High singleton live birth rate confirmed after ovulation induction in women with anovulatory polycystic ovary syndrome: validation of a prediction model for clinical practice

Classical ovulation induction is an effective therapy for women with polycystic ovary syndrome. Women with a poor treatment prognosis can be identified according to age, duration of infertility, and body mass index.

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Authors

Susanne M.Veltman-Verhulst, M.D., Bart C.J.M. Fauser, M.D., Ph.D., Marinus J.C. Eijkemans, M.Sc., Ph.D.

Vol 98, Issue 3, Pages 761-768.e1

Abstract

Objective:

To evaluate the cumulative singleton live birth rate following classical ovulation induction in women with anovulatory Polycystic Ovary Syndrome (PCOS) and to validate a previously developed prediction model.

Design:

Prospective follow-up study.

Setting:

Tertiary Infertility Unit, University Medical Center Utrecht, the Netherlands.

Patients:

Validation cohort of 108 treatment naïve anovulatory PCOS patients.

Interventions:

Conventional ovulation induction, applying clomiphene citrate as first line treatment followed by exogenous gonadotropins as second line intervention.

Main Outcome Measures:

Singleton live birth prediction. Model calibration and discrimination were assessed for the initial model (variables included: age, duration of infertility and insulin/glucose ratio) and a second model in which the insulin/glucose ratio was replaced by Body Mass Index (BMI).

Results:

The cumulative singleton live birth rate after 12 and 24 months was 60% and 78%, respectively. Overall, the observed rates were higher than predicted; hazard ratio of 1.21 (95% CI 0.89-1.64), 1st model and 1.25 (95% CI 1.20-1.30), 2nd model. However, the predictive capacity of the model variables was reliable with calibration slopes of 0.79 (95% CI -0.04-1.63) and 1.06 (95% CI 0.95–1.18), respectively.

Conclusions:

The current study confirms the previously reported good treatment prognosis for women with PCOS undergoing classical ovulation induction. Women with a poor prognosis – where alternative treatment options may be considered – can best be identified by a prediction model including age, duration of infertility and BMI.

Clinical trial registration number:

NCT00821379

Read the full text at: http://www.fertstert.org/article/S0015-0282(12)00482-7/fulltext


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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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