Which patient features predict the time to pregnancy (TTP) leading to term live birth in infertile women diagnosed with polycystic ovary syndrome (PCOS)?
Prospective cohort follow-up study was completed, in which initial standardized phenotyping was conducted at two Dutch university medical centres from January 2004 to January 2014. Data were linked to the Netherlands Perinatal Registry to obtain pregnancy outcomes for each participant. All women underwent treatment according to a standardized protocol, starting with ovulation induction as first-line treatment. Predictors of pregnancies (leading to term live births) during the first year after PCOS diagnosis were evaluated.
A total of 1779 consecutive women diagnosed with PCOS between January 2004 and January 2014 were included. In the first year following screening, 659 (37%) women with PCOS attained a pregnancy leading to term birth (≥37 weeks of gestational age). A higher chance of pregnancy was associated with race, smoking, body mass index (BMI), insulin, total testosterone and sex hormone-binding globulin (SHBG) concentrations (c-statistic = 0.59).
Predictors of an increased chance of a live birth include White race, no current smoking, lower BMI, insulin and total testosterone concentrations, and higher SHBG concentrations. This study presents a nomogram to predict the chances of achieving a pregnancy (leading to a term live birth) within 1 year of treatment.
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- The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance.Hum. Reprod. Update. 2016; 22: 687-708https://doi.org/10.1093/humupd/dmw025
- How time to healthy singleton delivery could affect decision-making during infertility treatment: a Delphi consensus.Reprod. Biomed. Online. 2019; 38: 118-130https://doi.org/10.1016/j.rbmo.2018.09.019
- The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis.Hum. Reprod. 2016; 31: 2841-2855https://doi.org/10.1093/humrep/dew218
- Pre-conception characteristics predict obstetrical and neonatal outcomes in women with polycystic ovary syndrome.J. Clin. Endocrinol. Metab. 2019; 104: 809-818https://doi.org/10.1210/jc.2018-01787
- Gestational age at birth and mortality in young adulthood.JAMA. 2011; 306: 1233-1240https://doi.org/10.1001/jama.2011.1331
- Cardiovascular and metabolic profiles amongst different polycystic ovary syndrome phenotypes: who is really at risk?.Fertil. Steril. 2014; 102 (e3): 1444-1451https://doi.org/10.1016/j.fertnstert.2014.08.001
- [Practice guideline ‘Perinatal management of extremely preterm delivery’].Ned. Tijdschr. Geneeskd. 2010; 154: A2701
- Anti-Müllerian hormone does not predict time to pregnancy: results of a prospective cohort study.Gynecol. Endocrinol. 2017; 33: 644-648https://doi.org/10.1080/09513590.2017.1306848
- High singleton live birth rate following classical ovulation induction in normogonadotrophic anovulatory infertility (WHO 2).Hum. Reprod. 2003; 18: 2357-2362https://doi.org/10.1093/humrep/deg459
- One-year survival of extremely preterm infants after active perinatal care in Sweden.JAMA. 2009; 301: 2225-2233https://doi.org/10.1001/jama.2009.771
- The use of big data to inform individualized ovarian stimulation for infertility care is still in its infancy.Fertil. Steril. 2022; 117: 419-420https://doi.org/10.1016/j.fertnstert.2021.12.011
- Seafood intake, sexual activity, and time to pregnancy.J. Clin. Endocrinol. Metab. 2018; 103: 2680-2688https://doi.org/10.1210/jc.2018-00385
- Indicators for metabolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria.Hum. Reprod. 2009; 24: 710-717https://doi.org/10.1093/humrep/den433
- Metabolic syndrome and time to pregnancy: a retrospective study of nulliparous women.BJOG. 2019; 126: 852-862https://doi.org/10.1111/1471-0528.15647
- A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome.Hum. Reprod. Update. 2006; 12: 13-21https://doi.org/10.1093/humupd/dmi036
- Two new prediction rules for spontaneous pregnancy leading to live birth among subfertile couples, based on the synthesis of three previous models.Hum. Reprod. 2004; 19: 2019-2026https://doi.org/10.1093/humrep/deh365
- A nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility.Fertil. Steril. 2002; 77: 91-97https://doi.org/10.1016/s0015-0282(01)02929-6
- Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome: data from a large community-based cohort study.J. Women's Health (Larchmt). 2015; 24: 299-307https://doi.org/10.1089/jwh.2014.5000
- Identification and replication of prediction models for ovulation, pregnancy and live birth in infertile women with polycystic ovary syndrome.Hum. Reprod. 2015; 30: 2222-2233https://doi.org/10.1093/humrep/dev182
- Surrogate end-points or primary outcomes in clinical trials in women with polycystic ovary syndrome?.Hum. Reprod. 2004; 19: 1697-1704https://doi.org/10.1093/humrep/deh322
- Letrozole versus clomiphene for infertility in the polycystic ovary syndrome.N. Engl. J. Med. 2014; 371: 119-129https://doi.org/10.1056/NEJMoa1313517
- Female adiposity and time-to-pregnancy: a multiethnic prospective cohort.Hum. Reprod. 2018; 33: 2141-2149https://doi.org/10.1093/humrep/dey300
- Prematurity: an overview and public health implications.Annu. Rev. Public Health. 2011; 32: 367-379https://doi.org/10.1146/annurev-publhealth-090810-182459
- Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis.Hum. Reprod. Update. 2010; 16: 347-363https://doi.org/10.1093/humupd/dmq001
- Long-term medical and social consequences of preterm birth.N. Engl. J. Med. 2008; 359: 262-273https://doi.org/10.1056/NEJMoa0706475
- Prediction of chances for success or complications in gonadotrophin ovulation induction in normogonadotrophic anovulatory infertility.Reprod. Biomed. Online. 2003; 7: 170-178https://doi.org/10.1016/s1472-6483(10)61747-6
- Predictors of pregnancy in women with polycystic ovary syndrome.J. Clin. Endocrinol. Metab. 2009; 94: 3458-3466https://doi.org/10.1210/jc.2009-0545
- Contemporary reproductive outcomes for patients with polycystic ovary syndrome: a retrospective observational study.J. Clin. Endocrinol. Metab. 2016; 101: 1664-1672https://doi.org/10.1210/jc.2015-2682
- Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.Fertil. Steril. 2004; 81: 19-25https://doi.org/10.1016/j.fertnstert.2003.10.004
- A personalized medicine approach to ovulation induction/ovarian stimulation: development of a predictive model and online calculator from level-I evidence.Fertil. Steril. 2022; 117: 408-418https://doi.org/10.1016/j.fertnstert.2021.10.024
- Couples’ body composition and time-to-pregnancy.Hum. Reprod. 2017; 32: 662-668https://doi.org/10.1093/humrep/dex001
- In vitro fertilization outcomes in women with polycystic ovary syndrome: a meta-analysis.Eur. J. Obstet. Gynecol. Reprod. Biol. 2021; 259: 146-152https://doi.org/10.1016/j.ejogrb.2021.02.023
- Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome.Hum. Reprod. 2018; 33: 1602-1618https://doi.org/10.1093/humrep/dey256
- Consensus on infertility treatment related to polycystic ovary syndrome.Hum. Reprod. 2008; 23: 462-477https://doi.org/10.1093/humrep/dem426
- The lasso method for variable selection in the Cox model.Stat. Med. 1997; 16: 385-395https://doi.org/10.1002/(sici)1097–0258(19970228)16:4<385::aid-sim380>3.0.co;2–3
- High singleton live birth rate confirmed after ovulation induction in women with anovulatory polycystic ovary syndrome: validation of a prediction model for clinical practice.Fertil. Steril. 2012; 98 (e1): 761-768https://doi.org/10.1016/j.fertnstert.2012.04.027
- First-line ovulation induction for polycystic ovary syndrome: an individual participant data meta-analysis.Hum. Reprod. Update. 2019; 25: 717-732https://doi.org/10.1093/humupd/dmz029
- Gonadotrophins for ovulation induction in women with polycystic ovary syndrome.Cochrane Database Syst. Rev. 2019; 1CD010290https://doi.org/10.1002/14651858.CD010290.pub3
Marlise Gunning obtained her MD, PhD and MSc in Clinical Epidemiology from the University of Utrecht. She currently works as a MD in OBGYN. Dr Gunning is active as Junior Deputy of the ESHRE's Special Interest Group for Reproductive Endocrinology and also serves on the Scientific Organizer Committee for this group.
Within 1 year of treatment, 37% of women with PCOS attain a pregnancy leading to term live birth. White race, non-smoking, low BMI, insulin and testosterone, and high SHBG predict this outcome. A nomogram is presented that predicts the likelihood of this outcome, which may allow for improvements in individualized treatment strategies.
Published online: October 05, 2022
Accepted: September 28, 2022
Received in revised form: September 26, 2022
Received: August 9, 2022Declaration: The authors report no financial or commercial conflicts of interest.
© 2022 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.