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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

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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

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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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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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