Predictors of pregnancy in women with polycystic ovary syndrome

Abstract

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.

Trial registration: ClinicalTrials.gov NCT00068861.

Figure 1

Live birth prediction chart for method of ovulation induction using clinical measures. How to use the chart: 1) choose the row of boxes depending on your desired treatment option; 2) choose the column of boxes that matches the time your patient has been attempting conception and her age; and 3) using her BMI and hirsutism score, find the cell that matches her chance of live birth success for each of the three treatment options.