Effects of the need for in-vitro fertilization to conceive on pregnancy risks in women with the polycystic ovary syndrome. Evaluation of a population database and a matched cohort

Objective

To determine if conception by in-vitro fertilization (IVF) confers risk for adverse obstetric outcomes in women with polycystic ovary syndrome (PCOS).

Design

A retrospective population-based cohort study was conducted using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (2004–2014). Women who underwent IVF comprised the study group (n = 360), and the remaining women with PCOS comprised the reference group (n = 14,522). Logistic regression analyses were performed to explore associations between IVF, pregnancy, and delivery outcomes through the estimation of odds ratio (OR) and 95 % confidence intervals (CI). Sub-analyses performed examined outcomes in singleton pregnancies. A matched cohort analysis was conducted, comparing PCOS patients who underwent IVF and those who did not.

Results

Among all pregnant women with PCOS, IVF was associated with an increased risk for pre-term delivery (aOR 1.74, 95 %CI 1.05–2.88; p = 0.03), while controlling for confounders. IVF did not significantly increase the risk of other obstetrical complications. In singleton pregnancies, IVF was associated with a higher risk of preterm delivery (aOR2.12, 95 %CI 1.15–3.89; p = 0.016) and operative vaginal delivery (aOR 1.98, 95 %CI 1.03–3.8; p = 0.041). Without adjustment for multiple gestation, IVF was associated with an increased risk of preeclampsia (aOR2.05, 95 %CI1.17–3.61; p = 0.01), pre-term delivery (aOR2.67, 95 %CI 1.68–4.24 ;p < 0.001), preterm premature rupture of membranes (aOR2.74, 95 %CI 1.15–6.54; p = 0.02), chorioamnionitis (aOR2.14 95 %CI 1.005–4.55; p = 0.048), and cesarean section (aOR1.69, 95 %CI 1.16–2.46; p = 0.007). In the matched cohort, women with PCOS who underwent IVF had a higher risk of placenta previa (aOR3.31 95 %CI 1.08–10.14; p = 0.05) and placental abruption (aOR3.04, 95 %CI 1.16–7.92; p = 0.02).

Conclusion

IVF appears minimally additive to the inherent risks associated with PCOS. Patients with PCOS who undergo IVF, are at an increased risk of placental abnormalities including placenta previa and placental abruption.