Higher Cumulative Live Birth Rate but Also Higher Late Miscarriage Risk in Non-Obese Women with Polycystic Ovary Syndrome Undergoing the First IVF/ICSI Cycle

Figures & data

Table 1 Baseline Characteristics of Patients with and without PCOS

	Control	PCOS	P value
No. of patients	4052	787
Female Age (y)	31.97±4.28	29.39±3.53	<0.001
Male Age (y)	34.21±5.44	31.96±4.43	<0.001
BMI (kg/m^2)	21.50±2.81	22.60±3.43	<0.001
Baseline FSH (IU/L)	5.83±2.16	5.04±1.27	<0.001
Baseline LH (IU/L)	3.48±1.93	6.89±4.84	<0.001
bE2 (pg/mL)	36.34±25.10	39.79±31.08	0.003
Baseline total T (ng/mL)	0.29±0.11	0.45±0.16	<0.001
AFC	10.54±6.15	17.47±10.40	<0.001
Duration of infertility (y)	3.70±2.93	3.76±2.44	0.516
Infertility type			<0.001
Primary infertility (%)	35.3	65.9
Secondary infertility (%)	64.7	34.1

Abbreviations: BMI, Body Mass Index; AFC, Antral Follicle Count; FSH, Follicle-Stimulating Hormone; LH, Luteinizing Hormone.

Table 2 Oocyte Retrieval Cycle Characteristics of the Patients in the PCOS Group and Control Group

	Control	PCOS	P value
No. of patients	4052	787
Gn initiation dose (IU)	217.73±60.96	163.45±42.10	<0.001
Gn treatment (days)	10.38±2.05	9.11±2.48	<0.001
Gonadotropin dose (IU)	2322.40±914.17	1434.18±550.32	<0.001
P on hCG day (ng/mL)	0.80±0.61	0.85±0.56	0.051
No. of >14-mm follicles on the Trigger day	9.74±4.94	13.65±5.85	<0.001
Number of retrieved oocytes	14.20±7.87	21.37±11.10	<0.001
No. of MII oocytes retrieved	12.62±7.16	18.53±9.69	<0.001
No. Of available embryos	5.25±3.60	7.59±4.59	<0.001
Mature oocyte rate (%)	82.4 (5492/6663)	82.4 (3591/4360)	0.932
Cleavage rate(%)	97.4 (36,867/37,836)	97.8 (10,366/10,594)	0.017
Blastocyst formation rate (%)	64.3 (17,107/26,615)	67.5 (5715/8468)	<0.001
High-quality embryo rate (%)	45.3 (16,711/36,867)	46.2 (4784/10,366)	0.137
Unavailable embryo rate (%)	1.8 (14/787)	3.2 (131/4052)	0.029

Table 3 Pregnancy Outcomes of Patients with and without PCOS

	Control	PCOS	P value
No. of patients	4052	787
Overall pregnancy rate per ET (%)	51.6% (3335/6465)	57.9% (773/1335)	<0.001
Overall miscarriage rate (%)	14.8% (494/3335)	15% (116/773)	0.891
Overall early miscarriage rate (%)	12.5% (417/3335)	11.3% (87/773)	0.340
Overall late miscarriage rate (%)	2.3% (77/3335)	3.8% (29/773)	0.023
Cumulative outcomes
Cumulative pregnancy rate (%)	70.7 (2866/4052)	82.8 (652/787)	<0.001
Cumulative live birth rate (%)	61.0 (2470/4052)	71.3 (561/787)	<0.001
Fresh cycle outcomes
Pregnancy rate per ET (%)	49.1 (1014/2066)	48.1 (104/216)	0.794
Miscarriage rate (%)	13.5 (137/1014)	21.2 (22/104)	0.034
Early miscarriage rate (%)	10.8 (110/1014)	15.4 (16/104)	0.164
Late miscarriage rate (%)	2.7 (27/1014)	5.8 (6/104)	0.075
Frozen-thawed cycle outcomes
Pregnancy rate per ET (%)	52.5 (2321/4418)	59.5 (669/1125)	<0.001
Miscarriage rate (%)	15.4 (357/2321)	14.1 (94/669)	0.397
Early miscarriage rate (%)	13.2 (307/2321)	10.6 (71/669)	0.073
Late miscarriage rate (%)	2.2 (50/2321)	3.4 (23/669)	0.058

Table 4 Subgroup Analysis for the Effect of BMI on Reproductive Outcome Over Multiple IVF/ICSI Cycles in PCOS and Control Group

Variables	BMI<25			BMI≥25
	Control	PCOS	P value	Control	PCOS	P value
Cumulative pregnancy rate (%)	71.2 (2565/3601)	84.7 (516/609)	<0.001	67.0 (302/451)	76.4 (136/178)	0.020
Cumulative live birth rate (%)	61.6 (2220/3601)	74.1 (451/609)	<0.001	55.4 (250/451)	61.8 (110/178)	0.146
Early miscarriage rate (%)	12.5 (374/2991)	10.5 (64/608)	0.174	12.5 (43/344)	13.9 (23/165)	0.651
Late miscarriage rate (%)	2.0 (60/2991)	4.1 (25/608)	0.002	4.9 (17/344)	2.4 (4/165)	0.181

Table 5 Logistic Regression Analysis for the Prediction of Late Miscarriage Rate

	B	Standard Error	P value	OR (95% CI)
Diagnosis of PCOS^a	0.594	0.250	0.018	1.811 (1.110,2.957)
BMI^a	0.577	0.254	0.023	1.780 (1.081,2.931)
Female age^a	0.116	0.283	0.595	1.123 (0.732,1.723)
Stage of ET^a	−0.097	0.208	0.640	0.907 (0.604,1.364)
Infertility type^a	0.019	0.027	0.481	1.019 (0.966,1.075)

Note: ^aReference is non-PCOS, BMI<25 kg/m², female age<30 y, cleavage-stage embryo, Primary infertility.