Cluster analysis reveals a homogeneous subgroup of PCOS women with metabolic disturbance associated with adverse reproductive outcomes
Hanxiao Chen, Rujun Zeng, Xun Zeng, Lang Qin- General Medicine
- General Medicine
Abstract
Background:
Polycystic ovarian syndrome (PCOS) is a heterogeneous and complex reproductive endocrinological disease that could lead to infertility. There were many attempts to classify PCOS but it remains unclear whether there is a specific subgroup of PCOS that is associated with the best or worst reproductive outcomes of assisted reproductive techniques (ART).
Methods:
Infertile PCOS patients who underwent their first cycle of
Results:
Our analysis clustered women with PCOS into "reproductive", "metabolic", and "balanced" clusters based on nine traits. Reproductive group was characterized by high levels of testosterone (T), sex hormone-binding globulin (SHBG), follicular stimulation hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH). Metabolic group was characterized by high levels of body mass index (BMI), fasting insulin (Ins0), and fasting glucose (Glu0). Balanced group was characterized by low level of both low level of the aforementioned reproductive and metabolic parameters, except for SHBG. Compared with PCOS patients in reproductive and balanced clusters, those in metabolic cluster had lower good quality D3 embryo rate and blastocyst formation rate. Moreover, we found that PCOS patients in the reproductive cluster had greater fresh ET cancelation rate and clinical pregnancy rate after fresh ET than metabolic cluster (OR = 3.37, 95% CI: 1.77–6.44, and OR = 6.19, 95% CI: 1.58–24.24, respectively). And compared with PCOS of metabolic cluster, those of balanced cluster also had higher chance for fresh ET cancelation (OR = 2.83, 95% CI: 1.26–6.35).
Conclusions:
Our study suggested that PCOS patients in metabolic cluster may be associated with adverse reproductive outcomes and might need individualized treatment and careful monitoring before and during ART.