Predictors of pregnancy in women with polycystic ovary syndrome.

Published

Journal Article

CONTEXT: Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. The selection of first-line therapies for ovulation induction is empiric. OBJECTIVE: The aim of the study was to develop a clinically useful predictive model of live birth with varying ovulation induction methods. DESIGN, SETTING, AND PARTICIPANTS: We built four prognostic models from a large multicenter randomized controlled infertility trial of 626 women with PCOS performed at academic health centers in the United States to predict success of ovulation, conception, pregnancy, and live birth, evaluating the influence of patients' baseline characteristics. INTERVENTIONS: Ovulation was induced with clomiphene, metformin, or the combination of both for up to six cycles or conception. MAIN OUTCOME MEASURE: The primary outcome of the trial was the rate of live births. RESULTS: Baseline free androgen index, baseline proinsulin level, interaction of treatment arm with body mass index, and duration of attempting conception were significant predictors in all four models. History of a prior loss predicted ovulation and conception, but not pregnancy or live birth. A modified Ferriman Gallwey hirsutism score of less than 8 was predictive of conception, pregnancy, and live birth (although it did not predict ovulation success). Age was a divergent predictor based on outcome; age greater than 34 predicted ovulation, whereas age less than 35 was a predictive factor for a successful pregnancy and live birth. Smoking history had no predictive value. CONCLUSIONS: A live birth prediction chart developed from basic clinical parameters (body mass index, age, hirsutism score, and duration of attempting conception) may help physicians counsel and select infertility treatments for women with PCOS.

Full Text

Duke Authors

Cited Authors

  • Rausch, ME; Legro, RS; Barnhart, HX; Schlaff, WD; Carr, BR; Diamond, MP; Carson, SA; Steinkampf, MP; McGovern, PG; Cataldo, NA; Gosman, GG; Nestler, JE; Giudice, LC; Leppert, PC; Myers, ER; Coutifaris, C; Reproductive Medicine Network,

Published Date

  • September 2009

Published In

Volume / Issue

  • 94 / 9

Start / End Page

  • 3458 - 3466

PubMed ID

  • 19509098

Pubmed Central ID

  • 19509098

Electronic International Standard Serial Number (EISSN)

  • 1945-7197

Digital Object Identifier (DOI)

  • 10.1210/jc.2009-0545

Language

  • eng

Conference Location

  • United States