In a nutshell
This study investigated the effect of combined oral contraceptives (COC) on fertility outcomes (FOs) in women with polycystic ovarian syndrome (PCOS). They found that a history of COC treatment may affect FOs in PCOS.
Some background
Polycystic ovarian syndrome (PCOS) is a common cause of infertility. Women with PCOS do not ovulate regularly. This makes it difficult to achieve a pregnancy naturally. Many women with PCOS undergo assisted reproductive technologies (ART). The first step in ART is harvesting of oocyte (egg) follicles. Normally, a follicle is released during the menstrual cycle. This does not occur in PCOS women. PCOS women undergo ovulation induction (OI). Drugs that stimulate the release of oocytes are administered. They are then harvested and used for ART. This includes in vitro fertilization (IVF).
Some doctors prescribe combined oral contraceptives (COC) before OI. This is to regulate the menstrual cycle. There is conflicting opinion on the effect of COC on fertility outcomes (FOs). It is unclear if COCs have an effect on FOs in women with PCOS.
Methods & findings
This study reviewed 7 published reports on ART in PCOS. Some women were treated with COC in these studies. Some underwent OI as part of ART. The authors analyzed and compared the data in these studies. The primary FOs were clinical pregnancy rate (CPR), miscarriage rate and live birth rate (LBR). The rate of ovarian hyperstimulation syndrome (OHSS) was also compared. OHSS is a serious complication of OI.
CPR was not altered by treatment with COC. OHSS rates were similar in both groups. However, the miscarriage rate was significantly higher (by 33%) in COC-treated patients. LBR was significantly lower (by 28%) in COC-treated women. Some protocols involved a gonadotrophin-releasing hormone (GnRH) antagonist. Higher miscarriage rate and lower LBR was seen with this OI protocol.
The bottom line
The authors concluded that a history of COC treatment might affect FOs in women with PCOS undergoing fertility treatment.
The fine print
A small number of trials were included in this analysis. Trial designs and protocols differed across the studies. More investigation is needed.
What’s next?
If you have any concerns regarding infertility, please consult with your physician.
Published By :
Archives of Gynecology and Obstetrics
Date :
Jun 06, 2019
