Is the fertile window extended in women with polycystic ovary syndrome Utilizing the SART registry to assess the impact of reproductive aging on live birth rate

Capsule:
Below the age of 40, women with polycystic ovary syndrome have higher clinical pregnancy and live-birth rates after in vitro fertilization compared with women with tubal factor infertility. After 40, despite a higher oocyte yield, there is no difference in pregnancy outcomes.

Authors:
Suleena Kansal Kalra, M.D., M.S.C.E., Sarah J. Ratcliffe, Ph.D., Anuja Dokras, M.D., Ph.D.

Volume 100, Issue 1, Pages 208-213, July 2013

Abstract:

Objective:
To assess whether women with polycystic ovary syndrome (PCOS) follow the same age-related decline in IVF outcomes as women with tubal factor infertility over the reproductive life span. PCOS is characterized by increased ovarian reserve as assessed by antral follicle counts and anti-Müllerian hormone levels. It is unclear whether these surrogate markers of ovarian reserve reflect a true lengthening of the reproductive window.

Design:
Retrospective cohort.

Setting:
Not applicable.

Patient(s):
Women with PCOS and tubal factor infertility (42,286 cycles).

Intervention(s):
IVF.

Main Outcome Measure(s):
Pregnancy and live-birth rates.

Result(s):
The mean number of oocytes retrieved was higher in women with PCOS compared with in women with tubal factor (16.4 vs. 12.8; odds ratio [OR], 1.27; 95% confidence interval [CI], 1.25–1.29). The clinical pregnancy (42.5% vs. 35.8%; OR, 1.32; 95% CI, 1.27–1.38) and live-birth rates were also increased in women with PCOS (34.8% vs. 29.1%; OR, 1.30; 95% CI, 1.24–1.35). A similar rate of decline in clinical pregnancy and live-birth rates was noted in both groups (20–44 years). The implantation, clinical pregnancy, miscarriage, and live-birth rates were not significantly different for each year after age 40 in the two groups.

Conclusion(s):
Despite a higher oocyte yield in all age groups, women with PCOS over age 40 had similar clinical pregnancy and live-birth rates compared with women with tubal factor infertility. These findings suggest that the reproductive window may not be extended in PCOS and that patients with infertility should be treated in a timely manner despite indicators of high ovarian reserve.

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