Fecundity among women with polycystic ovary syndrome (PCOS)—a population-based study

Abstract

STUDY QUESTION Does the long-term fecundity of women with polycystic ovary syndrome (PCOS) differ from those without PCOS? SUMMARY ANSWER Cumulative probability of childbirth is similar between women with and without PCOS. WHAT IS KNOWN ALREADY PCOS is the main cause of anovulatory infertility in women after menarche. Previous studies indirectly suggest that fecundity in women with PCOS over the longer term may not be lower than in women without PCOS. STUDY DESIGN, SIZE, DURATION This is a population-based study using four linked Swedish national registries. A total of 45 395 women with PCOS and 217 049 non-PCOS women were included. Follow-up began at the age of 18 years and continued for a maximum of 26 years, from 1989 to the end of 2015. Childbirth was the main outcome, as identified from the Medical Birth Register. PARTICIPANTS/MATERIALS, SETTING, METHODS All women born between 1971 and 1997 who were identified with a PCOS diagnosis in the Swedish Patient Registry between 1 January 2001 and 31 December 2016 were included in the study population. Five controls per women with PCOS were randomly drawn from the Total Population Registry. The control women were born in the same year and living in the same municipality as the patient. The fecundity ratio (FR) was calculated by clustered Cox regression using a robust variance, adjusted for maternal birth period, country of birth and level of education. MAIN RESULTS AND THE ROLE OF CHANCE The cumulative probability of childbirth was 80.2% (95% CI, 79.5–80.9%) in women with PCOS and 78.2% (95% CI, 77.9–78.5%) in those without PCOS. Adjusted FR was 0.81 (95% CI, 0.80–0.82) for first childbirth and 0.58 (95% CI, 0.57–0.60) for first childbirth following a spontaneous pregnancy. The FR for second childbirth was 0.79 (95% CI, 0.77–0.80). Women with PCOS had more than one child less frequently than the comparison group. Within the PCOS group, early age at diagnosis, later birth year, Nordic country of origin and low educational level positively influenced the FR. LIMITATIONS, REASONS FOR CAUTION Results are not adjusted for BMI, and time from intention to conceive to first childbirth could not be captured. Data on pregnancies, miscarriages or abortions and fertility treatment are unknown for women who did not give birth during the study period. Women with PCOS who did not seek medical assistance might have been incorrectly classified as not having the disease. Such misclassification would lead to an underestimation of the true association between PCOS and outcomes. WIDER IMPLICATIONS OF THE FINDINGS While cumulative probability of childbirth is similar between groups, women with PCOS need longer time to achieve their first childbirth. Women with PCOS have a lower FR and give birth to fewer children per woman than women without PCOS. Early diagnosis of and information about PCOS may improve affected women’s reproductive potential. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Swedish Society of Medicine. Inger Sundström Poromaa has, over the past 3 years, received compensation as a consultant and lecturer for Bayer Schering Pharma, MSD, Gedeon Richter, Peptonics and Lundbeck A/S. The other authors declare no competing interests.

Pregnancy outcome in women with polycystic ovary syndrome in relation to second-trimester testosterone levels

“…The syndrome is characterized by hyperandrogenism, anovulation and polycystic ovaries (Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome [PCOS], 2004), and the polycystic ovarian morphology is associated with high levels of anti-Müllerian hormone (AMH) (Indran et al, 2018). In childbearing age, infertility is one of the most common problems in women with PCOS, but with assisted reproductive technology, longitudinal studies suggest overall high fecundity (Persson et al, 2019). Once pregnant, women with PCOS face a higher risk of miscarriage, gestational diabetes, gestational hypertension, preeclampsia and preterm birth (Palomba et al, 2015;Yu et al, 2016;Bahri Khomami et al, 2018;Bahri Khomami et al, 2019).…”

A pilot study of assisting IVF by personalized Endo-Gym®exercises

“…Their condition causing subfertility and compromising conception was often uncharacterized. In category 2 ("Hormonal"), women had conditions related to menopause or sub-fertility, such as POF (also empty ovary or ovarian insufficiency), early menopause, irregular/painful period or PCOS [12,13] and low libido. Their primary aim was to relieve adverse longterm consequences of their condition (e.g.…”

“…Beneficial effects of the method combining personalized physical exercises, fertility-optimizing diet and personal coaching are statistically established by following 251 women who have exercised Endo-Gym® for various periods of time during 2012-2019, with the goal of improving their success in IVF or seeking remedy for a range of other gynecological conditions. Several of them had already undergone unsuccessful IVF cycles or struggled with directly related fertility issues, such as polycystic ovary syndrome (PCOS) [12] or premature ovarian failure (POF, also ovarian insufficiency) [13]. Others had different but not less disturbing gynecological problems, such as incontinence, pelvic organ prolapse (POP), irregular/painful periods and low libido.…”

Prediction of Gut Microbial Community Structure and Function in Polycystic Ovary Syndrome With High Low-Density Lipoprotein Cholesterol

“…Polycystic ovary syndrome (PCOS) is one of the most common anovulatory infertility in women of childbearing age ( Zhao et al., 2016 ; Persson et al., 2019 ). The prevalence rate of PCOS in women of childbearing age is as high as 5–10%, accounting for 50–70% of anovulatory infertility ( O’Brien and Emans, 2008 ).…”