T-186 The Role of Ethnicity in PCOS Patient Responses to Ovulation Induction in Timed Intercourse and Intrauterine Insemination Cycles.

摘要

Introduction: Polycystic Ovary Syndrome (PCOS) is the most frequently diagnosed cause of infertility, however it is still one of the most misunderstood. Studies have shown differences in the clinical manifestations of PCOS in patients of different ethnic backgrounds. Yet, questions remain whether such differences are also seen in PCOS patient responses to assisted reproductive techniques (ART). Data has shown that certain ethnicities respond differently to ART and have greater gonadotropin sensitivity, resulting in increased an increased number of retrieved oocytes but worse fertilization and ongoing pregnancy rates compared to their Caucasian counterparts. Thus, this study sought to investigate whether or not the same is true in these patients' responses to ovulation induction (OI) in timed intercourse (TIC) and intrauterine insemination (IUI) cycles. Methods: A retrospective cohort analysis was performed on PCOS patients undergoing OI and either TIC or IUI. OI was performed using either letrozole, clomiphene citrate or gonadotropins. Baseline demographic characteristics included ethnicity, age, BMI, anti-Mullerian hormone (AMH) level and endometrial stripe thickness. The primary outcome measure was clinical pregnancy defined as ultrasound confirmation of a gestational sac with a heartbeat at 5-6 weeks. Logistic regressions controlling for the above demographic factors were performed using SPSS (SPSS Inc., Chicago, IL, USA). Results: 349 cycles consisting of 244 (69.9%) Caucasian, 39 (11.2%) Asian, 43 (12.3%) Hispanic/Latin American and 23 (6.6%) African American cycles were analyzed. Baseline characteristics did not differ between ethnicities. When comparing all non-Caucasian ethnicities to Caucasians and controlling for patient age, BMI, AMH level and endometrial stripe thickness, ethnicity was not found to be a significant and independent predictor of clinical pregnancy in PCOS patients (OR 0.73, 95% CI 0.4-1.4; P = 0.35). Similarly, when comparing each cohort of PCOS patients to the others, ethnicity was again not a significant and independent predictor. This also held true when stratifying for patients who only utilized letrozole for OI (78% of cycles). Conclusion: Preliminary data showed that when controlling for age, BMI, AMH level and endometrial stripe thickness in PCOS patient cohorts, ethnicity was not a significant and independent predictor of clinical pregnancy in TIC/IUI cycles. Therefore, although PCOS patients may have differing clinical presentations depending on ethnicity, these patients can receive the standard of care for ovulation induction due to the equal efficacy.