Miscarriage rates following in-vitro fertilization are increased in women with polycystic ovaries and reduced by pituitary desensitization with buserelin

Abstract

To assess the risk of miscarriage after in-vitro fertilization (IVF) with respect to age, cause of infertility, ovarian morphology and treatment regimen, a retrospective analysis was performed of the first 1060 pregnancies conceived between June 1984 and July 1990 as a result of 7623 IVF cycles. Superovulation induction was achieved with human menopausal gonadotrophin (HMG) and/or purified follicle stimulating hormone (FSH) together with either clomiphene citrate or the gonadotrophin hormone-releasing hormone (GnRH) agonist buserelin, the latter either as a short 'flare' regimen or as a 'long' regimen to induce pituitary desensitization. There were 282 spontaneous abortions (26.6%) and 54 ectopic pregnancies (5.1%). The mean age of women with ongoing pregnancies was 32.2 (SD 3.9) years compared with 33.2 (SD 4.1) years in those who miscarried, which were significantly different (P = 0.008). There was no relation between the miscarriage rate and the indication for IVF. The miscarriage rate was 23.6% in women with normal ovaries compared with 35.8% in those with polycystic ovaries [P = 0.0038, 95% confidence interval (CI) 4.68-23.10%]. There was no difference in the miscarriage rate between treatment with HMG or FSH. Women whose ovaries were normal on ultrasound were just as likely to miscarry if they were treated with clomiphene or with the long buserelin protocol. Those with polycystic ovaries, however, had a significant reduction in the rate of miscarriage when treated with the long buserelin protocol, 20.3% (15/74), compared with clomiphene citrate, 47.2% (51/108) (P = 0.0003, 95% CI 13.82-40.09%).

Comparison of embryological and clinical outcome in GnRH antagonist vs. GnRH agonist protocols for in vitro fertilization in PCOS non-obese patients. A prospective randomized study

“…Since LH determines the final stage of the oocyte nucleus maturation and the degeneration of gap junctions, the elevated levels of LH may also activate premature meiotic cleavage, damage the oocyte nucleus and lead to apoptosis [21]. High LH concentrations in patients with PCOS have been associated with an increased rate of miscarriage [22], although it has been questioned recently [23,24]. Increased androgen concentration in follicular fluid induced by elevated LH may block the dominant follicle selection and cause the follicle degeneration.…”

Hirsutismo: diagnóstico diferencial

“…Entretanto, não há comprometimento da fertilidade (46). Em determinadas situações, sua presença pode ser um indicador útil como preditor de resposta à citrato de clomifeno em mulheres com infertilidade (47) e risco de síndrome de hiperstimulação ovariana (48).…”

Off to a good start: the influence of pre- and periconceptional exposures, parental fertility, and nutrition on children's health.

“…Because twinning carries a suite of increased health risks (Kovacs et al 1989;Naeye et al 1978), this is not viewed as a benign outcome. Use of ovulation drugs, particularly clomiphene, has also been implicated as a risk factor for spontaneous abortion (Balen et al 1993;Dickey et al 1996;McFaul et al 1993;Oktay et al 2000;Shoham et al 1991), preterm delivery (Olivennes et al 1993;Sundstrom et al 1997) and low birth weight (Olivennes et al 1993;Sundstrom et al 1997). This research raises the question about whether such medications might adversely affect oocytes directly.…”