Contributing factors for pregnancy outcomes in women with PCOS after their first FET treatment: a retrospective cohort study

Abstract

AbstractBackground There is no consensus on the factors influencing pregnancy outcomes in frozen embryo transfer (FET) cycles in patients with polycystic ovary syndrome (PCOS). Our aim is to explore the contributing factors of clinical pregnancy outcomes in PCOS patients undergoing their first FET treatment. Methods A retrospective analysis was conducted on patients with PCOS undergoing their first FET treatment at a private fertility center from January 2018 to December 2021. A total of 574 patients with PCOS were eventually included. Our main outcome was to identify the factors influencing the clinical pregnancy rate, live birth rate, miscarriage rate and preterm delivery rate of PCOS patients during their first FET. Results Women with clinical pregnancy had significantly lower progesterone levels (P = 0.014) and significantly higher endometrial thickness (EMT) (P = 0.006) on human chorionic gonadotropin (hCG) trigger day than women with non-pregnancy. In multivariate logistics regression analysis adjusted for maternal age, body mass index (BMI), infertility years and some other confounders, progesterone levels (adjusted odds ratio [aOR] 0.109, 95% confidence interval [CI] 0.018–0.670) and EMT (aOR 1.126, 95% CI 1.043–1.419) on the hCG trigger day were associated with the clinical pregnancy rate. Similarly, in another multivariate logistics regression analysis, progesterone levels (aOR 0.055, 95% CI 0.007–0.420) and EMT (aOR 1.179, 95% CI 1.011–1.376) on the hCG trigger day were associated with the live birth rate. Quantitative insulin sensitivity check index (QUICKI) < 0.357 and fewer oocytes retrieved were associated with miscarriage in univariate logistic regression analysis, but after adjusting for relevant confounders, they had no significant effect on miscarriage. Antral follicle count (AFC) (aOR 1.179, 95% CI 1.011–1.376) was found to be a risk factor for preterm delivery in the first FET cycle of PCOS patients. Conclusions In women with PCOS undergoing their first FET, lower progesterone levels and higher EMT on hCG trigger day were associated with clinical pregnancy and live birth, and AFC was a risk factor for preterm delivery. During FET treatment, paying attention to the patient's endocrine indicators and follicle status may have a positive effect on predicting and improving the pregnancy outcome of PCOS patients.