Impact of Polycystic Ovary Syndrome on Fertility and Pregnancy Outcomes: A Prospective Cohort Study

Abstract

Objective: To assess the impact of PCOS on fertility and pregnancy outcomes by evaluating time to conception, ovulation rates, and pregnancy complications including miscarriage, gestational diabetes mellitus, preeclampsia, preterm birth and neonatal outcomes.

Methodology: This prospective study was consisted of   12 months’ duration from January 2021 to December 2021. Participants were enrolled from outpatient department of Saidu Teaching Hospital, Swat, and were followed up during the whole period of pregnancy and postpartum. Women aged 18–40 years who were either diagnosed with PCOS (based on the Rotterdam criteria) or seeking prenatal care/reproductive treatment without PCOS were enrolled. A total of 300 patients were enrolled. Women of comparable age in the control group did not have PCOS and were seeking prenatal care or reproductive treatment. Women with additional endocrinologic conditions (thyroid dysfunction, Cushing's syndrome), type II diabetes mellitus or hypertension, repeated or unexplained pregnancy loss in the past, and women using assisted reproductive technologies (ART) for purposes other than inducing ovulation were excluded. Data were analyzed using SPSS version 25. Descriptive statistics were used to summarize the data, while chi-square tests and t-tests were conducted for group comparisons.

Results: The PCOS group had a significantly longer time to conception (9.2 ± 4.5 vs. 4.6 ± 2.3 months, p < 0.001) and lower ovulation rates (61.3% vs. 89.4%, p < 0.001) compared to controls. Pregnancy outcomes showed higher rates of miscarriage (22.7% vs. 10.7%, p = 0.008), GDM (27.3% vs. 12.0%, p = 0.014), preeclampsia (14.7% vs. 6.0%, p = 0.022), and preterm birth (18.0% vs. 8.0%, p = 0.019) in the PCOS group. Neonatal outcomes revealed lower birth weights (2.89 ± 0.6 vs. 3.14 ± 0.5 kg, p = 0.031) and higher NICU admissions (16.0% vs. 7.3%, p = 0.027) in the PCOS group.

Conclusion: PCOS significantly impacts a woman's fertility and pregnancy by increasing the chances of prolonged time to conception, miscarriage, gestational diabetes mellitus, preeclampsia, and preterm birth. Optimizing reproductive health in women with PCOS involves early diagnosis with targeted interventions coupled with a personalized approach.