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Risk factors for clinical pregnancy loss after IVF in women with PCOS

  • Wenqi Wang
    Affiliations
    Center for Reproductive Medicine, Shandong University, Jinan, China

    Medical Integration and Practice Center, Shandong University, Jinan, China

    Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China

    Shandong Key Laboratory of Reproductive Medicine, Jinan, China
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  • Xiaoqian Tang
    Affiliations
    Center for Reproductive Medicine, Shandong University, Jinan, China

    Medical Integration and Practice Center, Shandong University, Jinan, China

    Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China

    Shandong Key Laboratory of Reproductive Medicine, Jinan, China
    Search for articles by this author
  • Qi Jiang
    Affiliations
    Center for Reproductive Medicine, Shandong University, Jinan, China

    Medical Integration and Practice Center, Shandong University, Jinan, China

    Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China

    Shandong Key Laboratory of Reproductive Medicine, Jinan, China
    Search for articles by this author
  • Yue Niu
    Affiliations
    Center for Reproductive Medicine, Shandong University, Jinan, China

    Medical Integration and Practice Center, Shandong University, Jinan, China

    Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China

    Shandong Key Laboratory of Reproductive Medicine, Jinan, China
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  • Ze Wang
    Correspondence
    Corresponding author.
    Affiliations
    Center for Reproductive Medicine, Shandong University, Jinan, China

    Medical Integration and Practice Center, Shandong University, Jinan, China

    Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China

    Shandong Key Laboratory of Reproductive Medicine, Jinan, China
    Search for articles by this author
  • Daimin Wei
    Correspondence
    Corresponding author.
    Affiliations
    Center for Reproductive Medicine, Shandong University, Jinan, China

    Medical Integration and Practice Center, Shandong University, Jinan, China

    Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China

    Shandong Key Laboratory of Reproductive Medicine, Jinan, China
    Search for articles by this author
Published:October 10, 2022DOI:https://doi.org/10.1016/j.rbmo.2022.10.002

      Abstract

      Research question

      Which factors are associated with the risk of clinical pregnancy loss in women with polycystic ovary syndrome (PCOS) undergoing IVF?

      Design

      Case–control study nested in a multicentre randomized trial comparing live birth rates between fresh and frozen embryo transfer in women with PCOS. Women with the outcome of clinical pregnancy loss were selected as the case group, those with live birth as the control group. Parameters before IVF treatment and variables during ovarian stimulation and embryo transfer were compared.

      Results

      Women with clinical pregnancy loss had higher maternal body mass index (BMI, P = 0.010), anti-Müllerian hormone (AMH, P = 0.032), 2-h glucose concentration after 75 g oral glucose tolerance test (OGTT, P = 0.025), and a higher proportion of fresh embryo transfers (P = 0.001). There were significant interactions between the types of transfer and antral follicle count (AFC, P = 0.013), 2-h glucose concentration after OGTT (P = 0.024) on clinical pregnancy loss in PCOS, indicating that these factors may have different effects on pregnancy loss after fresh versus frozen embryo transfer. When the multivariable logistic regression analysis was stratified by the fresh or frozen embryo transfer, AFC (adjusted odds ratio [aOR] 1.03, 95% confidence interval [CI] 1.01–1.05) was a risk factor for clinical pregnancy loss after fresh embryo transfer, while 2-hour glucose concentration after OGTT (aOR 1.13, 95% CI 1.01–1.25) was associated with clinical pregnancy loss in frozen embryo transfer (FET) cycles.

      Conclusions

      In women with PCOS, fresh embryo transfer, higher BMI, AFC and 2-h glucose concentration after OGTT were risk factors for clinical pregnancy loss. FET may be a better choice to decrease the risk of clinical pregnancy loss, especially for those with higher AFC. During FET, 2-h glucose after OGTT appears to be associated with clinical pregnancy loss and warrants close monitoring.

      Keywords

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      Biography

      Dr Wenqi Wang is pursuing her PhD at the Center for Reproductive Medicine of Shandong University, which is one of the largest IVF centres in China. Her major research interests are reproductive endocrinology and health.
      Key message
      In women with PCOS, fresh embryo transfer, higher BMI, AFC and 2-h glucose concentration after OGTT were risk factors for clinical pregnancy loss. FET may be a better choice to decrease the risk of clinical pregnancy loss, especially for those with higher AFC. During FET, abnormal glucose metabolism was associated with clinical pregnancy loss and warrants close monitoring.