O-39: Risk of miscarriage in women having polycystic ovarian syndrome (PCOS) does not differ from non-PCOS women receiving care for infertility

Abstract

ObjectiveTo determine whether patients diagnosed with PCOS experience increased early pregnancy loss (SAB) compared with other patients receiving infertility care.DesignRetrospective cohort study.Materials and methodsAll consecutive pregnancies during 2000-2005 were ascertained among women attending a tertiary care infertility clinic; for these analyses, the earliest pregnancy for each woman was used. Patients were classified as PCOS (defined by the joint ASRM/ESHRE Rotterdam criteria, with all having oligo- or anovulation) vs. other infertility diagnoses. Treatment was categorized as (1) oral ovulation induction (OI), (2) HMG, or (3) treatment-independent pregnancy (TIP). Patients undergoing assisted reproduction and those with ectopic gestation, genetic termination or history of recurrent pregnancy loss were excluded. Pregnancy status was tracked by serum hCG following each treatment cycle to diagnose early pregnancies and online/chart review data were used to classify outcome in 100% of patients. Pregnancy outcome was classified as SAB if the pregnancy loss occurred within 20 weeks gestation. All patients had at least one patent tube, no hydrosalpinx and total motile inseminate > 5 million sperm. Crude rates by PCOS status were determined and differences in age, race/ethnicity, BMI, type of infertility treatment and SAB outcome were examined using chi-square or t-test. Multivariable logistic regression was used to determine the association of these factors and pregnancy outcome. Significance was assigned at p<0.05.Results312 pregnant women (age, mean/SD 34.7/4.7 years) met the above criteria and were included in these analyses. These included 104 (33.3%) women with PCOS. The overall SAB rate was 25.0%. The racial/ethnic composition was 51.3% White, 28.2% Asian, 7.7% Hispanic, 1.0% Black, and 11.8% Other/unknown. Women with PCOS were significantly younger, had higher BMI, and were less likely to be White or have a TIP, compared to women without PCOS (Table 1). However, the proportion having SAB did not differ by PCOS status. Furthermore, after adjusting for age, BMI, race/ethnicity and treatment type, women with PCOS did not have an increased odds of SAB compared to women without PCOS (OR 0.99, 95% CI 0.49-2.00). The only independent predictor of SAB in these analyses was increased maternal age (adjusted OR 1.11, 1.03-1.19).Tabled 1ConclusionDespite differences in age, BMI, race/ethnicity and types of treatments used to achieve pregnancy, these data do not support an excess of early pregnancy loss in PCOS compared with non-PCOS patients in a carefully characterized sample. Subgroup analyses of outcome according to specific adjunctive medications and infertility treatment will be presented. ObjectiveTo determine whether patients diagnosed with PCOS experience increased early pregnancy loss (SAB) compared with other patients receiving infertility care. To determine whether patients diagnosed with PCOS experience increased early pregnancy loss (SAB) compared with other patients receiving infertility care. DesignRetrospective cohort study. Retrospective cohort study. Materials and methodsAll consecutive pregnancies during 2000-2005 were ascertained among women attending a tertiary care infertility clinic; for these analyses, the earliest pregnancy for each woman was used. Patients were classified as PCOS (defined by the joint ASRM/ESHRE Rotterdam criteria, with all having oligo- or anovulation) vs. other infertility diagnoses. Treatment was categorized as (1) oral ovulation induction (OI), (2) HMG, or (3) treatment-independent pregnancy (TIP). Patients undergoing assisted reproduction and those with ectopic gestation, genetic termination or history of recurrent pregnancy loss were excluded. Pregnancy status was tracked by serum hCG following each treatment cycle to diagnose early pregnancies and online/chart review data were used to classify outcome in 100% of patients. Pregnancy outcome was classified as SAB if the pregnancy loss occurred within 20 weeks gestation. All patients had at least one patent tube, no hydrosalpinx and total motile inseminate > 5 million sperm. Crude rates by PCOS status were determined and differences in age, race/ethnicity, BMI, type of infertility treatment and SAB outcome were examined using chi-square or t-test. Multivariable logistic regression was used to determine the association of these factors and pregnancy outcome. Significance was assigned at p<0.05. All consecutive pregnancies during 2000-2005 were ascertained among women attending a tertiary care infertility clinic; for these analyses, the earliest pregnancy for each woman was used. Patients were classified as PCOS (defined by the joint ASRM/ESHRE Rotterdam criteria, with all having oligo- or anovulation) vs. other infertility diagnoses. Treatment was categorized as (1) oral ovulation induction (OI), (2) HMG, or (3) treatment-independent pregnancy (TIP). Patients undergoing assisted reproduction and those with ectopic gestation, genetic termination or history of recurrent pregnancy loss were excluded. Pregnancy status was tracked by serum hCG following each treatment cycle to diagnose early pregnancies and online/chart review data were used to classify outcome in 100% of patients. Pregnancy outcome was classified as SAB if the pregnancy loss occurred within 20 weeks gestation. All patients had at least one patent tube, no hydrosalpinx and total motile inseminate > 5 million sperm. Crude rates by PCOS status were determined and differences in age, race/ethnicity, BMI, type of infertility treatment and SAB outcome were examined using chi-square or t-test. Multivariable logistic regression was used to determine the association of these factors and pregnancy outcome. Significance was assigned at p<0.05. Results312 pregnant women (age, mean/SD 34.7/4.7 years) met the above criteria and were included in these analyses. These included 104 (33.3%) women with PCOS. The overall SAB rate was 25.0%. The racial/ethnic composition was 51.3% White, 28.2% Asian, 7.7% Hispanic, 1.0% Black, and 11.8% Other/unknown. Women with PCOS were significantly younger, had higher BMI, and were less likely to be White or have a TIP, compared to women without PCOS (Table 1). However, the proportion having SAB did not differ by PCOS status. Furthermore, after adjusting for age, BMI, race/ethnicity and treatment type, women with PCOS did not have an increased odds of SAB compared to women without PCOS (OR 0.99, 95% CI 0.49-2.00). The only independent predictor of SAB in these analyses was increased maternal age (adjusted OR 1.11, 1.03-1.19).Tabled 1 312 pregnant women (age, mean/SD 34.7/4.7 years) met the above criteria and were included in these analyses. These included 104 (33.3%) women with PCOS. The overall SAB rate was 25.0%. The racial/ethnic composition was 51.3% White, 28.2% Asian, 7.7% Hispanic, 1.0% Black, and 11.8% Other/unknown. Women with PCOS were significantly younger, had higher BMI, and were less likely to be White or have a TIP, compared to women without PCOS (Table 1). However, the proportion having SAB did not differ by PCOS status. Furthermore, after adjusting for age, BMI, race/ethnicity and treatment type, women with PCOS did not have an increased odds of SAB compared to women without PCOS (OR 0.99, 95% CI 0.49-2.00). The only independent predictor of SAB in these analyses was increased maternal age (adjusted OR 1.11, 1.03-1.19). ConclusionDespite differences in age, BMI, race/ethnicity and types of treatments used to achieve pregnancy, these data do not support an excess of early pregnancy loss in PCOS compared with non-PCOS patients in a carefully characterized sample. Subgroup analyses of outcome according to specific adjunctive medications and infertility treatment will be presented. Despite differences in age, BMI, race/ethnicity and types of treatments used to achieve pregnancy, these data do not support an excess of early pregnancy loss in PCOS compared with non-PCOS patients in a carefully characterized sample. Subgroup analyses of outcome according to specific adjunctive medications and infertility treatment will be presented.