Non-linear saturation threshold of gonadotropin dose on cumulative live birth rates in advanced-age women with polycystic ovary syndrome: a retrospective cohort study - Report - MDSpire
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Non-linear saturation threshold of gonadotropin dose on cumulative live birth rates in advanced-age women with polycystic ovary syndrome: a retrospective cohort study
Threshold Effects of Gonadotropin Dosing on Cumulative Live Birth Rates in Older Women with PCOS
Overview
This study investigates the non-linear relationship between total gonadotropin dose and cumulative live birth rates (CLBR) in older women with polycystic ovary syndrome (PCOS). It identifies a threshold of 1,600 IU above which increased gonadotropin dosing does not enhance CLBR, emphasizing the importance of endometrial thickness in reproductive outcomes.
Background
Polycystic ovary syndrome (PCOS) is a prevalent cause of anovulatory infertility, particularly affecting women of advanced reproductive age. Despite a high antral follicle count, older PCOS patients often face significant declines in reproductive success, necessitating a better understanding of gonadotropin dosing strategies. This study aims to clarify the dose-response relationship between gonadotropin administration and CLBR, which is critical for optimizing assisted reproductive technology outcomes in this population.
Data Highlights
Age Group
Cumulative Live Birth Rate (CLBR)
Advanced Age (≥35 years)
44.40%
Younger Cohorts
63.90%–69.40%
Key Findings
CLBR was significantly lower in the advanced-age group (44.40%) compared to younger cohorts (63.90%–69.40%, P < 0.001).
A non-linear dose-response relationship was observed for total gonadotropin dose (P = 0.019), with a saturation threshold at 1,600 IU.
Below the threshold of 1,600 IU, each 100-IU increase in gonadotropin was associated with higher odds of CLBR (aOR: 1.059, P = 0.034).
Endometrial thickness (EMT) positively correlated with CLBR, with predicted rates increasing from 32.5% at 6 mm to 66.1% at 22 mm (aOR: 1.088, P = 0.016).
The predictive nomogram demonstrated moderate discrimination (AUC = 0.74) and adequate calibration (P = 0.108).
Clinical Implications
Clinicians should consider a gonadotropin dosing strategy that does not exceed the identified threshold of 1,600 IU to optimize CLBR in older PCOS patients. Additionally, attention to endometrial thickness is crucial, as it independently predicts reproductive success.
Conclusion
The findings highlight the importance of individualized gonadotropin dosing and endometrial assessment in enhancing reproductive outcomes for older women with PCOS undergoing assisted reproductive technology.
