Effects of dyslipidemia on in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) pregnancy outcome in patients with polycystic ovary syndrome(PCOS)

Abstract

To investigate the impact of dyslipidemia on IVF/ICSI pregnancy outcome in patients with PCOS. Retrospective cohort study. From July 2013 to March 2016,468 cases of PCOS patients with antagonist protocol in in-vitro fertilization and embryo transfer were included using CCRM database of our center,cycles were divided into dyslipidemia group(DG,n=108) and normol blood lipids group(NG,n=360) according to the serum cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low density lipoprotein (LDL) levels.The general condition and clinical outcomes of the two groups were analyzed retrospectively, including the implantation rate(IR), clinical pregnancy rate(CPR), and live birth rate(LBR), etc. Besides,stratified analysis and multivariate logistic regression analysis were used to correct the impact of body mass index(BMI). 1.Age,years of infertility, basic hormone levels and other basic data of two groups were similar (P>0.05), but BMI of DG was significantly higher than NG(25.01±2.96 vs. 23.11±3.05 , P<0.001); 2.The high quality embryo rate,endometrial thickness,progesterone and LH levels on the day of HCG injection,severe hyperstimulation rate and miscarriage rate in two groups falied to exhibit remarkable difference(P>0.05). However, the number of oocytes retrieved,estradiol(E2) level on the day of HCG injection,IR,biochemical pregnancy rate(BPR),CPR and LBR in DG were significantly lower than NG(10.24±5.06 vs. 11.48±5.62, 15824.53±8925.22 vs. 18985.61±10751.99, 31.03% vs. 52.97%, 57.14% vs. 77.68%, 40.00% vs. 70.54%, 25.71% vs.59.82%,P<0.05), the dose of Gn and days of stimulation were significantly higher compared to NG(1778.94±797.20 vs. 1358.84±510.01, 10.83±2.43 vs. 9.76±1.90,P<0.05). 3.Stratified analysis showed that no matter in BMI < 24 or BMI≥24 group, the dose of Gn and days of stimulation were significantly higher in DG than NG (P<0.05).However,the number of oocytes retrieved, E2 level on the day of HCG injection had obvious downtrend, and the difference was statistically significant (P <0.05) in BMI≥24 group.Even after adjustment of BMI, dyslipidemia still had a negative impact on IR,BPR,CPR and LBR (OR 0.377, 0.382, 0.250, 0.233,P <0.05).4.Further analysis of the different components of blood lipids in the clinical pregnancy group and unobtained pregnancy group revealed that TG in the non-pregnant group was significantly higher (1.49±0.84 vs. 1.24±0.65,P=0.045), Logistic regression analysis also showed that the increase of TG levels was negatively correlated with the CPR in PCOS patients(OR 0.274,P=0.041). In patients with PCOS,patients combined with dyslipidemia have a higher BMI,and dyslipidemia increases the dosage of Gn, reduces the IR,CPR and LBR, especially the increase of TG level,which has adverse effects on IVF/ICSI outcome.A reasonable control of blood lipid level and weight may help to improve the pregnancy outcome in patients with PCOS.