Predictors of pregnancy in women with polycystic ovary syndrome.
BACKGROUND
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.


METHODS
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.


METHODS
Ovulation was induced with clomiphene, metformin, or the combination of both for up to six cycles or conception.


METHODS
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.
Rausch
Mary E
ME
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Legro
Richard S
RS
Barnhart
Huiman X
HX
Schlaff
William D
WD
Carr
Bruce R
BR
Diamond
Michael P
MP
Carson
Sandra A
SA
Steinkampf
Michael P
MP
McGovern
Peter G
PG
Cataldo
Nicholas A
NA
Gosman
Gabriella G
GG
Nestler
John E
JE
Giudice
Linda C
LC
Leppert
Phyllis C
PC
Myers
Evan R
ER
Coutifaris
Christos
C
D000328:Adult; D015992:Body Mass Index; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000503:physiopathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*