Asian women with PCOS have enhanced ovarian reserve and ART outcomes, even at an advanced maternal age: a model for reproductive longevity?

STUDY QUESTION Does PCOS represent a human model for reproductive longevity? SUMMARY ANSWER Asian women with PCOS have enhanced ovarian reserve and ART outcomes, even at an advanced maternal age. WHAT IS KNOWN ALREADY Polycystic ovary syndrome (PCOS) afflicts 4–20% of women at reproductive age and is associated with anovulation, hyperandrogenism and polycystic ovarian morphology. However, there remains a paucity in research into the PCOS-related reproductive outcomes in Asian women following assisted reproduction techniques (ART). This study addresses a critical gap in elucidating the Asian PCOS phenotype and reproductive longevity associated with PCOS, within the context of a multi-ethnic Asian population. STUDY DESIGN, SIZE, DURATION A retrospective observational cohort with a total of 3,092 women from a tertiary-care centre in Singapore was analyzed in this study. PARTICIPANTS/MATERIALS, SETTING, METHODS PCOS was diagnosed according to the 2003 Rotterdam Criteria. After exclusions, 1249 women were grouped into the PCOS (n = 212) or normo-ovulatory (n = 1037) groups. Clinical demographics, ART protocols, reproductive outcomes and hormone levels were evaluated in the study. Modified Poisson Regression analyses were used to compare the ART outcomes between PCOS and normal-ovulatory groups. MAIN RESULTS AND THE ROLE OF CHANCE Women with PCOS exhibit elevated levels of anti-Müllerian hormone (AMH) in comparison to normo-ovulatory women. While AMH levels typically decreased with age, the decline was observed to be significantly slower in women with PCOS when compared to their normo-ovulatory counterparts. Even after the age of 36 years, women with PCOS maintained relatively higher AMH levels (PCOS vs. normo-ovulatory: 44.4 vs 19.3 pmol/L). The cumulative pregnancy rate following one ovarian stimulation cycle of ART decreased with age in normo-ovulatory women after 30 years old: 46.0% for ages 31–35 and 28.6% for ages 36 and older (p < 0.001). Conversely, for women with PCOS following ART, cumulative pregnancy rates remained stable in advanced maternal age, namely 56.7% for ages 31–35 and 55.9% for ages 36 and older. Compared with the normal-ovulatory group, the adjusted relative risk (aRR) of cumulative pregnancy rates in the PCOS group were significantly higher for women aged 36 years and older undergoing ART (aRR: 1.78; 95% CI: 1.24–2.54), especially for those undergoing IVF (2.01; 1.40–3.14). LIMITATIONS, REASONS FOR CAUTION This retrospective study included only Asian women and hence this may not be applicable to other non-Asian populations. WIDER IMPLICATIONS OF THE FINDINGS Our findings provide strong support for our hypothesis that women with PCOS may exhibit an extended reproductive life span and could attain successful pregnancy outcomes through ART, even at advanced maternal ages. These results demonstrate that women with PCOS are likely to have an enhanced reproductive lifespan and warrant further prospective longitudinal studies to unravel the mechanisms underlying the reproductive longevity observed in women with PCOS. STUDY FUNDING/COMPETING INTEREST(S) This work was funded in part by the NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality. All authors declare that no competing interests exist.