Body mass index and basal androstenedione are independent risk factors for miscarriage in polycystic ovary syndrome

Abstract

BackgroundThere is limited literature investigating the effects of body mass index (BMI) and androgen level on in vitro fertilization (IVF) outcomes with a gonadotropin-releasing hormone (GnRH)-antagonist protocol in polycystic ovary syndrome (PCOS). Androgen-related variation in the effect of body mass index (BMI) on IVF outcomes remains unknown.MethodsIn this retrospective study, 583 infertile women with PCOS who underwent IVF using the conventional GnRH-antagonist protocol were included. Patients were divided into four groups according to BMI and androgen level: overweight- hyperandrogenism(HA) group, n = 96, overweight-non-HA group, n = 117, non-overweight-HA group, n = 152, and non-overweight-non-HA group, n = 218.ResultsA significantly higher number of oocytes were retrieved, and the total Gn consumption as well Gn consumption per day was significantly lower, in the non-overweight groups than in the overweight groups. The number of available embryos was significantly higher in the HA groups than in the non-HA groups. Clinical pregnancy rate was of no significant difference among four groups. Live-birth rates in the overweight groups were significantly lower than those in non-overweight-non-HA group (23.9, 28.4% vs. 42.5%, P<0.05). The miscarriage rate in overweight-HA group was significantly higher than that in non-overweight-non-HA group (45.2% vs. 14.5%, P<0.05). Multivariate logistic regression analysis revealed that BMI and basal androstenedione (AND) both acted as significantly influent factors on miscarriage rate. The area under the curve (AUC) in receiver operating characteristic (ROC) analysis for BMI and basal AND on miscarriage rate were 0.607 (P = 0.029) and 0.657 (P = 0.001), respectively, and the cut-off values of BMI and basal AND were 25.335 kg/m2 and 10.95 nmol/L, respectively.ConclusionsIn IVF cycles with GnRH-antagonist protocol, economic benefits were seen in non-overweight patients with PCOS, with less Gn cost and more retrieved oocytes. BMI and basal AND were both significantly influential factors with moderate predictive ability on the miscarriage rate. The predictive value of basal AND on miscarriage was slightly stronger than BMI.

High BMI and Insulin Resistance Are Risk Factors for Spontaneous Abortion in Patients With Polycystic Ovary Syndrome Undergoing Assisted Reproductive Treatment: A Systematic Review and Meta-Analysis

“…Outcomes of interest were reported in 11182 patients in 17 retrospective cohort studies ( 20 – 26 , 28 , 30 – 36 , 40 , 41 ), three prospective cohort studies ( 38 , 39 , 42 ) and two case-control studies ( 27 , 37 ). Fourteen studies were conducted in China ( 22 , 23 , 25 , 28 , 30 – 33 , 35 , 36 , 38 , 39 , 41 , 42 ), five in the USA ( 20 , 21 , 24 , 26 , 27 ), and the remaining three in Japan ( 37 ), Turkey ( 34 ), and Australia ( 40 ).…”

“…Outcomes of interest were reported in 11182 patients in 17 retrospective cohort studies ( 20 – 26 , 28 , 30 – 36 , 40 , 41 ), three prospective cohort studies ( 38 , 39 , 42 ) and two case-control studies ( 27 , 37 ). Fourteen studies were conducted in China ( 22 , 23 , 25 , 28 , 30 – 33 , 35 , 36 , 38 , 39 , 41 , 42 ), five in the USA ( 20 , 21 , 24 , 26 , 27 ), and the remaining three in Japan ( 37 ), Turkey ( 34 ), and Australia ( 40 ). Seventeen studies measured BMI ( 20 – 26 , 30 – 32 , 34 – 38 , 41 , 42 ), four assessed age ( 28 , 30 , 37 , 40 ), three evaluated insulin resistance ( 30 , 37 , 42 ), five investigated chromosome aberrations ( 26 , 30 , 31 , 33 , 39 ), and the other four assessed hyperandrogenism ( 27 , 30 , 37 , 42 ).…”

“…Fifteen articles with a total of 7499 patients evaluated the relationship between spontaneous abortion and BMI in PCOS patients undergoing ART ( 20 – 26 , 32 , 34 – 38 , 41 , 42 ), including 13 articles with categorical variables ( 20 – 26 , 32 , 34 – 36 , 38 , 41 ) and two with continuous variables ( 37 , 42 ). Assessment of the risk of bias demonstrated a symmetrical funnel chart, indicating no publication bias ( Supplementary Figure 2 ).…”

“…In order to better show the homogeneity in heterogeneity analysis, patients were divided into overweight and obesity based on the BMI of different races. Among 13 articles with two categorical variables, eight were from China ( 22 , 23 , 25 , 32 , 35 , 36 , 38 , 41 ), five of which used the Chinese BMI standard ( 47 ) of BMI ≥ 24 kg/m 2 as overweight ( 22 , 23 , 25 , 35 , 38 ), while the remaining three used the WHO BMI standard ( 48 ) of BMI ≥ 25 kg/m 2 as overweight ( 32 , 36 , 41 ). All the others studies applied the standard of BMI ≥ 25 kg/m 2 as overweight ( 20 , 21 , 24 , 26 , 34 ).…”

Pregnancy outcome and cost‐effectiveness comparisons of artificial cycle‐prepared frozen embryo transfer with or without GnRH agonist pretreatment for polycystic ovary syndrome: a randomised controlled trial

“…It was suggested that the long‐term deleterious effect of estrogen alone for women with PCOS could be related to endometrial impairment 8 – 10 . A hyper‐androgenic environment and overproduction of luteinising hormone (LH) as well as inflammatory factors related to endocrine disorders were also reported to affect endometrial receptivity in women with PCOS 11,12 .…”