens in normal and pathological ovarian function

“…This review will outline the evidence supporting a role for AR actions in the development of traits of PCOS, with the main focus being on reproductive and endocrine features, which lead to the dysfunctional ovarian function observed in many patients with PCOS. Reduced fertility is a key feature of PCOS, caused by arrested follicular maturation, dysfunctional ovulation and an increased risk of gestational diabetes, pre-eclampsia, pre-term birth and miscarriage (Tandulwadkar et al 2014). Patterns of reproductive hormone release are also altered, with R204 K A Walters PCOS women exhibiting LH hypersecretion and hyperandrogenism.…”

Cost-effectiveness of short COH protocols with GnRH antagonists using different types of gonadotropins for in vitro fertilization

“…The choice of stimulation short protocol was made primarily based on (1) the individual characteristics of the patient (age, habitat, ovarian reserve, BMI (body mass index), presence of polycystic ovary syndrome (PCOS), [14] ovarian response to stimulation during a previous cycle (if available)); (2) price of medicines; and (3) experience and preferences of the physician leading the stimulation. In the observed clinic, only one team of physicians was responsible for ovarian stimulation and, therefore, there were considered to be no differences in the experience.…”

“…The choice of the COH protocol and the combination of medicines depends on the individual characteristics of each patient: age, habitat, ovarian reserve, BMI, presence of PCOS, [14] and ovarian response to stimulation during a previous cycle (if data were available). The three groups in this study were defined based on the groups of medicines included in the short COH protocols: recombinant gonadotropins, urinary gonadotropins or a combination of both.…”