Is ovulation induction in patients with polycystic ovary syndrome associated with negative maternal outcomes?

Marta Hentschke (BR), Carina Vitola (BR), Vitoria Piccinini (BR), Gustavo Raupp (BR), Vanessa Trindade (BR), Giovana Maffazioli (BR), Alvaro Petracco (BR), Mariangela Badalotti (BR)

[Hentschke] Pontifícia Universidade Católica do Rio Grande do Sul, [Vitola] Pontifícia Universidade Católica do Rio Grande do Sul, [Piccinini] Pontifícia Universidade Católica do Rio Grande do Sul, [Raupp] Pontifícia Universidade Católica do Rio Grande do Sul, [Trindade] Pontifícia Universidade Católica do Rio Grande do Sul, [Maffazioli] Pontifícia Universidade Católica do Rio Grande do Sul, [Petracco] Pontifícia Universidade Católica do Rio Grande do Sul, [Badalotti ] Pontifícia Universidade Católica do Rio Grande do Sul

Context: Polycystic ovary syndrome (PCOS) affects 4 to12% of reproductive-aged women, being a cause of anovulatory infertility. Thus, ovulation induction (OI) combined with programmed intercourse (PI) are recommended to treat infertility. Objective: To evaluate ovulation response, pregnancy and live birth rates, and maternal outcomes in PCOS patients submitted to OI. Methods: Observational, retrospective cohort study, conducted at HSL/PUCRS, Brazil. Ovulation control was made by serial ultrasound scans. Data were collected from medical records. Clomiphene citrate (CC) 50 mg or letrozole 2.5 mg – added to gonadotropins when indicated – was administrated for OI. Patient (s): Anovulatory infertility in women with PCOS. All other infertility factors were excluded. Interventions: None Main Results Measure (s): Pregnancy evidence, live births, maternal outcomes. Results: 279 cycles related to 81 PCOS patients (median of 2 (1-4) cycles/patient) were analyzed. Ovulation was observed in 59.9% of cycles and in 87% of patients. Mean patient and partner age were 27.8±4.7 and 32.3±6.2 y/o, respectively. Mean women body mass index (BMI) was 28.5±4.5kg/m2 and endometrial thickness close to ovulation was 7.3±2.5 mm. From 81 patients, 28 pregnancies were observed (three were pregnant twice). Of these 28 pregnancies, 78% (22/28) were clinical. At least, 50% (14/28) delivered live births, 29% aborted and 21% lost to follow-up. From the 14 pregnancies with live births, at least 57% had gestational hypertensive disease, gestational diabetes and/or both (one case of eclampsia with PRES syndrome). Two twin pregnancies went into preterm labor at 23 (newborn infants died in the neonatal intensive care unit) and 35 weeks. Of note, the 28 biochemical pregnancies were related to whom underwent OI with CC, seven of them associated with FSH (85% used 225 UI/cycle) and eight with HCG. The number of cycles to achieve clinical pregnancy was 3.0 (2.0-4.75) (five pregnancies in the 1st cycle, four in the 2nd, three in the 3rd, four in the 4th, three in the 5th one in the 6th who aborted and got pregnant again in the 8th, and another one in the 10th). Conclusions: There seems to be no great benefit to plan OI/PI for more than six cycles. CC appears to be the drug of choice, associated, or not, to gonadotropins. Metabolic disturbances observed in PCOS patients might be correlated with negative maternal and fetal outcomes. PCOS pregnant women should be forwarded to high-risk prenatal care.