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PCOS and Miscarriage

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a blog by Eric Levens, M.D., Shady Grove Fertility Center, June 25, 2010

One question that comes up all of the time in my clinical practice is whether the risk of miscarriage is greater among women with PCOS.

Numerous studies have addressed this question, each with its own strengths and weaknesses. From my perspective, the most useful studies are those that identify women with PCOS and follow them forward (cohort studies) to see if the risk of miscarriage is greater compared to women without PCOS. One closely followed group of women are those undergoing assisted reproductive technologies (ART), as clinics are required by law to monitor the outcomes of IVF cycles.

One of the best studies was a 2003 report by Schieve and colleagues who analyzed 62,228 pregnancies achieved with assisted reproductive technologies (ART). The authors of this study determined that the overall miscarriage rate among women with PCOS was 14.7%. This risk was no different from the average miscarriage rate of all the other groups.

While older papers suggest that the risk of miscarriage may be increased for women with PCOS, in the end it is safe to conclude that the evidence of an increased miscarriage risk is weak. And, even if the risk of miscarriage is greater, it's likely to be very small risk.

As I continue to develop this blog, I invite your questions and comments! Feel free to post them below or on the Shady Grove Fertility Facebook page.

In the end, I hope that you find this information to be comforting as you look forward to a Fertile Future.

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Comments

Is the treatment for PCOS the same for women who are non Insulin resistance to women who are Insulin Resistance. I am not IR but was put on Met and Clomid but I did not respond. So what would be my next step?
Also does Metformin help prevent misscariage?

Thank You

The treatment for women with insulin resistance and without insulin resistance may differ. For those with insulin resistance, I typically start metformin; however it may be appropriate to start metformin in a situation where insulin resistance has not been demonstrated. The specifics of your situation would determine the recommendation.

In terms of response to medication, the highest pregnancy rates for women with PCOS in a recent randomized study was observed among women who were taking both metformin and Clomid. If you haven't responded to the dose of Clomid that you are on, it may be necessary to increase the dose. Typically about 50% of women will respond to 50 mg of Clomid, another 25% will respond to 100 mg and another 13% will respond to 150 mg. I don't go beyond 150 mg as the likelihood of response is dramatically reduced at this point. The next step usually involves injectable medication to induce ovulation.

Metformin may reduce the risk of miscarriage especially among women with insulin resistance and it appears to be safe in early pregnancy.

I hope that you find this information helpful and I wish you the best in your pursuit of a Fertile Future.

My OB just prescribed Metformin for me after seeing that I have a high but non-diabetic blood glucose level of 5.6, the fact that I have a BMI over 30, and have had 2 miscarriages in a row, no live births.

She also gave me a diet plan and exercise recommendation, which I am following earnestly, for the past 2 weeks. My question is, shouldn't I attempt to lower my BMI (lose weight) with the diet and exercise regimen first, before using a drug? Or is there something I don't understand, that metformin can be helpful even if I also have success from changes in diet/exercise?

Basically, I worry about becoming dependent on a drug, especially when before now, I have never seriously attempted to improve my diet. I feel like trying that first might improve the insulin resistance which she suspects (but did not test specifically for).

Thanks for your thoughts!

Hello im very worried about having another miscarrige o have pcos but all ready have a two year old little girll i get get bad acne but i am not over weight (8 stone) is it possible keeping an eye on my weight will lower my chances of having a miscarrige ??

I am not expert but I read that pcos has to sides. Insulin résistant and High androgen (male hormone) and treatment should prescrib according to which side is prédominant. It will be of no good prescribing metmorfin to a patient that do not have insulin régulation problem. Médication to regulate thé androgen will be more appropriate if mâle hormone is the issue.

I was diagnosed with pcos and lost a baby then put on metformin.I got pregnant with my daughter and delivered her healthy but had gestational diabities.After her birth I decided I would diet.I lost 93 lbs and went on to have 2 more healthy babies with NO gestational diabities.Weight and PCOS play a HUGE rule in conceiving healthy babies!

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