Association Between Menstrual Patterns and Adverse Pregnancy Outcomes in Patients With Polycystic Ovary Syndrome.

Jun Zhai,Ting Yu,Di Wu,Yurong Cao

doi:10.3389/fendo.2021.740377

Abstract

ObjectiveTo investigate the results of in vitro fertilization among polycystic ovary syndrome (PCOS) patients using the long-acting long protocol regarding the relationship between menstrual patterns and adverse pregnancy outcomes.Design Retrospective cohort study.SettingUniversity-affiliated reproductive medical center.BackgroundThe menstrual patterns of patients with PCOS is considered related to metabolism; however, no study has analyzed the outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in patients with PCOS who have different menstrual patterns. This study aimed to observe the outcomes of IVF/ICSI in patients with PCOS with different menstrual patterns who used the long-acting long protocol.MethodsThis was a retrospective analysis in the first cycle of IVF/ICSI at the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2019. In total, 1834 patients with PCOS were classified into the regular menstruation group (n=214), the oligomenorrhea group (n=1402), and the amenorrhea group (n=218).ResultsPCOS patients who used the long-acting long protocol of IVF/ICSI had similar clinical pregnancy rates and live birth rates despite having different menstrual patterns. The overall incidence of adverse pregnancy outcomes, including abortion, spontaneous preterm birth (sPTB), gestational diabetes(GDM), hypertensive disorder inpregnancy (HDP), and premature rupture of membranes(PROM, was significantly higher in the amenorrhea group than in the regular menstrual and oligomenorrhea groups (25.88% vs. 30.41% vs. 43.69%; P = 0.013). Additionally, the rates of GDM (2.35% vs. 6.10% vs. 13.79%; P=0.015) and macrosomia (5.26% vs. 10.94% vs. 18.39%; P=0.026) in the amenorrhea group were significantly higher than those in the other two groups. Correction for confounding factors showed that menstrual patterns are related to the occurrence of adverse pregnancy outcomes. Amenorrhea is an independent risk factor for adverse pregnancy outcome (OR [odds ratio]: 2.039, 95% CI [confidence interval]: 1.087-3.822), GDM (OR: 5.023, 95% CI: 1.083–23.289), and macrosomia (OR: 4.918, 95% CI: 1.516–15.954).ConclusionsIVF/ICSI can achieve similar pregnancy and live birth rates in PCOS patients with different menstrual patterns. However, the overall incidence of adverse pregnancy outcomes in PCOS patients with amenorrhea is higher than that in patients with regular menstruation or oligomenorrhea.

Highlights

Polycystic ovary syndrome (PCOS) is a common reproductive and endocrine disease among women of childbearing age
The length of infertility, body mass index (BMI), LH/FSH, anti-Müllerian hormone (AMH), AFC, Length of stimulation, and Total dosage of Gn used were higher, and the thickness on the human chorionic gonadotropin (hCG) injection day was lower in the amenorrhea group than in the regular menstruation and oligomenorrhea groups
SPTB, Hypertensive disorder in pregnancy (HDP), Premature rupture of membranes (PROM), and the incidence of LBW and Very low birth weight (VLBW) had a tendency to increase in the amenorrhea group compared with the regular menstruation group and the oligomenorrhea group; there was no significant difference (Table 2 and Figure 2)

Summary

Introduction

Polycystic ovary syndrome (PCOS) is a common reproductive and endocrine disease among women of childbearing age. Conclusions on related risk factors that lead to adverse pregnancy outcomes in patients with PCOS are not completely consistent Some of these risk factors include age, body mass index (BMI), and the application of assisted reproductive technology [3]. This study retrospectively analyzed the pregnancy outcomes of patients with PCOS that have different menstrual patterns during the long-acting long protocol assisted by IVF/ICSI and the related risk factors for adverse pregnancy outcomes. This analysis further aimed to enable clinicians to strengthen the treatment of high-risk groups, as perinatal monitoring can reduce the incidence of maternal and infant adverse outcomes. This study aimed to observe the outcomes of IVF/ICSI in patients with PCOS with different menstrual patterns who used the long-acting long protocol

Methods

Results

Conclusion