Outcome-Dependent Variations in Homocysteine-Androgen Relationships in PCOS Women
Overview
This study reveals that the associations between homocysteine (HCY) and androgen levels in women with polycystic ovary syndrome (PCOS) vary significantly depending on reproductive outcomes. Infertile PCOS patients show broad positive correlations between HCY and multiple androgens, while pregnant women exhibit narrower and outcome-specific patterns, including a positive association with total testosterone in live births and a negative association with DHEA in spontaneous abortions.
Background
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder characterized by hyperandrogenism, insulin resistance, and ovulatory dysfunction, leading to infertility and increased risk of pregnancy complications. Elevated homocysteine (HCY) levels are common in PCOS and may contribute to hyperandrogenism and adverse reproductive outcomes. However, the relationship between HCY and androgen profiles across different reproductive outcomes in PCOS remains unclear. Understanding these associations could improve risk stratification and management of reproductive dysfunction in PCOS.
Data Highlights
Group
Sample Size (n)
HCY-Androgen Correlation Pattern
Infertility
302
Broad positive correlations with TT, Bio-T, FT, FAI (β=0.12–0.21, P<0.01)
Pregnancy
573
Narrower correlations overall
Live Birth
266
Positive association between HCY and TT (β=0.30, P<0.01)
Spontaneous Abortion
292
Negative association between HCY and DHEA (β=-0.16, P=0.02)
Key Findings
Metabolic disturbances were most severe in infertile PCOS patients, intermediate in spontaneous abortion cases, and least pronounced in live birth cases (all P < 0.05).
In infertile patients, HCY positively correlated with multiple androgen measures including total testosterone, bioavailable testosterone, free testosterone, and free androgen index.
Pregnant PCOS women showed reduced breadth of HCY-androgen correlations compared to infertile patients.
Within pregnancy subgroups, HCY was positively associated with total testosterone in women who achieved live birth.
Conversely, HCY was negatively associated with dehydroepiandrosterone (DHEA) in women who experienced spontaneous abortion.
Clinical Implications
These findings suggest that the relationship between homocysteine and androgen levels in PCOS is influenced by reproductive outcomes, highlighting the importance of tailored metabolic and hormonal assessment in this population. Monitoring HCY and androgen profiles may aid in identifying women at higher risk for infertility or adverse pregnancy outcomes, potentially guiding personalized interventions to improve reproductive success.
Conclusion
The study demonstrates that homocysteine-androgen associations in PCOS women are dependent on reproductive outcomes, with distinct patterns observed in infertility, live birth, and spontaneous abortion groups. These insights may enhance understanding of PCOS heterogeneity and inform clinical risk stratification across reproductive stages.
References
Study Authors/Beijing Obstetrics and Gynecology Hospital/2026 -- Outcome-dependent variations in the relationship between homocysteine and androgen levels in women with polycystic ovary syndrome
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