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Predicting pregnancy chances leading to term live birth in oligo/anovulatory women diagnosed with PCOS

  • Author Footnotes
    # These authors should be considered joint first authors.
    Marlise N. Gunning
    Footnotes
    # These authors should be considered joint first authors.
    Affiliations
    Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht Utrecht, the Netherlands
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  • Author Footnotes
    # These authors should be considered joint first authors.
    Jacob P. Christ
    Correspondence
    Corresponding author.
    Footnotes
    # These authors should be considered joint first authors.
    Affiliations
    Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht Utrecht, the Netherlands

    Cleveland Clinic Lerner College of Medicine, Cleveland Ohio, USA

    Department of Obstetrics & Gynecology, University of Washington Medical Center, SeattleWashington, USA
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  • Bas B. van Rijn
    Affiliations
    Department of Obstetrics, University Medical Center Utrecht Utrecht, the Netherlands

    Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Maria P.H. Koster
    Affiliations
    Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Gouke J. Bonsel
    Affiliations
    Department of Obstetrics, University Medical Center Utrecht Utrecht, the Netherlands
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  • Joop S.E. Laven
    Affiliations
    Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Marinus J.C. Eijkemans
    Affiliations
    Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht Utrecht, the Netherlands

    Julius Center for Health Sciences and Primary care, University Medical Center Utrecht Utrecht, the Netherlands
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  • Bart C.J.M. Fauser
    Affiliations
    Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht Utrecht, the Netherlands
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  • Author Footnotes
    # These authors should be considered joint first authors.
Published:October 05, 2022DOI:https://doi.org/10.1016/j.rbmo.2022.09.024

      Abstract

      Research question

      Which patient features predict the time to pregnancy (TTP) leading to term live birth in infertile women diagnosed with polycystic ovary syndrome (PCOS)?

      Design

      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.

      Results

      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).

      Conclusions

      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.

      Keywords

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      Biography

      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.
      Key message
      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.