MISCARRIAGE RATES FOLLOWING INVITRO FERTILIZATION ARE INCREASED IN WOMEN WITH POLYCYSTIC OVARIES AND REDUCED BY PITUITARY DESENSITIZATION WITH BUSERELIN

To assess the risk of miscarriage after in-vitro fertilization (IVF) w ith respect to age, cause of infertility, ovarian morphology and treat ment regimen, a retrospective analysis was performed of the first 1060 pregnancies conceived between June 1984 and July 1990 as a result of 7623 IVF cycles. Superovulation induction was achieved with human meno pausal gonadotrophin (HMG) and/or purified follicle stimulating hormon e (FSH) together with either clomiphene citrate or the gonadotrophin h ormone-releasing hormone (GnRH) agonist buserelin, the latter either a s a short 'flare' regimen or as a 'long' regimen to induce pituitary d esensitization. There were 282 spontaneous abortions (26.6%) and 54 ec topic pregnancies (5.1%). The mean age of women with ongoing pregnanci es was 32.2 (SD 3.9) years compared with 33.2 (SD 4.1) years in those who miscarried, which were significantly different (P = 0.008). There was no relation between the miscarriage rate and the indication for IV F. The miscarriage rate was 23.6% in women with normal ovaries compare d with 35.8% in those with polycystic ovaries [P = 0.0038, 95% confide nce interval (CI) 4.68-23.10%]. There was no difference in the miscarr iage rate between treatment with HMG or FSH. Women whose ovaries were normal on ultrasound were just as likely to miscarry if they were trea ted with clomiphene or with the long buserelin protocol. Those with po lycystic ovaries, however, had a significant reduction in the rate of miscarriage when treated with the long buserelin protocol, 20.3% (15/7 4), compared with clomiphene citrate, 47.2% (51/108) (P = 0.0003, 95% Cl 13.82-40.09%).