Elevated serum uric acid tied to adverse reproductive outcomes in women with PCOS undergoing IVF

A study published in the American Journal of Obstetrics and Gynecology has concluded that in women with PCOS (polycystic ovary syndrome), elevated serum uric acid level decreases the probability of live birth and clinical pregnancy. The researchers also added that it increases the risk of low birth weight in such cases.

Nearly 8–12% of women of reproductive age are affected by PCOS. It is one of the most common endocrinopathies affecting 10–35% of obese women.

PCOS is associated with infertility and hormonal changes. During the development of PCOD, some women showed evidence of increased serum uric acid levels than ordinary women.

Serum uric acid, one of the distinguishing factors of metabolic syndrome, is elevated in PCOD. This is closely attributed to its relationship with insulin resistance, hyperandrogenemia and hyperinsulinemia in PCOD women

Uric acid is a potent scavenger and essential antioxidant in humans. It is the independent risk factor for metabolic syndrome. The relationship and association between hormonal changes and SUA level in PCOD remain unclarified. A study has concluded that the incidence of hyperuricemia in PCOS subjects is 66.25%.

Considering the above background, a study was conducted by Dr Yang from Reproductive Medicine Center at Wenzhou Medical University, China, to evaluate:

What is the relationship between Serum Uric Acid level and reproductive outcomes in PCOS women undergoing in-vitro fertilization or intracytoplasmic sperm injection (IVF or ICSI) embryo transfer cycles?

The critical points of the study are:

• The study was a retrospective cohort study conducted in a university-affiliated reproductive medicine centre.
• The study included 883 women with a history of PCOS and first IVF or ICSI embryo transfer cycles (January 2010-January 2021).
• Logistic regression analysis was performed to obtain the OR/Odds Ratio for IVF outcomes based on the SUA quartiles(with or without adjusting).
• The primary outcome measured in the study was the live birth rate.
• There was a decreasing trend in the live birth rate from the lowest quartile to the highest (Q1: 61.8% and Q4: 45.9%) in quartiles of SUA levels. This was significant, and the value of the P trend was 0.002.
• There was an increase in low birth weight percentage from Q1 (22.3%) to Q4 (31.7%). The value of the P trend was 0.049.
• Women in Q4 had a lower probability of clinical pregnancy and live birth. There was a higher risk of low birth weight with all P values of < 0.05.

The researchers said, "The GAM models (unadjusted and adjusted) indicated that with an increase in SUA level, there was an overall decrease in the probability of the live birth rate and clinical pregnancy. We also observed the increasing profile of low birth weight risk."

We warrant further studies and investigations to confirm these findings in the future, they said.

The researchers explained that we investigated the association between Serum Uric Acid Levels and the reproductive outcomes in PCOS women. The previous studies mentioned that SUA levels are elevated significantly in PCOS women, but our study has added additional evidence relating it to adverse reproductive outcomes.

Further reading:

Elevated serum uric acid level is associated with adverse reproductive outcomes in women with polycystic ovary syndrome undergoing IVF or ICSI embryo transfer cycles: a retrospective cohort study. Haiyan Yang et al