Abstract
BackgroundThe risk of adverse pregnancy outcomes is increased by having a polycystic ovary syndrome (PCOS) diagnosis. However, the confounders in previous studies preclude firm conclusions, and further studies are warranted.ObjectivesTo investigate whether PCOS affects pregnancy outcomes and complications in infertile women undergoing their first in vitro fertilization (IVF) treatment, taking into account important confounders.MethodsWe performed a retrospective cohort study of 7,678 infertile women, including 666 women with PCOS and 7,012 controls undergoing their first IVF treatment at a private fertility center from January 2010 to December 2017. Our main outcome was the impact of PCOS on adverse pregnancy outcomes (miscarriage, preterm delivery, pregnancy-induced hypertension) and pregnancy outcomes (live birth rate, clinical pregnancy rate, implantation rate). PCOS effects were summarized by adjusted odds ratios (aORs) with 95% confidence intervals (CIs) after controlling for maternal characteristics.ResultsAfter adjusting for differences in maternal age, BMI, infertility duration, total dose of gonadotropin, serum E2 and endometrial thickness on the day of hCG trigger, number of fertilized occytes, number of embryos transferred, embryo type (cleavage-stage embryo or blastocyst) and quality, women with PCOS had an increased risk of developing unfavorable pregnancy complications, including miscarriage (aOR 1.629, 95% CI 1.240–2.141), very preterm delivery (< 32 weeks) (aOR 2.072, 95% CI 1.133–3.791). For pregnancy outcomes, PCOS was associated with higher clinical pregnancy rate (aOR 1.248, 95% CI 1.038–1.501) and implantation rate (aOR 1.238, 95% CI 1.030–1.489) after adjusting for the above-mentioned confounders.ConclusionsWomen with PCOS are at increased risk of adverse pregnancy outcomes after adjusting for differences in maternal characteristics. These women may need more frequent medical consultants and management during pregnancy and parturition.
Highlights
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders that affects 5%–15% in women of reproductive age, depending on the population studied and the diagnostic criteria used [1]
A total of 7,678 couples undergoing their first IVF treatments between 2010 and 2017 were included in the cohort, with 666 women diagnosed with PCOS and 7,012 controls
The predominant PCOS phenotype in this study was oligo-menorrhea with polycystic ovaries; 85.7% of the PCOS population displayed oligo- or amenorrhea, 61.4% had hyperandrogenism, 78.7% showed polycystic ovary morphology, and 25.8% met all three criteria
Summary
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders that affects 5%–15% in women of reproductive age, depending on the population studied and the diagnostic criteria used [1]. The most common features of PCOS are oligo- or anovulation, hyperandrogenism, and polycystic ovaries [2] Other endocrinal disorders such as insulin resistance and obesity play essential roles in the pathogenesis of PCOS [3, 4]. These endocrinal diseases are known risk factors to induce metabolic syndrome, pregnancy loss and late pregnancy complications, which indicates that PCOS is a chronic disease with manifestations across the lifespan [5]. The confounders in previous studies preclude firm conclusions, and further studies are warranted
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