Predicting Success and Efficiency of ART in PCOS Patients by Forming a Predictive Model-Study Finds

Polycystic ovary syndrome (PCOS) affects 3%-10% of women of reproductive age globally. It compromises ovarian function, oocyte quality, and endometrial receptivity, frequently resulting in infertility.

Infertility Management in PCOS

First-Line Approaches

• Lifestyle modification (diet, exercise) remains the primary non-pharmacological intervention.

• Clomiphene citrate is the preferred first-line agent for ovulation induction.

Second-Line Options

• Letrozole (aromatase inhibitor) and gonadotropin therapy serve as alternatives for clomiphene-resistant cases or failed first-line therapy, provided no additional infertility factors are present.

Third-Line Interventions

• IVF/ICSI is indicated for patients unresponsive to ovulation induction or with persistent anovulatory infertility.

• IVF-embryo transfer (ET) is common for these patients.

Determinants of Clinical Pregnancy in PCOS

Patient-Related Factors

• Maternal age

• Endocrine parameters: Baseline FSH, LH, oestradiol

Ovarian Stimulation Parameters

• Gonadotropin treatment duration (reflects intensity/duration of stimulation)

• Stimulation protocols: Long-acting GnRH, modified protocols, antagonist regimens, luteal phase/other superovulation protocols

Sperm Quality

• Sperm velocity and deformity index impact fertilization rates

Embryo and Endometrial Factors

• Endometrial thickness (predicts receptivity)

• Embryo number and quality: Transferable embryos per oocyte retrieved; number of embryos transferred

Study Synopsis: Predicting IVF-ET Outcomes in PCOS

A retrospective cohort analysis was conducted at the Reproductive Medicine Center of Northern Theater Command General Hospital (Jan 2017–Mar 2024).

• Inclusion: Women aged 20–39 with PCOS (Rotterdam criteria), first IVF-ET cycle, informed consent.

• Sample: 425 patients; mean age 30.56 ± 3.47 years

• Infertility duration: Median 4.00 (2.00–5.00) years

• Primary infertility: 63.53%; Secondary: 36.47%

• ART distribution: 61.41% IVF, 38.59% ICSI

Independent Predictors of Clinical Pregnancy

Logistic regression identified six independent predictors:

• LH/FSH ratio (inverse association with clinical pregnancy; OR=0.577)

• Free thyroxine (FT4) level (OR=1.107; higher FT4, higher chance)

• Number of embryos transferred (OR=1.781)

• Number of oocytes retrieved (OR=1.071)

• Optimal embryo rate (OR=21.347)

• Antral follicle count (OR=1.444)

Note: LH/FSH is a negative predictor; all other parameters showed positive associations with successful clinical pregnancy.

Predictive Model for Clinical Pregnancy

• Combined model AUC: 0.732 (95% CI: 0.683–0.782) — superior to any single variable.

• Nomograms were developed to assist clinicians in real-time prediction of pregnancy probability post-IVF-ET in PCOS.

Clinical Implications and Recommendations

• Risk stratification using these predictors can guide patient counseling and informed consent.

• Adjusting modifiable factors (e.g., optimizing number of embryos transferred, targeting FT4 levels) may improve outcomes.

• Nomogram use in clinical practice can personalize reproductive counseling.

Study Limitations and Future Directions

• Single-center, retrospective design; limited generalizability.

• Further research: Multicenter, prospective studies needed. Focus should include refining the role of antral follicle count and optimal oocyte retrieval numbers to improve outcomes and minimize OHSS risk.

Summary Points

• PCOS compromises ovarian, oocyte, and endometrial function.

• Six predictors (LH/FSH ratio, FT4, embryos transferred, oocytes retrieved, optimal embryo rate, antral follicle count) are key post-IVF-ET outcomes.

• Predictive modeling (AUC 0.732) enhances clinical counseling and decision-making.

• Nomograms facilitate individualized risk estimation for PCOS patients undergoing ART.

Citation:

Li Y-H, Yu Y-X, Wang S-H, et al. Prediction of clinical pregnancy after in vitro fertilisation-embryo transfer in infertile patients with polycystic ovary syndrome. Gynecology and Obstetrics Clinical Medicine 2026;6:e000250. doi:10.1136/gocm-2025-000250