Outcomes of ovulation induction-intrauterine insemination in lean, overweight, and obese women with polycystic ovary syndrome

Objective: To compare pregnancy rates between lean, overweight, and obese women with polycystic ovary syndrome (PCOS) undergoing ovulation induction-intrauterine insemination (OI-IUI). Design: Retrospective cohort study Setting: Academic training program Patient(s): All women with PCOS undergoing OI-IUI from January 2000 to November 2013. Interventions: Ovulation induction-intrauterine insemination with oral (oral OI-IUI) or combined oral and injectable (combined OI-IUI) agents. Main Outcome Measures: Clinical pregnancy rates (CPR) per IUI were compared in 198 women undergoing oral OI-IUI and combined OI-IUI. Multivariate logistic regression was used to calculate the odds of clinical pregnancy while adjusting for potential confounders. Results were expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI), using lean women as the referent population. Results: In lean PCOS patients undergoing combined OI-IUI, the unadjusted CPR was 52%; CPR was comparatively lower in overweight (22%), obese (27%) and morbidly obese (21%) women for all cycles. Adjusting for age and duration of infertility, the odds of clinical pregnancy after combined OI-IUI was significantly diminished in overweight (OR=0.27 CI=0.12-0.63), obese (OR=0.41, CI=0.20-0.83) and morbidly obese women (OR=0.33 CI=0.140.78) as compared to the lean PCOS referent. A similar but non-significant trend was identified in women undergoing oral OI-IUI. Conclusion: Lean women with PCOS have a higher CPR after combined OI-IUI as compared to their overweight, obese, and morbidly obese counterparts. Patients with a lean PCOS phenotype may preferentially benefit from this