Impact of pretreatment with combined oral contraceptives in women with PCOS before assisted reproductive technology

  • Song SY & al.
  • Arch Gynecol Obstet
  • 6 Jun 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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).

Limitations

  • Small number of studies included.
  • Heterogeneity among studies and ART protocol.