PCOS and Miscarriage
Overall birth rate only 5% lower in PCOS; superior ovarian reserve in PCOS
Among women who had attempted a pregnancy, 86.7% of PCOS patients and 91.6% of controls had given birth to at least one child. Among PCOS patients who had given birth, 73.6% had done so following a spontaneous conception. Mean ovarian volume and the number of antral follicles in PCOS patients were significantly greater than in control women. PCOS patients also had higher serum concentrations of anti-Müllerian hormone and lower follicle-stimulating hormone (FSH) levels. CONCLUSIONS: Most women with PCOS had given birth, and the rate of spontaneous pregnancies was relatively high. Together with the ultrasound findings and the hormonal analyses, this finding could imply that PCOS patients have a good fecundity, and an ovarian reserve possibly superior to women with normal ovaries.
http://www.ncbi.nlm.nih.gov/pubmed/19168874
Improving insulin resistance leads to fewer miscarriages for PCOS sufferers
Continuous use of an insulin sensitizer in PCOS patients during pregnancy significantly reduced incidence of miscarriage and intrauterine growth restriction.
http://onlinelibrary.wiley.com/doi/10.1111/j.1447-0756.2008.00856.x/full
Using metformin through the first trimester lowers miscarriage risk from 49% to 13%
All women in this study had a confirmed diagnosis of PCOS. These women were followed till the final outcome of pregnancy was achieved. Both groups were compared for risk of miscarriage. It was found that continuation of Metformin during pregnancy reduces miscarriage, i.e. 8.8 vs. 29.4% in cases and controls, respectively. In the subset of women with a prior history of miscarriage, the pregnancy loss rate was 12.5% in the Metformin versus 49.4% in control group. CONCLUSION: Metformin continuation during pregnancy significantly reduces miscarriages in women with PCOS. Insulin resistance may play a significant role in miscarriage.
http://www.ncbi.nlm.nih.gov/pubmed/20029224
Using metformin through the first trimester lowers risk of miscarriage from 32% to 4%
In Group A, metformin administration (500 mg three times daily) was stopped immediately after diagnosis of pregnancy (5-6 weeks gestation), in Group B, metformin was administered until the end of 8 weeks gestation and in Group C until the end of 12 weeks gestation. There was a significant statistical difference between previous and current miscarriage in the current pregnancy with a decline in Group B from 40% to 8% and in group C from 32% to 4%. In spite of the reduced rate of miscarriage seen in Group A, from 20% to 4%, this difference was not statistically significant. Fetal anomalies were absent in all three groups.According to the current findings, it seems that continuing metformin during the first trimester of pregnancy has beneficial effects in patients with PCOS.
http://www.ncbi.nlm.nih.gov/pubmed/20441061
Decrease in estrogen and progesterone receptor linked with miscarriage in PCOS
The expressions of estrogen receptor and progesterone receptor in the endometrium in the PCOS group were significantly lower than those of the control group. The decrease of estrogen receptor and progesterone receptor of endometrium in the PCOS patients may be a reason for miscarriage, and the cyclical irregularity of estrogen receptor and progesterone receptor in the PCOS patients is another cause of miscarriage.
http://www.ncbi.nlm.nih.gov/pubmed/18600000
Testosterone and DHEA-S, but not PCOS, associated with higher miscarriage risk
The recurrent miscarriage group as a whole exhibited gonadotrophin and androgen levels comparable to those seen in the controls. Ultrasound examination revealed polycystic ovaries (PCOS) in 22 patients (44%) and in four control women (20%) but no differences in the levels of gonadotrophins and androgens emerged between the patients with or without PCOS. During follow up, 33 (66%) women with a history of recurrent miscarriage who became pregnant; 16 miscarried again (48.5%), whereas 17 (51.5%) succeeded. The presence of PCOS did not predict miscarriage, but the patients who miscarried had higher levels of total testosterone, free testosterone and dehydroepiandrosterone sulphate (DHEA-S) than recurrent miscarriage women with continuing pregnancies.
http://www.ncbi.nlm.nih.gov/pubmed/8494836
PCOS not associated with miscarriage after adjusting for BMI and other confounding factors
The presence of PCOS increased the risk of miscarriage in this cohort and has been considered in detail previously. However, controlling for BMI and other confounding factors identified here completely eliminated the effect of PCOS.
http://www.nature.com/oby/journal/v10/n6/full/oby200274a.html
Insulin resistance, but not obesity or PCOS, associated with miscarriage risk
The association of insulin resistance with the risk of miscarriage was significant after adjusting for other risk factors. The effect of overweight/obesity and PCOS was not statistically significant in the multivariate model.
http://www.ncbi.nlm.nih.gov/pubmed/17244790
PCOS does not increase miscarriage risk in ovulatory women with recurrent pregnancy loss
The livebirth rate during the next pregnancy was similar amongst women with PCOS (60.9%) compared to that amongst women with normal ovarian morphology with a history of recurrent miscarriage (58.5%; not significant). Neither an elevated serum luteinizing hormone (LH) concentration (>10 IU/l) nor an elevated serum testosterone concentration (>3 nmol/l) was associated with an increased miscarriage rate. Polycystic ovarian morphology is not predictive of miscarriage amongst ovulatory women with recurrent miscarriage conceiving spontaneousy. The search for a specific endocrine abnormality that can divide women with PCOS into those with a good and those with a poorer prognosis for a future successful pregnancy continues.
http://www.ncbi.nlm.nih.gov/pubmed/10686206
PCOS found in 8% of women with recurrent miscarriage
Hypersecretion of luteinising hormone (LH) or ultrasonographic features of polycystic ovarian disease was present in 8% and 7.8% of women with unexplained recurrent miscarriage, respectively. Free testosterone was elevated in 14.6% of subjects. In the mid-luteal phase, low progesterone level was found in 17.4% and delayed endometrial development was noted in 27.1% of women. Although women with recurrent miscarriage women and delayed endometrium had significantly lower progesterone levels than those with normal endometrial development, only 8/24 had mid-luteal progesterone levels below 30 nmol/L. Recurrent miscarriage was not associated with hyperprolactinaemia or abnormal thyroid function test.
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2000.tb11670.x/full