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Research Article

Perinatal Outcomes by Mode of Assisted Conception and Sub-Fertility in an Australian Data Linkage Cohort

  • Jennifer L. Marino,

    Affiliation: Department of Obstetrics and Gynaecology, The University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia

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  • Vivienne M. Moore,

    Affiliations: Discipline of Public Health, The University of Adelaide, Adelaide, South Australia, Australia, Robinson Institute, The University of Adelaide, Adelaide, South Australia, Australia

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  • Kristyn J. Willson,

    Affiliation: Discipline of Public Health, The University of Adelaide, Adelaide, South Australia, Australia

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  • Alice Rumbold,

    Affiliations: Robinson Institute, The University of Adelaide, Adelaide, South Australia, Australia, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia

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  • Melissa J. Whitrow,

    Affiliations: Discipline of Public Health, The University of Adelaide, Adelaide, South Australia, Australia, Robinson Institute, The University of Adelaide, Adelaide, South Australia, Australia

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  • Lynne C. Giles,

    Affiliations: Discipline of Public Health, The University of Adelaide, Adelaide, South Australia, Australia, Robinson Institute, The University of Adelaide, Adelaide, South Australia, Australia

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  • Michael J. Davies mail

    michael.davies@adelaide.edu.au

    Affiliations: Robinson Institute, The University of Adelaide, Adelaide, South Australia, Australia, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia

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  • Published: January 08, 2014
  • DOI: 10.1371/journal.pone.0080398

Reader Comments (2)

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More evidence for better informed consent in ART

Posted by jennybrd on 10 Jan 2014 at 04:23 GMT

For many infertile couples, the only realistic pathway to parenthood is via ART. For these couples, these data on pregnancy risks will not change their decision to start treatment.

However, there are substantial numbers of women with PCOS seeking ART who (knowingly or unknowingly) are using reproductive technologies as an alternative to the dietary and lifestyle changes that might have resulted in a spontaneous pregnancy. I accept that the data shows an increased risk of poor outcomes with spontaneous conception in these women. Nonetheless, the inherent risks and cost of ART may well be unnecessary after adequate weight loss and exercise. Moreover, there is accumulating evidence that pregnancy complications in this group are improved if weight management is continued after conception.

The increasing weight of evidence regarding adverse outcomes after ART behoves infertility specialists to counsel women with PCOS more carefully. Women in this group need to be adequately informed of any alternative to ART so they can make an informed decision. Anecdotal evidence from my obstetric practice leads me to believe that this has not always been done.

Our health system allows women to choose between medical treatments, provided that they understand the risks and benefits of each option. All prescribers of clomiphene citrate, as well as providers of other ART, must ensure that women whose infertility is primarily caused by PCOS appreciate the consequences of their choices.



No competing interests declared.