Association between hyperandrogenism and adverse pregnancy outcomes in patients with different polycystic ovary syndrome phenotypes undergoing in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis

Abstract

Objective

To study the association between hyperandrogenism (HA) and adverse pregnancy outcomes in patients with different polycystic ovary syndrome phenotypes undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).

Methods

We reviewed all eligible articles published up to October 2020 after searching in PubMed, Embase, Cochrane Library, Web of Science, Wanfang Data, and CNKI databases. The primary outcomes were the clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rate (LBR), whereas the secondary outcomes were the number of retrieved oocytes and endometrial thickness. Risk ratios (RRs) or mean differences with 95% confidence intervals (CIs) were calculated to estimate the HA impact on IVF/ICSI outcomes in patients with polycystic ovary syndrome (PCOS) phenotypes.

Results

Of the 789 trials identified, nine retrospective studies involving 3037 patients with PCOS were included. Compared to the PCOS group with normal androgen levels, the PCOS group with HA exhibited increased MR (RR: 1.56, 95% CI: 1.13, 2.16); the CPR (RR: 0.88, 95% CI: 0.77, 1.01) and LBR (RR: 0.79, 95% CI: 0.55, 1.11) were not significantly different between these groups. Subgroup analysis revealed that the CPR was lower in the polycystic ovarian (PCO)-morphology + HA + oligo-anovulation (AO) group than in the PCO + AO group (RR: 0.81, 95% CI: 0.67, 0.99). Among Asians, the PCOS/HA group had increased MR (RR: 1.56, 95% CI: 1.06, 2.31) and showed thinner endometrial thickness. However, among Caucasians, no differences were observed between the two groups.

Conclusions

HA may have adverse effects on clinical pregnancy and miscarriage outcomes in different PCOS phenotypes, particularly among Asians.

不同表型多囊卵巢综合征患者接受体外受精/胞浆内单精子注射后高雄激素血症与不良妊娠结局的关系：系统回顾和荟萃分析 摘要

目的：研究不同表型多囊卵巢综合征患者行体外受精（IVF）/卵胞浆内单精子注射（ICSI）后高雄激素血症（HA）与不良妊娠结局的关系。

方法：通过在PubMed,Embase,Cochrane Library,Web of Science,万方数据库以及CNKI数据库对截至2020年10月发表的所有符合条件的文章进行回顾。主要指标有临床妊娠率（CPR）、流产率（MR）和活产率（LBR）, 而次要指标是取卵术和子宫内膜厚度。计算风险率（RRs）或95%置信区间（CIs）的平均差异, 以评估HA对多囊卵巢综合征（PCOS）表型患者IVF/ICSI结局的影响。

结果：在789项试验中有9项包括3037例多囊卵巢综合征患者的回顾性研究。与雄激素水平正常的PCOS组相比, HA组MR增高（RR:1.56, 95% CI:1.13, 2.16）；CPR（RR:0.88, 95% CI:0.77, 1.01）和LBR（RR:0.79, 95% CI:0.55, 1.11）两组间无显著性差异。表型亚组分析显示卵巢多囊样改变（PCO）+HA+稀发排卵或无排卵（AO）的CPR低于PCO+AO组（RR:0.81, 95% CI:0.67, 0.99）。在亚洲人中, PCOS/HA组MR升高（RR:1.56, 95% CI:1.06, 2.31）, 子宫内膜厚度更薄。然而在白种人中, 两组之间无明显差异。

结论：HA可能对不同PCOS表型的临床妊娠和流产结局产生不利影响, 尤其是在亚洲人中。

Keywords:

• Hyperandrogenism
• in vitro fertilization/intracytoplasmic sperm injection
• polycystic ovary syndrome
• pregnancy outcome
• meta-analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was financially supported by the National Natural Science Foundation of China [82071649].