Pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization

Capsule:
The authors identify PCOS as an independent risk factor for the development of specific pregnancy complications in singleton pregnancies after IVF with or without intracytoplasmic sperm injection.

Authors:
Lynn Sterling, M.D., Jennifer Liu, H.B.Sc., Nan Okun, M.D., F.R.C.S.C., M.H.Sc., Anamika Sakhuja, M.B.B.S., M.S., M.C.E., Sony Sierra, M.D., M.Sc., F.R.C.S.C., Ellen Greenblatt, M.D., F.R.C.S.C.

Volume 105, Issue 3, Pages 791-797

Abstract:

Objective:
To determine whether the diagnosis of polycystic ovary syndrome (PCOS) independently predicts increased rates of pregnancy complications relative to control subjects, after adjusting for important confounders.

Design:
Retrospective cohort.

Setting:
A single university-affiliated reproductive endocrinology unit.

Patient(s):
A review of all pregnancies after fresh IVF with or without intracytoplasmic sperm injection transfers from December 2006 to 2012 (n = 1,084) identified 394 eligible singleton births (71 women with PCOS; 323 controls without).

Intervention(s):
None.

Main Outcome Measure(s):
Singleton births were assessed for selected adverse pregnancy and birth outcomes.

Result(s):
Women with PCOS demonstrated a higher risk of developing the following pregnancy complications after adjusting for differences in age, parity, body mass index, and time to conception: gestational diabetes (adjusted odds ratio [AOR] 3.15, 95% confidence interval [CI] 1.35–7.33), hypertensive disorders of pregnancy (AOR 4.25, 95% CI 1.94–9.32), preterm birth <37 weeks (AOR 2.30, 95% CI 1.07–4.97), and large for gestational age >90th percentile (AOR 2.77, 95% CI 1.21–6.35). The increased risk of preterm birth <37 weeks was eliminated after adjusting for development of hypertensive disorders of pregnancy, whereas the increased risk of large for gestational age remained significant after adjusting for gestational diabetes mellitus status. Time to conception did not differ significantly between groups, nor did rates of antepartum hemorrhage, cesarean section, or perinatal mortality. Conclusion(s):
Polycystic ovary syndrome independently predicts higher risk of adverse pregnancy outcomes after adjusting for differences in maternal age, parity, body mass index, and time to conception. This new information may be of relevance in counseling and monitoring women with PCOS, although larger prospective studies may be needed to validate our findings.

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