Predictors of pregnancy after intrauterine insemination in women with polycystic ovary syndrome

Abstract

Objective To evaluate the effects of body mass index (BMI) in patients with polycystic ovary syndrome (PCOS) undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI). Methods This retrospective study evaluated couples with PCOS undergoing COS and IUI. The relationship between cumulative IUI pregnancy outcomes and BMI, treatment cycles, treatment schemes, number of dominant follicles, endometrial thickness, infertility duration and type of infertility was analysed. Results The study evaluated 831 IUI cycles in 451 couples with PCOS. Compared with normoweight women, overweight and obese women required more human menopausal gonadotropin (hMG) doses and more days of COS. Gestational diabetes mellitus occurred more frequently in the obese group than in the other BMI groups. The clinical pregnancy and live birth rates in the hMG, clomiphene citrate (CC) + hMG and letrozole (LE) + hMG groups were significantly higher than those in the CC and LE groups. The clinical pregnancy rate was higher in the secondary infertility group compared with the primary infertility group. Conclusion Obese women might require more hMG doses and more days of COS to overcome the effects of weight. As BMI increases, the incidence of gestational diabetes might also increase. The number of cycles and type of infertility may have a predictive value for pregnancy outcomes.

Association between Pre-Pregnancy Overweightness/Obesity and Pregnancy Outcomes in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

“…World Health Organization (WHO) classification for nutritional status is defined by underweight as <18.5 kg/m 2 , normal weight as 18.5–24.9 kg/m 2 , overweight as 25.0–29.9 kg/m², and obese as BMI ≥ 30 kg/m 2 [ 2 , 33 ], and most of studies adopted this classification [ 13 , 15 , 16 , 17 , 18 , 19 , 34 , 35 , 36 ]. However, some studies used 24 kg/m 2 and 28 kg/m 2 as cut-off points for overweightness and obesity [ 37 ], respectively, especially studies conducted in China [ 12 , 14 , 20 , 21 , 38 , 39 ]. Regarding the criteria of PCOS, 15 studies used the 2003 Rotterdam criteria to diagnose PCOS, while only one study in 1992 used ultrasound images as diagnostic criteria [ 40 ].…”

“…The conception method in most of the studies were in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) (13 studies). Ovulation induction was used in one study [ 40 ], ovulation induction with intrauterine insemination (IUI) in one study [ 38 ], and any conception method (including spontaneous pregnancy, timed-coitus, IUI, IVF/ICSI) in one study [ 34 ]. Among IVF or ICSI studies, four studies used long protocol [ 12 , 14 , 19 , 20 ], one study applied ultra-long protocol [ 17 ], three studies were conducted with GnRH antagonist protocol [ 18 , 36 , 39 ], two studies used various protocols [ 15 , 16 ], and three studies did not mention which protocol they used [ 13 , 21 , 35 ].…”

“…Among IVF or ICSI studies, four studies used long protocol [ 12 , 14 , 19 , 20 ], one study applied ultra-long protocol [ 17 ], three studies were conducted with GnRH antagonist protocol [ 18 , 36 , 39 ], two studies used various protocols [ 15 , 16 ], and three studies did not mention which protocol they used [ 13 , 21 , 35 ]. Regarding the causes of infertility, five studies excluded tubal factor [ 15 , 17 , 36 , 38 , 40 ], five studies excluded male factor [ 14 , 21 , 36 , 38 , 40 ], and three studies exclude oocyte cryopreservation or donation [ 13 , 14 , 21 ]. The detail information of infertility cause was presented in Table S2 .…”

The impact of hyperandrogenism on the outcomes of ovulation induction using gonadotropin and intrauterine insemination in women with polycystic ovary syndrome

“…The percentages of cancellation or conversion to IVF and IVM treatment were comparable between HA and non-HA groups. Previous studies on IUI considered factors such as age [ 21 ], obesity [ 22 ], ovulation dysfunction [ 23 , 24 ], ovarian reserve [ 21 , 25 - 27 ], and the presence of HA [ 28 ] as predictors for pregnancy. This study could not demonstrate the hypothesis that HA has a negative impact on pregnancy outcomes after OI+IUI.…”

“…High BMI could also affect OI+IUI treatment outcomes negatively. A recent retrospective study by Guan et al [ 22 ] investigating 831 IUI cycles showed that obese women might require more gonadotropin doses and more days of stimulation. Moreover, obesity is recognized in the literature as an aggravating factor of endocrine-metabolic disorders, insulin resistance, response to ovarian stimulation, and adverse events in pregnancy and the neonatal period [ 32 - 38 ].…”