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Predictors of Pregnancy in Women with Polycystic Ovary Syndrome

Department of Obstetrics and Gynecology (M.E.R., C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania 17033; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.R.M., H.X.B.), Duke University Medical Center, Durham, North Carolina 27710; University of Colorado (W.D.S.), Denver, Colorado 80045; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; Departments of Obstetrics and Gynecology (M.P.D.), Wayne State University, Detroit, Michigan 48201; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35249; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15213; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology (L.C.G.), University of California at San Francisco, San Francisco, California 94110; and Reproductive Sciences Branch (P.C.L.), National Institute of Child Health and Human Development, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Richard S. Legro, M.D., Department of Obstetrics and Gynecology, Penn State College of Medicine, M.S. Hershey Medical Center, 500 University Drive, H103, Hershey, Pennsylvania 17033. E-mail: RSL1{at}psu.edu.

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.

This article has been cited by other articles:

				B. C. J. M. Fauser and M. J. C. Eijkemans Predicting Pregnancy in Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., September 1, 2009; 94(9): 3183 - 3184. [Full Text] [PDF]