Polycystic ovary syndrome and its effect on pregnancy outcomes in women with infertility
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20243582Keywords:
Polycystic ovary syndrome, Pregnancy and infertilityAbstract
Background: Polycystic ovary syndrome (PCOS) is a multisystem disorder featuring reproductive issues and metabolic problems, with a global prevalence of 5-15%. PCOS is linked to infertility, oligomenorrhea, amenorrhea, and adverse pregnancy outcomes like miscarriage and gestational diabetes. Genetic factors contribute to its cause, and lifestyle changes can improve its metabolic and endocrine impacts, aiding in fertility. This study aimed to explore the association between PCOS and various pregnancy outcomes in infertile women by comparison with control group.
Methods: This cross-sectional analytical study was conducted at the department of obstetrics and gynecology (indoor and outdoor) in BSMMU, Dhaka from January 2021 December 2021. Along with ethical approval, the study involving 275 female participants selected via purposive sampling and categorized into two groups: case group (n=110) with PCOS and control group (n=165) without PCOS. Data collection included baseline demographics, blood samples, and IVF/ICSI outcomes.
Results: This study explored how polycystic ovary syndrome (PCOS) impacts pregnancy outcomes in infertile women undergoing their first IVF treatment. It included 275 participants. The case group's average age was slightly higher (p<0.001). The case group had lower BMI (p<0.001) and higher rates of primary infertility (p<0.001). Ovulatory disorders were more common in the case group (p<0.001). The case group exhibited higher fasting insulin levels (p<0.001). The case group had higher clinical pregnancy (p<0.001) and live birth rates (p=0.003) but higher early miscarriage rates (p<0.001).
Conclusions: PCOS negatively affects infertility and pregnancy, causing ovulatory issues, insulin resistance, and complications like gestational diabetes. Despite lower fertility and pregnancy rates, effective treatments can lead to live births comparable to non-PCOS women.
References
Franks S, Gharani N, McCarthy M. Candidate genes in polycystic ovary syndrome. Hum Reprod Update. 2001;7(4):405-10.
Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998;83(9):3078-82.
Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012;97(1):28-38.
ESHRE TR, ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25.
Rotterdam ESHRE/ASRM‐Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long‐term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-7.
Wild RA. Long-term health consequences of PCOS. Human Reprod Update. 2002;8(3):231-41.
Norman RJ, Noakes M, Wu R, Davies MJ, Moran L, Wang JX. Improving reproductive performance in overweight/obese women with effective weight management. Hum Reprod Update. 2004;10(3):267-80.
Laven JS, Imani B, Eijkemans MJ, Fauser BC. New approach to polycystic ovary syndrome and other forms of anovulatory infertility. Obstet Gynecol Surv. 2002;57(11):755-67.
Balen AH. Polycystic ovarian syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod. 1995;10:2705-12.
Hart R, Hickey M, Franks S. Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome. Best Pract Res Clin Obstet Gynecol. 2004;18(5):671-83.
Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, et al. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab. 2004;89(2):453-62.
Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-18.
Katulski K, Czyzyk A, Podfigurna-Stopa A, Genazzani AR, Meczekalski B. Pregnancy complications in polycystic ovary syndrome patients. Gynecol Endocrinol. 2015;31(2):87-91.
Palomba S, Santagni S, Falbo A, La Sala GB. Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Women’s Health. 2015:745-63.
Toulis KA, Goulis DG, Kolibianakis EM, Venetis CA, Tarlatzis BC, Papadimas I. Risk of gestational diabetes mellitus in women with polycystic ovary syndrome: a systematic review and a meta-analysis. Fertil Steril. 2009;92(2):667-77.
Yu HF, Chen HS, Rao DP, Gong J. Association between polycystic ovary syndrome and the risk of pregnancy complications: a PRISMA-compliant systematic review and meta-analysis. Medicine. 2016;95(51):e4863.
Barker DJ. Fetal programming of coronary heart disease. Trends Endocrinol Metab. 2002;13(9):364-8.
Legro RS, Driscoll D, Strauss III JF, Fox J, Dunaif A. Evidence for a genetic basis for hyperandrogenemia in polycystic ovary syndrome. Proceed Nat Acad Sci. 1998;95(25):14956-60.
Rajashekar L, Krishna D, Patil M. Polycystic ovaries and infertility: our experience. J Hum Reprod Sci. 2008;1(2):65-72.
Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019(3).
Haakova L, Cibula D, Rezabek K, Hill M, Fanta M, Zivny J. Pregnancy outcome in women with PCOS and in controls matched by age and weight. Hum Reprod. 2003;18(7):1438-41.
Tracy L, Setji A, Brown J, Feinglos Mark N. Gestational diabetes mellitus. Clin Diabetes. 2005;23(1):17-24.
Liu S, Mo M, Xiao S, Li L, Hu X, Hong L, et al. Pregnancy outcomes of women with polycystic ovary syndrome for the first in vitro fertilization treatment: a retrospective cohort study with 7678 patients. Front Endocrinol. 2020;11:575337.
Franks S. Polycystic ovary syndrome. Medicine. 2013;41(10):553-6.
Naver KV, Grinsted J, Larsen SO, Hedley PL, Jørgensen FS, Christiansen M, et al. Increased risk of preterm delivery and pre‐eclampsia in women with polycystic ovary syndrome and hyperandrogenaemia. BJOG. 2014;121(5):575-81.
Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745-9.
Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006;12(6):673-83.
Nivedhitha SV, Sankareswari R. Pregnancy outcome in women with polycystic ovary syndrome. Int J Reprod Contracept Obstet Gynecol. 2015;4(4):1169-76.
Sterling L, Liu J, Okun N, Sakhuja A, Sierra S, Greenblatt E. Pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization. Fertil Steril. 2016;105(3):791-7.
Kjerulff LE, Sanchez-Ramos L, Duffy D. Pregnancy outcomes in women with polycystic ovary syndrome: a metaanalysis. Am J Obstet Gynecol. 2011;204(6):558-e1.
Qin JZ, Pang LH, Li MJ, Fan XJ, Huang RD, Chen HY. Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2013;11:1-4.
Boomsma CM, Fauser BC, Macklon NS. Pregnancy complications in women with polycystic ovary syndrome. Semin Reprod Med. 2008;26(01):072-084.
Lo JC, Feigenbaum SL, Escobar GJ, Yang J, Crites YM, Ferrara A. Increased prevalence of gestational diabetes mellitus among women with diagnosed polycystic ovary syndrome: a population-based study. Diabetes Care. 2006;29(8):1915-7.
Holte J. Disturbances in insulin secretion and sensitivity in women with the polycystic ovary syndrome. Baillière’s Clin Endocrinol Metab. 1996;10(2):221-47.
