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Research question: Which patient features predict the time to pregnancy (TTP) leading to term live birth in infertile women diagnosed with polycystic ovary syndrome (PCOS)? Design: Prospective cohort follow-up study was completed, in which initial standardized phenotyping was conducted at two Dutch university medical centres from January 2004 to January 2014. Data were linked to the Netherlands Perinatal Registry to obtain pregnancy outcomes for each participant. All women underwent treatment according to a standardized protocol, starting with ovulation induction as first-line treatment. Predictors of pregnancies (leading to term live births) during the first year after PCOS diagnosis were evaluated. Results: A total of 1779 consecutive women diagnosed with PCOS between January 2004 and January 2014 were included. In the first year following screening, 659 (37%) women with PCOS attained a pregnancy leading to term birth (≥37 weeks of gestational age). A higher chance of pregnancy was associated with race, smoking, body mass index (BMI), insulin, total testosterone and sex hormone-binding globulin (SHBG) concentrations (c-statistic = 0.59). Conclusions: Predictors of an increased chance of a live birth include White race, no current smoking, lower BMI, insulin and total testosterone concentrations, and higher SHBG concentrations. This study presents a nomogram to predict the chances of achieving a pregnancy (leading to a term live birth) within 1 year of treatment.

The lack of ovulatory cycles may be considered as a major problem for women seeking pregnancy. This is reflected by the fact that about 20 percent of couples visiting a fertility clinic with an unfulfilled wish to conceive present with anovulation. Clinical manifestation of anovulation is oligomenorrhea (intermenstrual period > 35 days) or amenorrhea (intermenstrual period > 6 months). Although ovulation may occur in oligomenorrhea, the longer the time period between menstruations the smaller the chance of that cycle being ovulatory. Classification of anovulatory patients may be performed using the criteria of the World Health Organization (WHO) as determined by Rowe et al. Criteria needed to classify patients are 1) serum prolactin in the normal range, 2) oligo- or amenorroea, and 3) serum concentrations of follicle-stimulating hormone (FSH) and estradiol (E2).In case of a hyperprolactinemia, a macro-prolactinoma should be ruled out by a scan (CT or MRI) of the sella turcica, and hyperprolactinemia should be treated with a dopamine-agonist. In case of normoprolactinemia or when the oligo- or amenorrea persists after correction of the hyperprolactinemia, these patients may be classified according to WHO criteria as follows: WHO1) ± 10% hypogonadotropic, hypoestrogenic status; WHO2) ± 80% normogonadotropic, normoestrogenic status; or WHO3) ± 10% hypergonadotropic, hypoestrogenic status. The vast majority of these patients, the WHO2 group, appear to be a very heterogeneous population in which – besides anovulation – obesity, biochemical, or clinical hyperandrogenism (alopecia, acne, or hirsutism) and insulin resistance play an important role.