High singleton live birth rate confirmed following ovulation induction in women with anovulatory polycystic ovary syndrome: Validation of a prediction model for clinical practice

Capsule:
Classical ovulation induction is an effective therapy for women with polycystic ovary syndrome. Women with a poor treatment prognosis can be identified according to age, duration of infertility, and body mass index.

Authors:
Susanne M.Veltman-Verhulst, M.D., Bart C.J.M. Fauser, M.D., Ph.D., Marinus J.C. Eijkemans, M.Sc., Ph.D.

Volume 98, Issue 3, Pages 761-768.e1, September 2012

Abstract:

Objective:
To evaluate the cumulative singleton live birth rate following classical ovulation induction in women with anovulatory Polycystic Ovary Syndrome (PCOS) and to validate a previously developed prediction model.

Design:
Prospective follow-up study.

Setting:
Tertiary Infertility Unit, University Medical Center Utrecht, the Netherlands.

Patients:
Validation cohort of 108 treatment naïve anovulatory PCOS patients.

Interventions:
Conventional ovulation induction, applying clomiphene citrate as first line treatment followed by exogenous gonadotropins as second line intervention.

Main Outcome Measures:
Singleton live birth prediction. Model calibration and discrimination were assessed for the initial model (variables included: age, duration of infertility and insulin/glucose ratio) and a second model in which the insulin/glucose ratio was replaced by Body Mass Index (BMI).

Results:
The cumulative singleton live birth rate after 12 and 24 months was 60% and 78%, respectively. Overall, the observed rates were higher than predicted; hazard ratio of 1.21 (95% CI 0.89-1.64), 1st model and 1.25 (95% CI 1.20-1.30), 2nd model. However, the predictive capacity of the model variables was reliable with calibration slopes of 0.79 (95% CI -0.04-1.63) and 1.06 (95% CI 0.95–1.18), respectively.

Conclusions:
The current study confirms the previously reported good treatment prognosis for women with PCOS undergoing classical ovulation induction. Women with a poor prognosis – where alternative treatment options may be considered – can best be identified by a prediction model including age, duration of infertility and BMI.

Clinical trial registration number:
NCT00821379

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