Abstract
Background: Polycystic ovary syndrome (PCOS) patients have a better ovarian reserve and age-related improvement in endocrine disturbances than non-PCOS patients. The effects of age on in vitro fertilization (IVF) treatment outcomes associated with cumulative live birth rate (CLBR) remain unclear.Objectives: To study the effect of age on CLBR after the first ovarian stimulation in IVF in PCOS patients.Method: This retrospective cohort study included 3,502 PCOS patients and 18,596 patients with tubal factor infertility, who underwent their first IVF cycles and subsequent frozen embryo transfer (ET) attempts. The primary outcome was CLBR associated with a single stimulation cycle and secondary outcomes included the implantation rate, clinical pregnancy rate, live birth rate (LBR), large for gestational age (LGA) rate, small for gestational age (SGA) rate, and preterm birth (PTB) rate of fresh ET cycles.Results: PCOS patients over 40 years had a higher implantation rate (27.8 vs. 15.7%, P < 0.05), clinical pregnancy rate (51.4 vs. 26.1%, P < 0.05), LBR (42.3 vs. 18.2%, P < 0.05), and CLBR (50.0 vs. 21.5%, P < 0.05) than non-PCOS patients over 40 years. These rates were comparable between PCOS patients aged 35 to 40 years and those aged over 40 years (P = 0.263, 0.385, and 0.112, respectively). The changes in the implantation rate, clinical pregnancy rate, and CLBR by age were slower for PCOS patients than for non-PCOS patients (all P < 0.05). Among PCOS patients less than 35 years, BMI was negatively associated with CLBR [aOR: 0.961 (0.939–0.985); P < 0.05]; however, among PCOS patients over 35 years, instead of BMI (P = 0.353), age [aOR: 0.891 (0.803–0.990); P < 0.05] and the number of oocytes retrieved [aOR: 1.093 (1.002–1.078); P < 0.05] were significantly associated with CLBR. No significant differences in LGA, LGA, or PTB were detected between PCOS and non-PCOS patients over 35 years (all P > 0.05).Conclusions: The declines in treatment outcomes with age are slower for PCOS patients than for non-PCOS patients. For patients over 40 years, PCOS patients have reproductive advantages over non-PCOS patients. In contrast to younger PCOS patients (<35 years), older PCOS patients (≥35 years) may benefit less from taking time to lose weight before IVF treatment, and the immediate initiation of assisted reproductive treatment is essential.
Highlights
Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by irregular menses, elevated androgen levels, hirsutism, insulin resistance, and polycystic ovaries, and it accounts for 18–25% of infertility among couples [1]
Studies have suggested that the serum anti-Mullerian hormone (AMH) level and antral follicle count (AFC), as surrogate markers of the ovarian reserve, decline with age in normo-ovulatory women, while this kind of age-related decrease is slower in PCOS patients, and levels are higher in women with PCOS than in normo-ovulatory women of the same age [6, 7]
A total of 22,098 patients undergoing their first in vitro fertilization (IVF)-embryo transfer (ET) attempts between January 2010 and July 2015 were included in this study, and all patients were followed up for at least 2 years (Figure 1)
Summary
Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by irregular menses, elevated androgen levels, hirsutism, insulin resistance, and polycystic ovaries, and it accounts for 18–25% of infertility among couples [1]. Age is a key factor affecting female fertility, because with increasing age, the reproductive capacity of a woman declines due to reduced ovarian reserve, oocyte quality, and the increased prevalence of embryonic aneuploidy [2,3,4]. Other studies have further shown that a small portion of women experience improvements in the symptoms and signs of PCOS after the age of 40 years, such as the improvement of irregular menses and hirsutism and a decline in androgen levels [8]. The age-related improvement of endocrine disturbance and relatively good ovarian reserve does not indicate that PCOS patients will acquire reproductive superiority over normoovulatory women, as other factors that affect female fertility still cannot be ignored. Polycystic ovary syndrome (PCOS) patients have a better ovarian reserve and age-related improvement in endocrine disturbances than non-PCOS patients. The effects of age on in vitro fertilization (IVF) treatment outcomes associated with cumulative live birth rate (CLBR) remain unclear
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