Early & Recurrent pregnancy loss
The reproductive issues with PCOS are manifold starting with anovulatory cycles leading to subfertility. Post conception, PCOS women are at increased risk for early pregnancy loss (EPL). After having successfully passed the first trimester, they commonly encounter later pregnancy complications like gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia, preterm delivery, and birth of small for gestational age (SGA) infant. Effective tackling of metabolic and reproductive issues relating to pregnancy forms the cornerstone of management of PCOS.
PCOS women are at risk of EPL, defined clinically as first trimester miscarriage. EPL occurs in 30 to 50% of PCOS women compared with 10 to 15% of normal women.
The EPL rate in PCOS women has been difficult to establish due to several confounding factors. Treatment with ovulation-inducing agents is associated with a higher incidence of spontaneous EPL compared with the prevalence in the normally ovulating, naturally conceiving population.
Luteinizing Hormone and Early Pregnancy Loss
Several studies have linked elevated LH levels with EPL in women with PCOS. The likelihood of miscarriage was increased and conception rate decreased as compared to those with normal LH in PCOS women.
Androgens and Early Pregnancy Loss
Hyperandrogenemia is hypothesized to be another probable cause of EPL in PCOS women. Hyperandrogenemia and/or clinical hyperandrogenism is currently considered as an essential prerequisite for diagnosis of PCOS. Elevated free/total testosterone ratios and isolated elevated free and total testosterone levels were found to be predictive of EPL in PCOS women in two different studies
Insulin Resistance and Early Pregnancy Loss
PCOS women are believed to be strongly associated with insulin resistance and compensatory hyperinsulinemia, which has been shown to be independently contributed by obesity prevalent among PCOS women. Insulin resistance and hyperinsulinemia is associated with Early pregnancy loss in women with PCOS.
Endometrial Dysfunction and Early Pregnancy Loss
Implantation of embryo is affected by the endometrial receptivity which seems to be affected in PCOS. Initial attachment of the embryo is mediated via certain cell adhesion molecules which are decreased in PCOS women. Endometrial secretory proteins are pivotal for implantation and maintenance of pregnancy. Both these proteins were shown to be significantly lower in women with EPL in first trimester.
Women with PCOS are at increased risk of adverse pregnancy and birth outcomes and may need increased surveillance during pregnancy and parturition.
Recurrent pregnancy loss (RPL), defined as two or more consecutive pregnancy losses before 20th week of pregnancy is a frequent obstetric complication. The clinical association of RPL in polycystic ovarian syndrome (PCOS) is more than common.