Polycystic ovary syndrome increases the rate of early spontaneous miscarriage in women who have undergone single vitrified euploid blastocyst transfer

Hyperandrogenism increases late spontaneous miscarriage in polycystic ovary syndrome women due to cervical insufficiency? A propensity-score matching study

BACKGROUND

The potential effects of hyperandrogenism (HA) on pregnancy outcomes among polycystic ovary syndrome (PCOS) patients are still unknown. The aim of this study was to explore the impact of HA on miscarriage rate after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment in PCOS patients.

METHODS

Women diagnosed with PCOS who underwent the first autologous IVF/ICSI cycles using gonadotropin-releasing hormone agonist (GnRH-a) protocols for ovarian stimulation during the period from January 2016 to December 2022 were included. Women were divided into the HA and non-HA group according to Hyperandrogenemia (serum testosterone level > 0.48 ng/mL), and/or the presence of hirsutism. Pregnancy outcomes were compared before and after propensity-score matching (PSM). Multiple logistic regression models were performed to demonstrate the independent impact of HA on pregnancy outcomes.

RESULTS

A total of 3066 patients were included. PCOS women with HA experienced a notably higher rates of late spontaneous miscarriage (LSM) as compared to those without HA before and after PSM (8.8% versus 3.5%, P < 0.001; 8.9% versus 3.9%, P = 0.001, respectively), but comparable rates of clinical pregnancy, early spontaneous miscarriage, and live birth. After adjusting for possible confounding factors, the logistic regression confirmed that HA was independently associated with the increased risk of LSM (adjusted OR: 2.540, 95% confidence interval: 1.326-4.672, P = 0.003). For the specific reasons for LSM, cervical insufficiency accounted for a larger proportion in women with HA than their counterparts without HA (15/32 versus 7/33, P = 0.029).

CONCLUSIONS

Androgen excess is postulated to play a role in late miscarriage via increased likelihood of cervical insufficiency.

TRIAL REGISTRATION

N/A.

Development and validation of a prediction model for suboptimal ovarian response in polycystic ovary syndrome (PCOS) patients undergoing GnRH-antagonist protocol in IVF/ICSI cycles

BACKGROUND

PCOS patients with unexpectedly low oocyte yield following conventional ovarian stimulation are referred to as suboptimal responders. However, identifying suboptimal responders presents a significant challenge within reproductive medicine and limited research exists on the occurrence of suboptimal response. This analysis aimed to develop a predictive model of suboptimal response during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments in PCOS patients.

METHODS

This retrospective study involved a cohort of 313 PCOS patients undergoing their first IVF/ICSI cycle from 2019 to 2022. Univariate logistic regression analyses, least absolute shrinkage, selection operator regression analysis, and recursive feature elimination were employed to identify relevant characteristics and construct predictive models. Moreover, a nomogram was constructed based on the best model. Receiver operating characteristic curves, decision curve analysis (DCA), and calibration curves were used to evaluate the model.

RESULTS

The predictors included in the model were age, Anti-Mullerian hormone, antral follicle count, and basal follicle-stimulating hormone. The area under the receiver operating characteristic curve (AUC) was 0.7702 (95% confidence interval 0.7157-0.8191). The AUC, along with the DCA curve and calibration curve, demonstrated a satisfactory level of congruence and discrimination ability.

CONCLUSION

The nomogram effectively predicted the probability of suboptimal response in PCOS patients undergoing gonadotropin-releasing hormone antagonist protocol during IVF/ICSI treatment.

Polycystic ovary syndrome

Despite affecting ~11-13% of women globally, polycystic ovary syndrome (PCOS) is a substantially understudied condition. PCOS, possibly extending to men's health, imposes a considerable health and economic burden worldwide. Diagnosis in adults follows the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome, requiring two out of three criteria - clinical or biochemical hyperandrogenism, ovulatory dysfunction, and/or specific ovarian morphological characteristics or elevated anti-Müllerian hormone. However, diagnosing adolescents omits ovarian morphology and anti-Müllerian hormone considerations. PCOS, marked by insulin resistance and hyperandrogenism, strongly contributes to early-onset type 2 diabetes, with increased odds for cardiovascular diseases. Reproduction-related implications include irregular menstrual cycles, anovulatory infertility, heightened risks of pregnancy complications and endometrial cancer. Beyond physiological manifestations, PCOS is associated with anxiety, depression, eating disorders, psychosexual dysfunction and negative body image, collectively contributing to diminished health-related quality of life in patients. Despite its high prevalence persisting into menopause, diagnosing PCOS often involves extended timelines and multiple health-care visits. Treatment remains ad hoc owing to limited understanding of underlying mechanisms, highlighting the need for research delineating the aetiology and pathophysiology of the syndrome. Identifying factors contributing to PCOS will pave the way for personalized medicine approaches. Additionally, exploring novel biomarkers, refining diagnostic criteria and advancing treatment modalities will be crucial in enhancing the precision and efficacy of interventions that will positively impact the lives of patients.