In a nutshell
This study examined whether polycystic ovarian syndrome is associated with an extended fertility beyond the age of 40.
Patients with polycystic ovarian syndrome (PCOS), commonly present with irregular ovulation and menstruation, elevated testosterone levels, which can lead to an overabundance of body hair, and multiple small cysts within the ovaries. Women with PCOS are generally successful at achieving pregnancy, either naturally or through assisted reproduction such as ovulation induction and in vitro fertilization (IVF). Overall, pregnancy and live birth rates are similar for women with PCOS and women without fertility issues. Women with PCOS tend to have an increased number of eggs preparing to be released from the ovary, as well as increased levels of anti-Müllerian hormone, which is produced by growing eggs and is thought to reflect ovarian reserve, or the number of eggs a woman has remaining. Therefore, it has been hypothesized that PCOS is associated with an increase in ovarian reserve. As fertility declines after the age of 40 in all women, a larger ovarian reserve may be associated with a longer fertile period in women with PCOS. The current study examined whether women with PCOS experienced similar age-related declines in pregnancy and birth rates following IVF compared to women with normal ovulatory cycles.
Methods & findings
This was a retrospective study examining the records of 44,286 IVF treatments. 16,416 of the treatments were with women diagnosed with PCOS, while the other 27,870 were with women who underwent IVF due to tubal factor infertility, meaning they ovulated normally but had blocked fallopian tubes. Number of oocytes (eggs) removed, pregnancy rates, and live birth rates were compared.
Women with PCOS had 27% more oocytes extracted at the start of treatment than did women with tubal infertility. The rate of successful clinical pregnancy in women with PCOS was 27.5%, compared to 21.3% in women with tubal infertility. The probability of pregnancy was 32% higher and the probability of live birth was 30% higher in women with PCOS compared to women with tubal infertility.
These increases, however, were only found for women under the age of 40. After 40 years of age, while women with PCOS continue to produce significantly higher numbers of oocytes, the rates of pregnancy and live birth did not differ from those of women with tubal infertility.
The bottom line
This study concluded that polycystic ovarian syndrome is associated with an increased number of oocytes, pregnancies, and live births following IVF compared to women with normal ovulatory cycles. This advantage, however, is not seen after the age of 40.
The fine print
This was a retrospective study (it looks back at patients who have been treated in the past). These studies are known to have lower statistical power than studies directly testing a hypothesis.
Published By :
Fertility and Sterility
Jul 01, 2013