Endocrine Abstracts

Background: Polycystic ovary syndrome (PCOS) is characterised by anovulation and insulin resistance but the effects on reproductive outcomes are unclear.

Objectives: To determine the impact of PCOS upon fertility, pregnancy complications and delivery method.

Methods: Data were extracted from the Clinical Practice Research Datalink. Patients with a diagnosis of PCOS (2000–2012) were matched to controls (1:2) by age (±1 year), BMI (± 3 units) and primary care practice. Date of PCOS diagnosis defined index date. Time between index date and first consultation for infertility was calculated and prevalence of infertility compared. Standardised fertility ratios (SFR) before/after diagnosis were calculated. Rates of pre-eclampsia, gestational diabetes (GDM), preterm delivery, miscarriage and delivery method were also compared.

Results: 9068 women with PCOS matched study criteria. Prior to index date, 1529 (16.9%) PCOS women consulted for fertility compared with 800 (4.4%) controls: a crude rate ratio (RR) of 4.69 (95% CI 4.30–5.11). Respective figures post index date were 796 (8.8%) vs 496 (2.7%): a crude RR of 3.59 (3.21–4.02). Prior to index date the SFR for patients with PCOS was 0.83 (0.80–0.86), following index date it was 1.17 (1.13–1.21). Risk of pre-eclampsia was 1.14 (1.00–1.30) and GDM was 1.30 (1.13–1.49). Of PCOS births, 27.8% were by Caesarean section compared with 23.8% of non-PCOS. In logistic regression the odds ratio of Caesarean delivery for PCOS was 1.13 (1.05–1.20) after adjustment for pre-eclampsia (2.62 (2.25–3.05)) and GDM (2.53 (2.14–3.00)). Mean length of stay for delivery was greater for PCOS (3.8 vs 3.5 days, P=0.002). Risk of miscarriage (RR 1.53 (1.43–1.64)) and premature delivery (RR 1.29 (1.15–1.45)) were also increased.

Conclusions: Infertility is associated with PCOS but fertility rates improve significantly following treatment. GDM, pre-eclampsia, miscarriage and pre-term delivery were more prevalent for women with PCOS and births were more likely to be by Caesarean delivery.