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.
Highlights
For infertile women with polycystic ovary syndrome (PCOS) who fail lifestyle intervention and ovulation induction therapy or who have additional infertility factors, in vitro fertilization (IVF) can be used
Moderate evidence suggests that a gonadotropin (Gn)-releasing hormone (GnRH)-antagonist protocol can significantly reduce the incidence of ovarian hyperstimulation syndrome (OHSS) [1,2,3], and the use of a gonadotropin-releasing hormone (GnRH)-antagonist protocol is gradually being adopted by clinicians
Bailey et al [7] indicated that obese women with PCOS had lower odds of clinical pregnancy and live birth than lean women with PCOS, while there was a trend toward decreased OHSS incidence with increasing body mass index (BMI) among women with PCOS
Summary
For infertile women with polycystic ovary syndrome (PCOS) who fail lifestyle intervention and ovulation induction therapy or who have additional infertility factors, in vitro fertilization (IVF) can be used. There is limited literature investigating the clinical phenotype of patients with PCOS who can benefit the most from a GnRH-antagonist protocol during IVF. Dechaud et al [8] showed that obese patients required a higher recombinant follicle-stimulating hormone (r-FSH) dose, but it did not have any adverse impact on IVF, including the cancellation rate, implantation rate, and pregnancy rate. There 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
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