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Polycystic ovarian syndrome and miscarriage in IVF: systematic revision of the literature and meta-analysis

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Abstract

Purpose

To evaluate the risk of miscarriage in IVF cycles in women with PCOS.

Methods

Systematic review and meta-analysis. Systematic search of MEDLINE, EMBASE and Google Scholar. The language search was restricted to English, Spanish and French, from 2000 to 2019, with crosschecking of references from relevant articles. Inclusion criteria were: (1) IVF cycles (2) a group of patients with PCOS was considered separately, (3) the miscarriage rate was reported, (4) there was a control group, (5) definition of PCOS according the Rotterdam criteria. Exclusion criteria were been excluded from the meta-analysis: (1) publication prior to the year 2000, (2) animal studies, (3) reviews, (4) abstracts or conference papers, (5) letters, (6) case reports, (7) studies comparing different IVF techniques, (8) studies comparing groups with and without metformin or other treatments, (9) studies on induced abortions. Risk of bias was assessed by the Newcastle–Ottawa score (NOS). All the included studies had a low risk of bias (NOS scores ranging 7–8). The review protocol was registered in PROSPERO (CRD42020186713). Seventeen studies were included in the meta-analysis. There was a total of 10,472 pregnancies (2650 in PCOS and 7822 in controls) of which 1885 were miscarriages (682 in PCOS and 1203 in controls). We considered the miscarriage rate (MR), preclinical MR, early MR, and late MR.

Results

In IVF pregnancies the risk of miscarriage was significantly increased when considering miscarriages in total (RR = 1.59; CI = 1.45–1.75), preclinical miscarriages (RR = 1.59; CI = 1.35–1.88), and early miscarriages (RR = 1.44; CI = 1.16–1.79). The increased miscarriage rate persisted in Chinese and Western populations when considered separately. The risk of miscarriage was increased in the subgroup of fresh transfers (RR = 1.21; CI = 1.06–1.39) as well as in the subgroup including either fresh or frozen transfers (RR = 1.95; CI = 1.72–2.22).

Conclusion

PCOS is linked to an increased MR in IVF pregnancies both of miscarriages in total, and to an increase in preclinical and early miscarriages.

Prospero number

CRD42020186713.

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Authors and Affiliations

  1. Human Reproduction Unit, Hospital de Cruces, Biocruces, Baracaldo, Vizcaya, Spain

    Roberto Matorras, Lucía Laínz, María Díaz-Nuñez, Héctor Sainz & Dayana Moreira

  2. Clinical Epidemiology Unit, Cruces University Hospital, Biocruces, Baracaldo, Vizcaya, Spain

    Jose Ignacio Pijoan & Silvia Pérez-Fernandez

  3. IVIRMA. IVI Bilbao, Bizkaia, Spain

    Roberto Matorras

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Contributions

MR and MD conceived the study design. MD made the systematic review of literature. MD, SH, DNM and LL performed data extraction. MD performed data processing. PJI and PFS performed the meta-analysis. MR wrote the article. All authors approved the final article.

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Correspondence to Roberto Matorras.

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Supplemmentary figure 1. Mean age of patients in IVF pregnancies (PDF 52 KB)

404_2022_6757_MOESM2_ESM.pdf

Supplemmentary figure 2. Total miscarriages in IVF pregnancies and ethnic background. A. Miscarriage rate in IVF pregnancies in China. B. Miscarriage rate in IVF pregnancies in Western Countries. C. Miscarriage rate in IVF pregnancies in South Korea. D. Miscarriage rate in IVF pregnancies in Tunisia. (PDF 337 KB)

Supplemmentary figure 3. Sensitivity meta-analysis for NOS score=8 for early miscarriage. (PDF 32 KB)

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Matorras, R., Pijoan, J.I., Laínz, L. et al. Polycystic ovarian syndrome and miscarriage in IVF: systematic revision of the literature and meta-analysis. Arch Gynecol Obstet 308, 363–377 (2023). https://doi.org/10.1007/s00404-022-06757-0

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