Miscarriage rate is not increased in polycystic ovarian syndrome patients compared with other infertility diagnoses

Abstract

Objective: To evaluate the risk of clinical pregnancy loss in patients with a diagnosis of polycystic ovary syndrome (PCOS) compared with other infertility diagnoses. Design: Retrospective weight- and age-matched cohort study in a tertiary REI teaching center. Materials and Methods: 486 consecutive infertility patients having a positive pregnancy test were evaluated. Patients diagnosed with PCOS were oligo-anovulatory, without ovulatory progesterone, and had evidence of either hyperandrogenism or hyperandrogenemia. All had polycystic appearing ovaries on endovaginal sonography. Comparison patients were ovulatory and had one or more diagnoses of infertility including unexplained infertility, mild male factor, pelvic factor, hypogonadotropic hypgonadism or mildly diminished ovarian reserve. All patients had at least one patent tube. Patients with unexplained infertility or total motile inseminates between 5 and 20 million/ml underwent washed intrauterine insemination following gradient separation. The most frequent intervention in both groups was gonadotropin therapy. Pregnancy was diagnosed by a positive serum βhCG 14 days following ovulation. Pregnancy outcome was determined by reviewing medical records. To control for the effects of weight and age, each PCOS miscarriage patient was matched with the next three consecutive PCOS delivered patients of the same age (within 1 year), and the matching process repeated for weight (within 5 pounds). SAS statistical analysis software was used. Chi-square evaluated classification versus outcome status and independent and matched t-tests were used for parametric data. Significance for p <0.05 was tested using two-tailed distributions. Results: Pregnancy results were available for all patients. The overall rate of early miscarriage in our non-PCOS infertility pregnancy group was 26.0%. In the 139 PCOS patient cohort, the miscarriage rate was 20.0% (p=n.s.). In our PCOS cohort, the mean age of the delivered group was 32.8 years vs. 35.2 years in the miscarriage group (p = 0.01). The mean weight in the PCOS delivered group did not differ from the PCOS miscarriage group (162.7 vs. 166.4 lbs, p=n.s.). However, among non-PCOS patients, a 6.4 lb. difference between miscarriage patients (151.7 lbs) and delivered patients (145.3 lbs) was significant (p < 0.05). When each PCOS patient with early miscarriage was age-matched with the next three consecutive PCOS delivered patients the difference in weight was 0.2 lbs (p = n.s.). In a similar weight-matched analysis of PCOS patients, the difference in age between early miscarriage and delivered patients was 1.2 years (p = n.s.). Examining separately those 15% of PCOS patients who underwent long protocol downregulation with subsequent luteal phase support for IVF, these similarities persisted. Serum total Testosterone showed no association with pregnancy outcome. Conclusion: Despite the perception that PCOS patients are at higher risk for miscarriage, these data suggest that treated PCOS patients when matched for age and weight with patients having other infertility diagnoses do not experience increased clinical pregnancy loss.