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Overweight and high serum total cholesterol were risk factors for the outcome of IVF/ICSI cycles in PCOS patients and a PCOS-specific predictive model of live birth rate was established

  • Original Article
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Abstract

Purpose

The clinical outcome after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is diverse in infertility patients with polycystic ovary syndrome (PCOS). The aim of this study was to develop a nomogram based on an association of patients’ characteristics to predict the live birth rate in PCOS patients.

Methods

All women in a public university hospital who attempted to conceive by IVF/ICSI for PCOS infertility from January 2014 to October 2018 were included. The nomogram was built from a training cohort of 178 consecutive patients and tested on an independent validation cohort of 81 patients. PCOS was confirmed in all participants.

Results

Three variates significantly associated with live birth rate of PCOS patients were BMI, total serum cholesterol (TC) and basal FSH. This predictive model built on the basis of BMI, TC, basal FSH, type of embryo transferred and age showed good calibration and discriminatory abilities, with an area under the curve (AUC) of 0.708 (95% CI 0.632–0.785) for the training cohort. The nomogram showed satisfactory goodness-of-fit and discrimination abilities in the independent validation cohort, with an AUC of 0.686 (95% CI 0.556–0.815).

Conclusion

Our simple evidence-based nomogram presents graphically risk factors and prognostic models for IVF/ICSI outcomes in patients with PCOS, which can offer useful guidance to clinicians and patients for individual adjuvant therapy.

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Abbreviations

IVF:

In vitro fertilization

ICSI:

Intracytoplasmic sperm injection

PCOS:

Polycystic ovary syndrome

ART:

Assisted reproduction technology

AUC:

Area under the curve

CI:

Confidence interval

OR:

Odds ratio

TC:

Total cholesterol

FSH:

Follicle-stimulating hormone

BMI:

Body mass index

ERB:

Ethical Review Board

GnRH:

Gonadotrophin-releasing hormone

LH:

Luteinizing hormone

hCG:

Human chorionic gonadotropin

OHSS:

Ovarian hyperstimulation syndrome

MLR:

Multivariable logistic regression

RMS:

Regression Modeling Strategies

TG:

Triglycerides

LDL-C:

Low-density lipoprotein cholesterol

VLDL-C:

Very low-density lipoprotein cholesterol

HDL-C:

High-density lipoprotein cholesterol

E2 :

Estrogen

T:

Testosterone

AMH:

Anti-Mullerian hormone

HDL:

High-density lipoprotein

COH:

Controlled ovarian hyperstimulation

References

  1. Rosenfield RL, Ehrmann DA (2016) The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as Functional ovarian hyperandrogenism revisited. Endocr Rev 37(5):467–520. https://doi.org/10.1210/er.2015-1104

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Azziz R, Carmina E, Chen Z, Dunaif A, Laven JS, Legro RS, Lizneva D, Natterson-Horowtiz B, Teede HJ, Yildiz BO (2016) Polycystic ovary syndrome. Nat Rev Dis Primers 2:16057. https://doi.org/10.1038/nrdp.2016.57

    Article  PubMed  Google Scholar 

  3. Chen ZJ, Shi Y, Sun Y, Zhang B, Liang X, Cao Y, Yang J, Liu J, Wei D, Weng N, Tian L, Hao C, Yang D, Zhou F, Shi J, Xu Y, Li J, Yan J, Qin Y, Zhao H, Zhang H, Legro RS (2016) Fresh versus frozen embryos for infertility in the polycystic ovary syndrome. N Engl J Med 375(6):523–533. https://doi.org/10.1056/NEJMoa1513873

    Article  PubMed  Google Scholar 

  4. Sha T, Wang X, Cheng W, Yan Y (2019) A meta-analysis of pregnancy-related outcomes and complications in women with polycystic ovary syndrome undergoing IVF. Reprod Biomed Online 39(2):281–293. https://doi.org/10.1016/j.rbmo.2019.03.203

    Article  PubMed  Google Scholar 

  5. Kollmann M, Martins WP, Lima ML, Craciunas L, Nastri CO, Richardson A, Raine-Fenning N (2016) Strategies for improving outcome of assisted reproduction in women with polycystic ovary syndrome: systematic review and meta-analysis. Ultrasound Obstet Gynecol 48(6):709–718. https://doi.org/10.1002/uog.15898

    Article  CAS  PubMed  Google Scholar 

  6. Sermondade N, Huberlant S, Bourhis-Lefebvre V, Arbo E, Gallot V, Colombani M, Freour T (2019) Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis. Hum Reprod Update 25(4):439–451. https://doi.org/10.1093/humupd/dmz011

    Article  CAS  PubMed  Google Scholar 

  7. Tziomalos K, Dinas K (2018) Obesity and outcome of assisted reproduction in patients with polycystic ovary syndrome. Front Endocrinol (Lausanne) 9:149. https://doi.org/10.3389/fendo.2018.00149

    Article  Google Scholar 

  8. He Y, Lu Y, Zhu Q, Wang Y, Lindheim SR, Qi J, Li X, Ding Y, Shi Y, Wei D, Chen ZJ, Sun Y (2019) Influence of metabolic syndrome on female fertility and in vitro fertilization outcomes in PCOS women. Am J Obstet Gynecol 221(2):138e1–138e12. https://doi.org/10.1016/j.ajog.2019.03.011

    Article  CAS  Google Scholar 

  9. Benoit L, Boujenah J, Poncelet C, Grynberg M, Carbillon L, Nyangoh Timoh K, Touleimat S, Mathieu D’Argent E, Jayot A, Owen C, Lavoue V, Roman H, Darai E, Bendifallah S (2019) Predicting the likelihood of a live birth for women with endometriosis-related infertility. Eur J Obstet Gynecol Reprod Biol 242:56–62. https://doi.org/10.1016/j.ejogrb.2019.09.011

    Article  CAS  PubMed  Google Scholar 

  10. Kim JH, Jee BC, Suh CS, Kim SH (2014) Nomogram to predict ongoing pregnancy using age of women and serum biomarkers after in vitro fertilization cycles. Eur J Obstet Gyn Reprod Biol 172:65–69. https://doi.org/10.1016/j.ejogrb.2013.10.015

    Article  Google Scholar 

  11. Loy SL, Cheung YB, Fortier MV, Ong CL, Tan HH, Nadarajah S, Chan JKY, Viardot-Foucault V (2017) Age-related nomograms for antral follicle count and anti-Mullerian hormone for subfertile Chinese women in Singapore. PLoS ONE 12(12):e0189830. https://doi.org/10.1371/journal.pone.0189830

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Papaleo E, Zaffagnini S, Munaretto M, Vanni VS, Rebonato G, Grisendi V, Di Paola R, La Marca A (2016) Clinical application of a nomogram based on age, serum FSH and AMH to select the FSH starting dose in IVF/ICSI cycles: a retrospective two-centres study. Eur J Obstet Gynecol Reprod Biol 207:94–99. https://doi.org/10.1016/j.ejogrb.2016.10.021

    Article  CAS  PubMed  Google Scholar 

  13. Rotterdam EA-SPcwg (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19(1):41–47. https://doi.org/10.1093/humrep/deh098

    Article  Google Scholar 

  14. Rotterdam EA-SPCWG (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81(1):19–25. https://doi.org/10.1016/j.fertnstert.2003.10.004

    Article  Google Scholar 

  15. Ballester M, Oppenheimer A, d’Argent EM, Touboul C, Antoine JM, Coutant C, Darai E (2012) Nomogram to predict pregnancy rate after ICSI-IVF cycle in patients with endometriosis. Hum Reprod 27(2):451–456. https://doi.org/10.1093/humrep/der392

    Article  CAS  PubMed  Google Scholar 

  16. van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F (2010) Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis. Hum Reprod Update 16(6):577–589. https://doi.org/10.1093/humupd/dmq015

    Article  PubMed  Google Scholar 

  17. Wang YA, Healy D, Black D, Sullivan EA (2008) Age-specific success rate for women undertaking their first assisted reproduction technology treatment using their own oocytes in Australia, 2002–2005. Hum Reprod 23(7):1633–1638. https://doi.org/10.1093/humrep/den135

    Article  CAS  PubMed  Google Scholar 

  18. Vaegter KK, Lakic TG, Olovsson M, Berglund L, Brodin T, Holte J (2017) Which factors are most predictive for live birth after in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) treatments? Analysis of 100 prospectively recorded variables in 8,400 IVF/ICSI single-embryo transfers. Fertil Steril 107(3):641. https://doi.org/10.1016/j.fertnstert.2016.12.005

    Article  PubMed  Google Scholar 

  19. Delitala AP, Capobianco G, Delitala G, Cherchi PL, Dessole S (2017) Polycystic ovary syndrome, adipose tissue and metabolic syndrome. Arch Gynecol Obstet 296(3):405–419. https://doi.org/10.1007/s00404-017-4429-2

    Article  CAS  PubMed  Google Scholar 

  20. Alves AC, Valcarcel B, Makinen VP, Morin-Papunen L, Sebert S, Kangas AJ, Soininen P, Das S, De Iorio M, Coin L, Ala-Korpela M, Jarvelin MR, Franks S (2017) Metabolic profiling of polycystic ovary syndrome reveals interactions with abdominal obesity. Int J Obes 41(9):1331–1340. https://doi.org/10.1038/ijo.2017.126

    Article  CAS  Google Scholar 

  21. Wild RA, Rizzo M, Clifton S, Carmina E (2011) Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis. Fertil Steril 95(3):1073–1079. https://doi.org/10.1016/j.fertnstert.2010.12.027

    Article  CAS  PubMed  Google Scholar 

  22. Bailey AP, Hawkins LK, Missmer SA, Correia KF, Yanushpolsky EH (2014) Effect of body mass index on in vitro fertilization outcomes in women with polycystic ovary syndrome. Am J Obstet Gynecol. https://doi.org/10.1016/j.ajog.2014.03.035

    Article  PubMed  Google Scholar 

  23. Lim SS, Kakoly NS, Tan JWJ, Fitzgerald G, Khomami MB, Joham AE, Cooray SD, Misso ML, Norman RJ, Harrison CL, Ranasinha S, Teede HJ, Moran LJ (2019) Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obes Rev 20(2):339–352. https://doi.org/10.1111/obr.12762

    Article  CAS  PubMed  Google Scholar 

  24. Horn J, Tanz LJ, Stuart JJ, Markovitz AR, Skurnik G, Rimm EB, Missmer SA, Rich-Edwards JW (2019) Early or late pregnancy loss and development of clinical cardiovascular disease risk factors: a prospective cohort study. BJOG 126(1):33–42. https://doi.org/10.1111/1471-0528.15452

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank MD. Qifeng Ou, Laboratory of General Surgery, The First Affiliated Hospital, Sun Yat-Sen University, for his technical support.

Funding

This work was supported by grants from the National Natural Science Foundation of China (81470063, 81671834 and 81971759), the Natural Science Foundation of Guangdong Province (2014A030310359), the Guangdong Special Support Plan-Science and Technology Innovation Youth Top Talents Project (2016TQ03R444) and the Youth Teacher Training Project of Sun Yat-sen University (17ykpy68).

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Authors and Affiliations

  1. Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China

    L. Gao, M. Li, Y. Wang, Z. Zeng, G. Liu, J. Li, B. Zhang, X. Liang, L. Wei & X. Yang

  2. Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China

    Y. Xie

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  1. L. Gao
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Contributions

Linzhi Gao, Manchao Li and Xing Yang designed the research. Yun Xie, Guihua Liu, Zhi Zeng, Yanfang Wang, and Bolun Zhang collected data. Jingjie Li and Xiaoyan Liang performed the analysis. Linzhi Gao, Manchao Li and Lina Wei wrote the manuscript. Linzhi Gao and Manchao Li contributed equally to this work.

Corresponding authors

Correspondence to L. Wei or X. Yang.

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All authors declare that they have no conflict of interest.

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This study was approved by the Ethical Review Board (ERB) of Sixth Affiliated Hospital of Sun Yat-sen University.

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Gao, L., Li, M., Wang, Y. et al. Overweight and high serum total cholesterol were risk factors for the outcome of IVF/ICSI cycles in PCOS patients and a PCOS-specific predictive model of live birth rate was established. J Endocrinol Invest 43, 1221–1228 (2020). https://doi.org/10.1007/s40618-020-01209-5

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