Management of polycystic ovary syndrome must include assessment and treatment of mental health symptoms

Polycystic ovary syndrome (PCOS) is an endocrine disorder with reproductive and metabolic manifestations affecting millions of women worldwide. The health risks associated with PCOS, however, go beyond physical health. Over the past decade, data have emerged demonstrating a high risk of concurrent mental health conditions, specifically depression and anxiety, but extending into other aspects of psychological health, including body image distress, eating disorders, and sexual dysfunction. International surveys suggest physician knowledge about the mental health associations with PCOS is poor and that patients are often dissatisfied regarding counseling-related psychological issues. We performed a review of mental health comorbidities in individuals with PCOS, including depression, anxiety, body image distress, eating disorders, psychosexual dysfunction, and decreased quality of life, as well as evaluated the impact of common PCOS treatments on these conditions. Most meta-analyses in reproductive age women demonstrate increased risks of these conditions, although data are more limited in adolescents and older adults. In addition, the impact of PCOS treatments on these conditions as well as data on first-line treatments in the PCOS population is limited. All providers involved in the multidimensional care of individuals with PCOS should be aware of these mental health risks to provide appropriate screening, counseling and referral options. Future studies should be designed to evaluate targeted treatment for individuals with PCOS.

Fertility care for all: impact of New York State's Medicaid expansion on infertility care

PURPOSE

To assess whether the New York State (NYS) mandate expanding Medicaid coverage of fertility diagnostic testing and treatment is successfully increasing patient access to and utilization of fertility care.

METHODS

A retrospective chart review was performed of NYS Medicaid patients who presented for fertility services to a large academic reproductive endocrinology and infertility (REI) clinic. Information on patient demographics, medical history, diagnostic testing, treatments, and outcomes was collected. Patients presenting to the clinic in the 1 year prior to the mandate (October 1, 2018-September 30, 2019) were compared to patients presenting in the 1 year after the mandate (October 1, 2019-September 30, 2020). Primary outcomes of the study were differences in presentation to the clinic between the two cohorts and differences in utilization of infertility diagnostic testing and treatment. Secondary outcomes were differences in treatment outcomes.

RESULTS

A significantly larger percentage of Medicaid patients presented to the clinic for fertility assessment post-mandate (22%) as compared to pre-mandate (9%, p < 0.05). There were no demographic differences between the pre- and post-mandate patient groups. A similar percentage of patients completed diagnostic testing pre- vs. post-mandate. Post-mandate patients underwent more treatment cycles with ovulation induction medications compared to natural treatment cycles. There was no significant difference in pregnancy rates pre- vs. post-mandate.

CONCLUSION

The NYS Medicaid mandate allowed a significantly larger percentage of Medicaid patients to present for fertility evaluation. The patients in the post-mandate cohort underwent more treatment cycles with ovulation induction medications compared to natural cycles.

Considerations in the Treatment of Depression and Anxiety in Women with PCOS

Women with polycystic ovary syndrome (PCOS) are known to be at a greater risk of depression and anxiety. What is less clear is whether existing treatments for PCOS are effective in managing this increased risk and what the optimal approach to treatment is. In this review, currently available interventions are explored including lifestyle modifications, oral contraceptives, insulin sensitizing agents, psychosocial interventions and psychiatric medications. While data are often conflicting, lifestyle interventions, and cognitive behavioral therapy (CBT) appear most promising in reducing depression and anxiety symptoms in this population. There is an urgent need for large prospective studies to fill gaps in the literature.

Risk of SARS-CoV-2 Infection Among Women with Polycystic Ovary Syndrome

OBJECTIVE

To identify if women with Polycystic ovary syndrome (PCOS) had a higher incidence of testing positive for SARS-COV-2 compared to women without PCOS. In those with positive SARS-COV-2 tests, evaluate whether PCOS diagnosis independently increased risk for moderate or severe disease.

STUDY DESIGN

Retrospective cohort study using the National COVID Cohort Collaborative (N3C).

SUBJECTS

Adult non-pregnant women (age 18-65 years) enrolled in the N3C with confirmed SARS-COV-2 testing for any indication. Sensitivity analyses were conducted in women age 18-49 years and in obese (body mass index > 30kg/m²) women.

EXPOSURE

The exposure was PCOS as identified by the N3C clinical diagnosis codes and concept sets, which are a compilation of terms, lab values and ICD codes for the diagnosis of PCOS. To further capture patients with the symptoms of PCOS we also included those who had concept sets for both hirsutism and irregular menses.

MAIN OUTCOME MEASURES

Odds of testing positive for SARS-COV-2 and odds of moderate or severe coronavirus disease 2019 (COVID-19) in the PCOS cohort compared to non-PCOS cohort.

RESULTS

Of 2,089,913 women included in our study, 39,459 had PCOS. In the overall cohort, the odds of being SARS-CoV-2 positive was OR 0.98, 95% CI 0.97-0.98 for women with PCOS compared to those without PCOS. The odds by disease severity were: mild disease: OR 1.02, 95% CI 1.01-1.03 moderate disease: OR 0.99, 95% CI 0.98-1.00 and severe disease: OR 0.99, 95% CI 0.99-1.00. There was no difference in COVID-related mortality (OR 1.00, 95% CI 0.99-1.00). These findings were similar in the reproductive-age and obese reproductive-cohorts.

CONCLUSIONS

Women with PCOS had a similar likelihood of testing positive for SARS-COV-2. Amongst those who tested positive, they were no more likely to have moderate or severe COVID-19 disease compared to the non-PCOS cohort.

RELEVANCE

PCOS is a chronic condition associated with several comorbidities including cardiovascular disease and mental health issues. While these comorbidities are also associated with COVID-19 morbidity, our findings suggest that the comorbidities themselves rather than PCOS, drive the risk for disease severity.

Asian Americans and Infertility: Genetic Susceptibilities, Sociocultural Stigma and Access to Care

Infertility affects over 6 million people in the United States and has been shown to disproportionally affect minority patient populations. Asian American infertility is a particularly understudied area of research. This mini review article explores the current state of published research focusing on Asian American infertility trends as well as their barriers to fertility care. A small number of published studies have found that Asian American patients have decreased success with fertility treatments, including lower rates of pregnancy and live birth. These trends may be attributed to a combination of genetic, environmental, and cultural factors, which will be discussed here in further detail. It is crucial to continue building on Asian American fertility research to provide this diverse patient population with comprehensive, compassionate, and culturally sensitive care.

Racial disparities in frozen embryo transfer success

PURPOSE

To compare pregnancy and birth outcomes after frozen embryo transfers (FETs) among White, Black, and Asian women and evaluate the effect of patient, protocol, and cycle characteristics on success.

METHODS

A retrospective chart review identified women who underwent an autologous FET at an academic fertility center between January 2013 and March 2020.

RESULTS

White, Black, and Asian women completed 1,181 (71.7%), 230 (14.0%), and 235 (14.3%) cycles, respectively. Black women were significantly less likely to achieve a positive hCG level (AOR 0.66, 95% CI 0.49-0.90), clinical pregnancy (AOR 0.71, 95% CI 0.53-0.97), and live birth (AOR 0.65, 95% CI 0.47-0.89) compared to White women after adjusting for possible confounders. There were no differences in the aforementioned outcomes when looking at cycles completed by Asian versus White women. When comparing outcomes by endometrial preparation protocol, significant differences were seen amongst the three groups for live birth rates following natural cycle FETs (52.36%, 25.81%, and 44.19% for White, Black, and Asian women, respectively, p = 0.02), a difference not appreciated after programmed FETs.

CONCLUSION

Black race is associated with significantly worse pregnancy and live birth rates following FET when compared to White race. Additionally, significant differences in live birth rates among White, Black, and Asian women exist following natural cycle FET versus programmed FET. These disparities in success are not only important for patient counseling, but also when determining management strategies to improve fertility rates among minority women.

Adolescent Fertility Preservation: Where Do We Stand Now

Adolescence is a period of flux for many body systems. While fertility potential typically increases after menarche, there are diseases where the opposite occurs and fertility preservation options need to be considered early. In cases of cancer, options vary by pubertal status and can include ovarian tissue cryopreservation, oocyte cryopreservation, sperm cryopreservation, and testicular tissue cryopreservation. Much remains to be learned about fertility and preservation options in those with differences in sexual development (DSDs); however, depending on the form of DSD, fertility preservation may not be necessary. Similarly, traditional fertility counseling in children with galactosemia may need to be changed, as data suggest that fertility rates attributed to other causes of premature ovarian insufficiency may not be as applicable to this disease. Adolescents with Turner's syndrome are at high risk for premature ovarian failure; therefore, it is important to consider options as early as possible since ovarian reserves are depleted quickly. On the other hand, transgender and gender diverse adolescents may even be able to undergo fertility preservation after starting hormone therapy. In all cases, there are additional ethical components including technical/surgical risks in childhood, offering experimental therapies without creating false hope and evaluating children's consent and assent capabilities that must be considered.

Racial differences in anxiety, depression, and quality of life in women with polycystic ovary syndrome

OBJECTIVE

To evaluate racial differences in the anxiety and depression prevalence and scores in women with polycystic ovary syndrome (PCOS).

DESIGN

Cross-sectional.

SETTING

Academic institution.

PATIENTS

Reproductive-aged women with PCOS (n = 272) and controls (n = 295).

INTERVENTIONS

Hospital anxiety and depression scale and modified PCOS quality-of-life survey (MPCOS-Q).

MAIN OUTCOME MEASURES

Differences in depression and anxiety scores and quality-of-life score measured using the hospital anxiety and depression scale and MPCOS-Q were determined between White and Black women with PCOS. Multivariable correlation regressions assessed the association of the Ferriman-Gallwey score, total testosterone, body mass index (BMI), and homeostatic model assessment of insulin resistance with anxiety, depression, and quality-of-life scores.

RESULTS

Multivariable regression controlling for age, BMI, and socioeconomic status showed that White women with PCOS had a significantly higher prevalence of anxiety than Black women with PCOS (75.9% vs. 61.3%) and significantly higher anxiety scores (mean ± SD, 10.3 ± 4.1 vs. 8.7 ± 4.6). The prevalence of depression (24.4% vs. 29%) and depression scores (4.8 ± 3.6 vs. 5.1 ± 4.0) was not significantly different. In multivariable correlation regressions, the interaction between BMI and race in its association with anxiety scores was significant. The association of race with Ferriman-Gallwey score, total testosterone, or homeostatic model assessment of insulin resistance was not significant. In multivariable models, although the total MPCOS-Q scores were similar, the infertility domain was significantly lower in Black women with PCOS (mean ± SD, 12.6 ± 7.8 vs. 17.5 ± 6.8) indicating a lower quality of life related to infertility.

CONCLUSION

Racial differences identified in the prevalence of anxiety and MPCOS-Q domains suggest the importance of routine screening and provide an opportunity for targeted interventions based on race.

Utilization of preimplantation genetic testing for monogenic disorders

OBJECTIVE

To determine the rate of utilization, factors influencing the decision-making process, and patient satisfaction with preimplantation genetic diagnosis for monogenic disorders (PGT-M).

DESIGN

Survey study.

SETTING

Academic center.

PATIENT(S)

Genetically at-risk patients seen for PGT-M consultation between January 2010 and 2018.

INTERVENTION(S)

Electronic survey including demographics, genetic history, consultation experience, decision-making process, and satisfaction with PGT-M process.

MAIN OUTCOME MEASURE(S)

Rate of utilization of PGT-M, importance of decision-making factors, and satisfaction with PGT-M process.

RESULT(S)

Among survey respondents (n = 49), the rate of utilization of PGT-M after consultation was 89.8%. Ninety-three percent of participants decided whether to pursue PGT-M within 3 months of consultation. Factors that were considered most important to this decision-making process included information provided at consultation, accuracy of test results after PGT-M, avoidance of suffering of an affected child, and ability to avoid termination of an affected pregnancy. Key barriers to utilization included financial burden and overall complexity of the in vitro fertilization (IVF)/PGT-M process. Of those utilizing PGT-M (n = 44), 72.1% had at least one live birth or were pregnant during the study period. Satisfaction with PGT-M was high, and most couples would use IVF/PGT-M for a future pregnancy (84.1%). Participants with a live birth were more satisfied with the PGT-M process than those who had no live birth.

CONCLUSION(S)

Most patients seeking consultation for PGT-M were likely to pursue this technology despite financial burden and complexity of the process. Exploring factors that influence patient decision-making regarding PGT-M is important for tailoring the consultation and optimizing the overall experience.

Postpartum complications increased in women with polycystic ovary syndrome

BACKGROUND

Women with polycystic ovary syndrome are at a higher risk of cardiometabolic and psychiatric comorbidities and preconception and antepartum complications, but the impact of polycystic ovary syndrome during the postpartum period is unknown.

OBJECTIVE

This study aimed to investigate the risk of postpartum cardiovascular disease complications and perinatal and postpartum depression.

STUDY DESIGN

This was a retrospective cohort study conducted using a United States insurance claims database. Women with and without polycystic ovary syndrome aged 18 to 50 years enrolled continuously in a single health plan during the preconception, antepartum, and postpartum periods between 2000 and 2016 were included. The primary outcome was postpartum cardiovascular disease and depression (perinatal and postpartum). Multivariable logistic regression was used to adjust for covariates including age, geographic location, preterm delivery, assisted reproductive technology use, multiple births, prepregnancy depression, prepregnancy diabetes, prepregnancy hypertension, gestational diabetes, gestational hypertension, obesity, history of hyperlipidemia, smoking, and race.

RESULTS

We identified 42,391 unique women with polycystic ovary syndrome and 795,480 women without polycystic ovary syndrome. In multivariable models, women with polycystic ovary syndrome had significantly higher odds of cardiovascular disease complications, including postpartum preeclampsia (adjusted odds ratio, 1.30; 95% confidence interval, 1.17-1.45), eclampsia (adjusted odds ratio, 1.45; 95% confidence interval, 1.14-1.86) cardiomyopathy (adjusted odds ratio, 1.26; 95% confidence interval, 1.03-1.54), hypertensive heart disease (adjusted odds ratio, 1.32: 95% confidence interval, 1.07-1.64), thrombotic disease (adjusted odds ratio, 1.50; 95% confidence interval, 1.20-1.87), congestive heart failure (adjusted odds ratio, 1.35; 95% confidence interval, 1.13-1.61), and cerebrovascular accidents (adjusted odds ratio, 1.21; 95% confidence interval, 1.14-1.29), than those without polycystic ovary syndrome, as well as both perinatal (adjusted odds ratio, 1.27; 95% confidence interval, 1.22-1.33) and postpartum depression (adjusted odds ratio, 1.46; 95% confidence interval, 1.36-1.57). Nonobese women with polycystic ovary syndrome had higher odds of postpartum eclampsia (adjusted odds ratio 1.72; 95% confidence interval, 1.31-2.26), peripartum cardiomyopathy (adjusted odds ratio, 1.43; 95% confidence interval, 1.14-1.79), and cerebrovascular accidents (adjusted odds ratio, 1.28; 95% confidence interval, 1.19-1.38) than nonobese women without polycystic ovary syndrome. In the group of women without prepregnancy depression, the odds of perinatal depression (adjusted odds ratio, 1.32; 95% confidence interval, 1.26-1.39) and postpartum depression (adjusted odds ratio, 1.50; 95% confidence interval, 1.39-1.62) were higher in women with polycystic ovary syndrome than those without polycystic ovary syndrome.

CONCLUSION

In a large United States cohort, our study found that women with polycystic ovary syndrome are at increased risk of both cardiovascular and psychiatric complications during the postpartum period. Polycystic ovary syndrome should be recognized as an at-risk condition; our findings underscore the need for routine screening and early interventions for these major comorbidities.

Postpartum weight retention in women with polycystic ovary syndrome

BACKGROUND

Compared with women without polycystic ovary syndrome, women with polycystic ovary syndrome have a higher prevalence of cardiometabolic risk factors. Postpartum weight retention has been shown to contribute to these risks in the general population, but little is known about postpartum weight retention among women with polycystic ovary syndrome.

OBJECTIVE

This study aimed to compare postpartum weight retention and peripartum weight trends between women with polycystic ovary syndrome and controls.

STUDY DESIGN

Data on live, full-term singleton deliveries from January 1, 2014, to January 1, 2019, in women with and without polycystic ovary syndrome were abstracted from the electronic medical record. Weights during the pregestational period, pregnancy, and up to 12 months postpartum were collected. The primary outcome was likelihood of high postpartum weight retention of ≥5 kg above pregestational weight at 12 months after delivery. Secondary outcomes included the prevalence of high weight retention at other postpartum time points (6 weeks, 3 months, 6 months), absolute postpartum weight retention, gestational weight gain, and excess weight gain above the Institute of Medicine guidelines for weight gain in pregnancy.

RESULTS

A total of 6333 women had the requisite weight information (pregestational, peak pregnancy, and at least 1 postpartum weight), including 429 (6.8%) with polycystic ovary syndrome. After adjusting for age, pregestational body mass index, race, gestational diabetes mellitus, and parity, women with polycystic ovary syndrome were less likely to be high weight retainers at 6 weeks after delivery (adjusted odds ratio, 0.71; P=.02). There was no difference in postpartum weight retention between groups at 3, 6, and 12 months after delivery. Overall, the prevalence of high weight retainers at 12 months after delivery was high in both groups (22.7% in polycystic ovary syndrome vs 29.2% in controls; P=.13), and there was no difference in absolute weight retention (1.69 kg in polycystic ovary syndrome vs 2.05 kg in controls; P=.25). Although women with polycystic ovary syndrome had a higher pregestational body mass index, they had lower gestational weight gain (median, 12.7 kg) than controls (median, 13.5 kg) (P=.01). These findings were driven by the group with obesity. The percentage of women who surpassed the Institute of Medicine guidelines for gestational weight gain based on the body mass index category was similar between groups (43.4% in polycystic ovary syndrome vs 47.3% in controls; P=.12). Overall, 18.5% of women with polycystic ovary syndrome and 23.4% of controls had a higher body mass index category at 12 months after delivery than before pregnancy.

CONCLUSION

Women with polycystic ovary syndrome had lower gestational weight gain and lower likelihood of high weight retention at 6 weeks after delivery but similar weight retention at 12 months after delivery compared with controls. Overall, the large proportion of women with high postpartum weight retention highlights the importance of the peripartum time period for weight management, particularly in this high-risk group predisposed to obesity and cardiometabolic disease.

Measuring serum estradiol and progesterone one day prior to frozen embryo transfer improves live birth rates

Background

Given no consensus in the literature, this study sought to determine if a protocol of measuring serum estradiol and progesterone the day prior to frozen embryo transfer (FET) improves likelihood of pregnancy and livebirth.

Methods

This was a retrospective time-series study of women undergoing autologous vitrified-warmed blastocyst programmed FETs at an academic institution. Live birth rates were compared between a surveillance protocol, where serum estrogen and progesterone surveillance are performed the day prior to a programmed FET, and a standard protocol, whereby no hormonal lab evaluation is performed the day prior.

Results

Three hundred seventy-nine standard FET and 524 surveillance FET cycles were performed. Patients in the surveillance protocol were significantly more likely to achieve live birth (51% vs. 39%; aOR 1.6, 95%CI [1.2, 2.2]). Obese women were noted to be more likely to have lower progesterone hormone levels on surveillance labs (OR 3.2, 95%CI [2.0, 5.3]). However those whose hormonal medication dose was modified because of pre-transfer labs were as likely to achieve live birth as those whose dose was not modified (47% vs. 53%; aOR 0.8, 95%CI [0.6, 1.2]).

Conclusions

Cycles with the surveillance protocol were more likely to result in live birth. Patients with low levels of pre-transfer hormones, such as obese patients, likely have lower pregnancy rates. It is possible that when these levels were corrected after measurement, pregnancy rates improved to match those whose levels were not low enough to warrant intervention.

Body-image distress is increased in women with polycystic ovary syndrome and mediates depression and anxiety

OBJECTIVE

To evaluate differences in body-image distress (BID) scores between women with polycystic ovary syndrome (PCOS) and controls and whether BID mediates anxiety and depression.

DESIGN

Cross-sectional study.

SETTING

Academic institution.

PATIENT(S)

Reproductive-aged women with PCOS (n = 189) and controls (n = 225).

INTERVENTION

Administering the Multidimensional Body-Self Relations-Appearance Subscale (MBSRQ-AS), Stunkard Figure Rating Scale (FRS), Hospital Anxiety and Depression Scale (HADS), and PCOS quality of life survey (MPCOS-Q).

MAIN OUTCOME MEASURE(S)

BID, depression, and anxiety scores and mediation of depression and anxiety scores by BID.

RESULT(S)

Women with PCOS had worse BID scores on all five MBSRQ-AS subscales adjusted for age, body mass index, race, pregnancy history, income, and employment, and larger differences on the FRS compared with the control women. In multivariable regression models, the prevalence of depressive (28% vs. 19.2%) and anxiety (76.5% vs. 56.5%) symptoms were also statistically significantly higher in women with PCOS compared with the controls. Most MBSRQ-AS subscale scores statistically significantly correlated with depression, anxiety, and quality of life scores. The association between PCOS/control status and higher anxiety and depression scores was completely mediated by the appearance evaluation and body areas satisfaction subscales and partially mediated by overweight preoccupation, appearance orientation, and self-classified weight.

CONCLUSION(S)

Women with PCOS have increased BID and depressive and anxiety symptoms. In our study different aspects of BID either fully or partially mediated the association between PCOS/control status and depression and anxiety scores, suggesting that therapeutic interventions targeted at improving body image may decrease depressive and anxiety symptoms.

Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis

OBJECTIVE

To compare the treatment success and failure rates, as well as side effects and surgery rates, between methotrexate protocols.

DATA SOURCES

PubMed, Embase, and the Cochrane library searched up to July 2018.

STUDY ELIGIBILITY CRITERIA

Randomized controlled trials that compared women with ectopic pregnancies receiving the single-dose, two-dose, or multi-dose methotrexate protocols.

STUDY APPRAISAL AND SYNTHESIS METHODS

Odds of treatment success, treatment failure, side effects, and surgery for tubal rupture, as well as length of follow-up until treatment success, were compared using random and fixed effects meta-analysis. Sensitivity analyses compared treatment success in the groups with high human chorionic gonadatropin (hCG) values and a large adnexal mass, as defined by individual studies. The Cochrane Collaboration tool was used to assess risk of bias.

RESULTS

The 2-dose protocol was associated with higher treatment success compared to the single-dose protocol (odds ratio [OR], 1.84; 95% CI, 1.13, 3.00). The 2-dose protocol was more successful in women with high hCG (OR, 3.23; 95% CI, 1.53, 6.84) and in women with a large adnexal mass (OR, 2.93; 95% CI, 1.23, 6.9). The odds of surgery for tubal rupture were lower in the 2-dose protocol (OR, 0.65; 95% CI, 0.26, 1.63), but this was not statistically significant. The length of follow-up was 7.9 days shorter for the 2-dose protocol (95% CI, -12.2, -3.5). The odds of side effects were higher in the 2-dose protocol (OR, 1.53; 95% CI, 1.01, 2.30). Compared to the single-dose protocol, the multi-dose protocol was associated with a nonsignificant reduction in treatment failure (OR, 0.56; 95% CI, 0.28, 1.13) and a higher chance of side effects (OR, 2.10; 95% CI, 1.24, 3.54). The odds of surgery for tubal rupture (OR, 1.62; 95% CI, 0.41, 6.49) and time to follow-up (OR, -1.3; 95% CI, -5.4, 2.7) were similar.

CONCLUSION

The 2-dose methotrexate protocol is superior to the single-dose protocol for the treatment of ectopic pregnancy in terms of treatment success and time to success. Importantly, these findings hold true in patients thought to be at a lower likelihood of responding to medical management, such as those with higher hCGs and a large adnexal mass.

OR25-2 Racial Differences in Anxiety, Depression, and Quality of Life between White and Black Women with PCOS and Controls

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting reproductive aged women. The prevalence of comorbidities associated with PCOS vary with phenotype and race. An increased risk of moderate and severe depressive and anxiety symptoms has been reported in this group. Racial differences in prevalence of mood disorders described in the general population are influenced by factors such as obesity and socioeconomic status (SES). We aimed to determine the prevalence of depression, anxiety and decreased quality of life between black and white women with PCOS and controls. We screened women (18-50 years) at an academic center from November 2015-18 using the Hospital Anxiety and Depression Scale (HADS) and PCOS quality of life survey (PCOSQ). Multivariable regression models were used to evaluate racial differences in the prevalence of depression and anxiety (HADS≥8) and mean scores for depression, anxiety and PCOSQ. Correlations between FG score, testosterone, BMI, HOMA-IR and depression, anxiety and PCOSQ scores were analyzed. Overall women with PCOS (n=272) had a higher prevalence of depressive (26% vs 17%, p<0.01) and anxiety symptoms (72% vs 52%, p<0.01) compared to controls (n=295) after adjusting for age, BMI, SES and race. Compared to black women with PCOS (n=70), white women with PCOS (n=202) had a higher prevalence of anxiety symptoms (76% vs 61%, p=0.01) and scores (10.3 +4.1 vs 8.7 +4.6, p=0.01) after adjusting for age, BMI and SES. BMI correlated with anxiety scores in white but not black women with PCOS (p<0.01). There were no racial differences in the prevalence of depressive symptoms (p=0.8) or mean scores (p=0.4). In the control group, white women (n=186) had a higher prevalence for anxiety symptoms (60% vs 47%, p=0.04) not depressive symptoms (13 % vs 18%, p=0.7) compared to black women (n=109). There were no significant differences in mean anxiety or depression scores in the controls. There were no racial differences in global PCOSQ score (110.7 +30 for white women vs 98.6 +36.1 for black women, p=0.6). On examining the individual domains of the PCOSQ, black women scored lower than white women on the emotion and infertility domain (p<0.01). There were no racial differences in the correlation between FG score, testosterone, HOMA-IR and anxiety, depression and total PCOSQ scores. This study is the first to examine racial differences in anxiety and depressive symptoms in PCOS. White women with PCOS had significantly higher anxiety symptoms compared to black women and BMI positively correlated with these symptoms. Black women however have lower scores in several PCOSQ domains indicating lower quality of life. Despite racial differences in anxiety symptoms, our study confirms the need to screen both races for anxiety and depressive symptoms given their high prevalence. Targeted interventions such as weight management may help mitigate some of these symptoms.

Impact of method of endometrial preparation for frozen blastocyst transfer on pregnancy outcome: a retrospective cohort study

OBJECTIVE

To determine whether live birth rates differ by type of endometrial preparation in frozen embryo transfer (FET) cycles.

DESIGN

Retrospective cohort study.

SETTING

Academic fertility center.

PATIENT(S)

Reproductive-aged women undergoing autologous vitrified-warmed blastocyst FETs.

INTERVENTION(S)

Comparison of two methods of endometrial preparation: programmed FET (known as group A: luteal phase GnRH agonist suppression, oral E2, and IM P starting 5 days before ET) versus unstimulated FET (known as group B: hormone and ultrasound monitoring for follicle collapse to time transfer).

MAIN OUTCOME MEASURE(S)

Live birth rates in group A and group B.

RESULT(S)

Group A consisted of 923 cycles, and group B consisted of 105. When stratified by age at transfer, there was no difference in any of the measured outcomes, including live birth rates in adjusted models (adjusted odds ratio 1.0, 95% confidence interval 0.6-1.5), except in patients older than 40 years. These patients in group B had a 100% failure rate (n = 6).

CONCLUSION(S)

In most women, unstimulated endometrial preparation with luteal support before FET has similar success compared with exogenous hormone preparation. Women older than 40 years may benefit from programmed FETs owing to the challenges of increased cycle variability expected in that age group.