KatCarney

Predictors of Pregnancy in Women with Polycystic Ovary Syndrome

{Kat note: If it were me, I'd try to get my hands on this entire study...or ask your RE to get it for you...}

Context: Polycystic ovary syndrome is the most common cause of anovulatory infertility. The selection of first line therapies for ovulation induction is empiric.

Objective: To develop a clinically useful predictive model of live birth with varying ovulation induction methods.

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.

Design, Setting and Participants: We built four prognostic models from a large multi-center randomized controlled infertility trial of 626 women with PCOS performed at academic health centers in the U.S. to predict success of ovulation, conception, pregnancy and live birth, evaluating the influence of patients' baseline characteristics. Interventions: Ovulation induction with clomiphene, metformin, or the combination of both for up to 6 cycles or conception.

Main Outcome Measure: Live birth 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 nor live birth. A modified Ferriman Gallwey hirsutism score 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.

SOURCE: J Clin Endocrinol Metab. 2009 Jun 9.

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; for the Reproductive Medicine Network.

Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA (Drs Rausch and Coutifaris); Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, PA (Dr Legro); Department of Obstetrics and Gynecology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (Drs Myers and Barnhart); University of Colorado, Denver, CO (Dr Schlaff); University of Texas Southwestern Medical Center, Dallas, TX (Dr Carr); Departments of Obstetrics and Gynecology, Wayne State University, Detroit, MI (Dr Diamond); Baylor College of Medicine, Houston, TX (Dr Carson); University of Alabama, Birmingham, AL (Dr Steinkampf); University of Medicine and Dentistry of New Jersey, Newark, NJ (Dr McGovern); Stanford University, Stanford, CA (Dr Cataldo); University of Pittsburgh, Pittsburgh, PA (Dr Gosman); Department of Medicine, Virginia Commonwealth University School of Medicine (Dr Nestler); Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, CA (Dr Giudice) Reproductive Sciences Branch, National Institute of Child Health and Human Development, Bethesda, MD (Dr Leppert).

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