Hyperandrogenism Increases Late Spontaneous Miscarriage in Polycystic Ovary Syndrome Women Due to Cervical Insufficiency? A Propensity-score Matching Study

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2025 Feb 28

PMID 40022012

Authors

Keyan Wang

Zhiqin Bu

Xiaofei Ge

Fang Wang

Menghui Zhang

Yihong Guo

Affiliations

Soon will be listed here.

Abstract

Background: The potential effects of hyperandrogenism (HA) on pregnancy outcomes among polycystic ovary syndrome (PCOS) patients are still unknown. The aim of this study was to explore the impact of HA on miscarriage rate after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment in PCOS patients.

Methods: Women diagnosed with PCOS who underwent the first autologous IVF/ICSI cycles using gonadotropin-releasing hormone agonist (GnRH-a) protocols for ovarian stimulation during the period from January 2016 to December 2022 were included. Women were divided into the HA and non-HA group according to Hyperandrogenemia (serum testosterone level > 0.48 ng/mL), and/or the presence of hirsutism. Pregnancy outcomes were compared before and after propensity-score matching (PSM). Multiple logistic regression models were performed to demonstrate the independent impact of HA on pregnancy outcomes.

Results: A total of 3066 patients were included. PCOS women with HA experienced a notably higher rates of late spontaneous miscarriage (LSM) as compared to those without HA before and after PSM (8.8% versus 3.5%, P < 0.001; 8.9% versus 3.9%, P = 0.001, respectively), but comparable rates of clinical pregnancy, early spontaneous miscarriage, and live birth. After adjusting for possible confounding factors, the logistic regression confirmed that HA was independently associated with the increased risk of LSM (adjusted OR: 2.540, 95% confidence interval: 1.326-4.672, P = 0.003). For the specific reasons for LSM, cervical insufficiency accounted for a larger proportion in women with HA than their counterparts without HA (15/32 versus 7/33, P = 0.029).

Conclusions: Androgen excess is postulated to play a role in late miscarriage via increased likelihood of cervical insufficiency.

Trial Registration: N/A.

References

Jie H, Zhou X, Zhao M, Hu M, Mai Q, Zhou C . Pregnancy outcomes in patients with polycystic ovary syndrome who conceived after single thawed blastocyst transfer: a propensity score-matched study. BMC Pregnancy Childbirth. 2022; 22(1):718. PMC: 9487057. DOI: 10.1186/s12884-022-05011-4. View

Wu Y, Liang X, Cai M, Gao L, Lan J, Yang X . Development and validation of a model for individualized prediction of cervical insufficiency risks in patients undergoing IVF/ICSI treatment. Reprod Biol Endocrinol. 2021; 19(1):6. PMC: 7789534. DOI: 10.1186/s12958-020-00693-x. View

Hu S, Xu B, Long R, Jin L . The effect of polycystic ovary syndrome without hyperandrogenism on pregnancy-related outcomes: a retrospective cohort study. BJOG. 2020; 128(6):1003-1010. DOI: 10.1111/1471-0528.16557. View

Wang J, Zhou W, Song Z, Ni T, Zhang Q, Chen Z . Does the Risk of Embryo Abnormality Increase in PCOS Women? A Secondary Analysis of a Multicenter, Randomized Controlled Trial. J Clin Endocrinol Metab. 2022; 108(6):e249-e257. DOI: 10.1210/clinem/dgac726. View

Mecenas C, Giussani D, Owiny J, Jenkins S, Wu W, Honnebier B . Production of premature delivery in pregnant rhesus monkeys by androstenedione infusion. Nat Med. 1996; 2(4):443-8. DOI: 10.1038/nm0496-443. View

Yang A, Xu X, Han Y, Wei J, Hao G, Cui N . Risk Factors for Different Types of Pregnancy Losses: Analysis of 15,210 Pregnancies After Embryo Transfer. Front Endocrinol (Lausanne). 2021; 12:683236. PMC: 8267909. DOI: 10.3389/fendo.2021.683236. View

Brown R, Gagnon R, Delisle M . No. 373-Cervical Insufficiency and Cervical Cerclage. J Obstet Gynaecol Can. 2019; 41(2):233-247. DOI: 10.1016/j.jogc.2018.08.009. View

Bu Z, Hu L, Su Y, Guo Y, Zhai J, Sun Y . Factors related to early spontaneous miscarriage during IVF/ICSI treatment: an analysis of 21,485 clinical pregnancies. Reprod Biomed Online. 2019; 40(2):201-206. DOI: 10.1016/j.rbmo.2019.11.001. View

Palomba S, de Wilde M, Falbo A, Koster M, La Sala G, Fauser B . Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update. 2015; 21(5):575-92. DOI: 10.1093/humupd/dmv029. View

10.

Pasquali R, Zanotti L, Fanelli F, Mezzullo M, Fazzini A, Labate A . Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: A Challenging Perspective. J Clin Endocrinol Metab. 2016; 101(5):2013-22. DOI: 10.1210/jc.2015-4009. View

11.

Chen Z, Shi Y, Sun Y, Zhang B, Liang X, Cao Y . Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome. N Engl J Med. 2016; 375(6):523-33. DOI: 10.1056/NEJMoa1513873. View

12.

Feigenbaum S, Crites Y, Hararah M, Yamamoto M, Yang J, Lo J . Prevalence of cervical insufficiency in polycystic ovarian syndrome. Hum Reprod. 2012; 27(9):2837-42. PMC: 3415288. DOI: 10.1093/humrep/des193. View

13.

Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz B . The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016; 31(12):2841-2855. DOI: 10.1093/humrep/dew218. View

14.

Yang W, Yang R, Lin M, Yang Y, Song X, Zhang J . Body mass index and basal androstenedione are independent risk factors for miscarriage in polycystic ovary syndrome. Reprod Biol Endocrinol. 2018; 16(1):119. PMC: 6245701. DOI: 10.1186/s12958-018-0438-7. View

15.

Mills G, Badeghiesh A, Suarthana E, Baghlaf H, Dahan M . Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies. Hum Reprod. 2020; 35(7):1666-1674. DOI: 10.1093/humrep/deaa099. View

16.

Ma L, Cao Y, Ma Y, Zhai J . Association between hyperandrogenism and adverse pregnancy outcomes in patients with different polycystic ovary syndrome phenotypes undergoing fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis. Gynecol Endocrinol. 2021; 37(8):694-701. DOI: 10.1080/09513590.2021.1897096. View

17.

. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2003; 19(1):41-7. DOI: 10.1093/humrep/deh098. View

18.

Palomba S, Daolio J, La Sala G . Oocyte Competence in Women with Polycystic Ovary Syndrome. Trends Endocrinol Metab. 2016; 28(3):186-198. DOI: 10.1016/j.tem.2016.11.008. View

19.

Ge X, Wang K, Sun Y, Bu Z . Body mass index impacts ectopic pregnancy during in vitro fertilization: an analysis of 42,362 clinical pregnancy cycles. Reprod Biol Endocrinol. 2023; 21(1):105. PMC: 10617086. DOI: 10.1186/s12958-023-01146-x. View

20.

Palomba S . Is fertility reduced in ovulatory women with polycystic ovary syndrome? An opinion paper. Hum Reprod. 2021; 36(9):2421-2428. DOI: 10.1093/humrep/deab181. View