Polycystic ovarian syndrome and the risk of spontaneous abortion following assisted reproductive technology treatment

Wang, Jim X.; Davies, Michael J.; Norman, Robert J.

doi:10.1093/humrep/16.12.2606

Cited by 193 publications

(115 citation statements)

References 16 publications

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“…We speculate that this could be due to poorer embryo competence in the PCOS group which might have offset the positive effect from the quantitative aspect. Actually it has been reflected in terms of higher miscarriage rates in the PCOS group compared to the isolated PCO and control groups, both from our findings as well as those reported by some others [12,20]. It was suggested that this increased miscarriage rate in PCOS was not explained genetically by increased risk of embryonic aneuploidy [21].…”

Section: Discussionsupporting

confidence: 83%

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

Lee

Lau

et al. 2013

J Assist Reprod Genet

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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.

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Section: Discussionsupporting

confidence: 83%

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

Lee

Lau

et al. 2013

J Assist Reprod Genet

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“…Wang et al found that a higher rate of spontaneous miscarriage in PCOS patients was due to higher prevalence of obesity [11]. In addition, Boots et al found that obese women are more prone to have euploid miscarriage compared to non-obese controls [12].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Pregnancy Loss in Patients with Polycystic Ovary Syndrome: A Case Control Study

Ashaq¹,

Mazer²,

Qahtani³

2017

OJOG

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Objectives: To identify different biophysical and hormonal factors that could contribute to recurrent pregnancy loss in Saudi women who have been diagnosed with polycystic ovary syndrome. Study Design: Case-control study. Settings: Infertility clinic in Dammam Maternity and Children Hospital. Cases: PCOS patients with recurrent pregnancy loss. Controls: PCOS patients without recurrent pregnancy loss. Results: The prevalence of recurrent abortion in PCOS patients was 31%. There was no significant difference between the cases and the controls in the age, 33.1 years versus 31.9 years, BMI, 31.4 kg/m 2 versus 31.6 kg/m 2 respectively. There was no significant difference in the successful pregnancies outcome in cases and controls, term deliveries 84% versus 90%, preterm deliveries 10% versus 5%, twin pregnancy 6% versus 5% respectively. There was no significant difference in the hormonal profile (prolactin, LH, FSH, LH/FSH ratio, TSH, progesterone, testosterone) between cases and controls. Serum estradiol level was significantly lower in the cases compared to the controls, 55.5 pg/mL versus 83.9 pg/mL respectively (p < 0.01). Conclusion: PCOS patients with recurrent abortions had no significant increase in the age, BMI, preterm pregnancy, multiple gestation and ectopic pregnancy. The hormonal profile (prolactin, LH, FSH, LH/FSH ratio, TSH, progesterone, testosterone) was comparable between the cases and the controls, except for serum estradiol level, which was significantly lower in PCOS patients with recurrent abortions.

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“…Glycodelin may play a role in inhibiting the endometrial immune response to the embryo and IGF binding protein-1 appears to facilitate adhesion processes at the feto-maternal interface. 35,36 Multiple studies have documented the link between high BMI and higher fetal loss rate, 22 probably linked to a higher insulin resistance among these obese women. Although many women with PCOS are obese, obesity is not a part of the diagnostic criteria for PCOS.…”

Section: Discussionmentioning

confidence: 99%

“…3 During the last decade, several retrospective and nonrandomized studies have evaluated metformin for its potential disease-modifying effects. Studies have shown that without metformin, spontaneous abortion may occur in 25% to 73% [21][22][23] of pregnancies than the general population. The increased risk may be due to hyperandrogenism, high LH level, more insulin resistance and higher levels of plasminogen activator inhibitor activity (PAI-1) which adversely affects endometrial function and environment.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Metformin on Pregnancy Outcome Among Filipino Women with Polycystic Ovary Syndrome

Uyking-Naranjo

Consencino

Mirasol

et al. 2013

JAFES

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Objective.To determine the effect of metformin on maternal and neonatal outcome among pregnant Filipino women with polycystic ovary syndrome (PCOS).Methodology.This is a retrospective cohort study of PCOS women who were on metformin treatment prior to achieving pregnancy. The women were divided into two groups: women who continued metformin during pregnancy and women who discontinued metformin at the time the pregnancy was confirmed. Determination of the effect of metformin on pregnancy outcomes were analyzed using chi-square test. Multivariate regression analysis was used to determine the factors related to spontaneous abortion.Result. A total of 101 women continued metformin during pregnancy while 60 women discontinued metformin. Women who continued metformin had lower rates of first trimester spontaneous abortion compared to those who discontinued metformin (5% versus 36.2%, p<0.001). There was no significant difference in gestational diabetes between those who continued and discontinued metformin during pregnancy (19.0% versus 32.6%, p=0.07). Logistic regression analysis showed that only metformin during pregnancy has a protective effect on abortion (OR=0.168; 95% CI 0.048,0.592; p=0.005). The differences in neonatal outcomes between the two groups did not achieve statistical significance.Conclusion. In Filipino women with PCOS, continuous use of metformin during pregnancy reduces the rate of first trimester spontaneous abortion.

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Polycystic ovarian syndrome and the risk of spontaneous abortion following assisted reproductive technology treatment

Abstract: The results of this study suggest that the higher risk of spontaneous abortion observed in women with PCOS is likely to be due to their high prevalence of obesity and the type of treatment they receive.

Cited by 193 publications

References 16 publications

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

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

Recurrent Pregnancy Loss in Patients with Polycystic Ovary Syndrome: A Case Control Study

The Effect of Metformin on Pregnancy Outcome Among Filipino Women with Polycystic Ovary Syndrome

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