TY - JOUR
T1 - Predictors of pregnancy in women with polycystic ovary syndrome
AU - Rausch, Mary E.
AU - Legro, Richard S.
AU - Barnhart, Huiman X.
AU - Schlaff, William D.
AU - Carr, Bruce R.
AU - Diamond, Michael P.
AU - Carson, Sandra A.
AU - Steinkampf, Michael P.
AU - McGovern, Peter G.
AU - Cataldo, Nicholas A.
AU - Gosman, Gabriella G.
AU - Nestler, John E.
AU - Giudice, Linda C.
AU - Leppert, Phyllis C.
AU - Myers, Evan R.
AU - Coutifaris, Christos
N1 - Funding Information:
This work was supported by National Institutes of Health/National Institute of Child Health and Human Development Grants U10 HD27049 (to C.C.), U10 HD38992 (to R.S.L.), U01 HD38997 (to E.R.M.), U10 HD39005 (to M.P.D.), U10 HD27011 (to S.A.C.), U10 HD33172 (to M.P.S.), U10 HD38988 (to B.R.C.), U10 HD38998 (to W.D.S.), U10 HD38999 (to P.M.G.), and U54-HD29834 to University of Virginia Center for Research in Reproduction Ligand Assay and Analysis Core; General Clinical Research Center Grants MO1RR00056 to the University of Pittsburgh , and MO1RR10732 and Construction Grant C06 RR016499 to Pennsylvania State University. Glucophage XR (Metformin) and matching placebo were provided by Bristol-Myers Squibb.
Funding Information:
Disclosure Summary: R.S.L. reports receiving lecture fees from Serono and grant support from Solvay. J.E.N. reports equity ownership/stock options in Bristol Myers Squibb. P.C.L., E.R.M., and H.X.B. report grant support from Tap; H.X.B. also reports grant support from Ortho Biotech; and E.R.M. has received research support from Merck and is also a consultant. W.D.S. has grant support from Organon and Wyeth. N.A.C. consults for Organon. P.G.M. has grant support from Ferring and Serono. M.P.D. reports grant support from Serono, Tap, Glaxo Smith Klein, and Merck, and has served as a consultant for Tap and Serono. S.A.C. is a medical advisor to EMD Serono, Ferring, Columbia Labs, and FUJIREBIO. M.E.R., C.C., L.C.G., M.P.S., G.G.G., and B.R.C. report no disclosures.
PY - 2009/9
Y1 - 2009/9
N2 - 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.
AB - 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.
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U2 - 10.1210/jc.2009-0545
DO - 10.1210/jc.2009-0545
M3 - Article
C2 - 19509098
AN - SCOPUS:69949096903
SN - 0021-972X
VL - 94
SP - 3458
EP - 3466
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 9
ER -