- In women with polycystic ovary syndrome (PCOS) who underwent assisted reproductive technology (ART), pre-treatment with combined oral contraceptives (COC) was associated with an increased rate of miscarriage and decreased rate of cumulative live birth, especially with gonadotropin-releasing hormone (GnRH) antagonist protocols.
Why this matters
- Findings suggest that clinicians should be aware of these possible risks when planning ART for patients with PCOS.
- 7 studies (1 randomised, 2 prospective, 4 retrospective cohort) were identified after a search across electronic databases.
- Primary outcomes: rates of clinical pregnancy, miscarriage, cumulative live birth and ovarian hyperstimulation syndrome (OHSS).
- Funding: Korea Medical Institute.
- COC vs placebo group did not differ in rate of clinical pregnancy (OR, 0.93; 95% CI, 0.65-1.34; P=.71; I2, 76%) and OHSS (OR, 0.90; 95% CI, 0.57-1.44; P=.67).
- COC group had higher rate of miscarriage (OR, 1.33; 95% CI, 1.02-1.72; P=.03) and lower rate of cumulative live birth (OR, 0.72; 95% CI, 0.54-0.98; P=.03; I2, 55%) than control group.
- In subgroup analysis, COC vs placebo group had higher rates of miscarriage (OR, 1.69; 95% CI, 1.17-2.44) and lower rates of cumulative live birth with GnRH antagonist protocol (OR, 0.38; 95% CI, 0.29-0.50).
- Small number of studies included.
- Heterogeneity among studies and ART protocol.