Non-linear saturation threshold of gonadotropin dose on cumulative live birth rates in advanced-age women with polycystic ovary syndrome: a retrospective cohort study

Category	Detail
Condition	Polycystic Ovary Syndrome (PCOS)
Key Mechanisms	Anovulatory infertility, hyperandrogenism, insulin resistance, impaired follicular development, and endometrial receptivity.
Target Population	Women with PCOS aged 35 years and older.
Care Setting	Assisted Reproductive Technology (ART) clinics.

Cumulative live birth rates (CLBR) significantly lower in advanced-age PCOS patients (44.40%) compared to younger cohorts (63.90%–69.40%).
Non-linear dose-response relationship identified between total gonadotropin (Gn) dose and CLBR, with saturation at 1,600 IU.
Endometrial thickness (EMT) positively correlated with CLBR, increasing from 32.5% at 6 mm to 66.1% at 22 mm.
A predictive nomogram was developed and validated, demonstrating moderate discrimination (AUC = 0.74).
Moderate stimulation with attention to EMT may improve outcomes in advanced-age PCOS patients.

PCOS diagnosed per 2004 Rotterdam criteria: oligo/anovulation, hyperandrogenism, polycystic ovarian morphology.

Consider moderate gonadotropin stimulation with careful monitoring of endometrial thickness.

Regular assessment of endometrial thickness and cumulative live birth rates during treatment.

Both insufficient and excessive gonadotropin stimulation may compromise oocyte competence and endometrial receptivity.

PCOS patients aged 35 years and older undergoing IVF/ICSI.

Total Gn dose should be carefully titrated, with attention to maintaining doses below 1,600 IU for optimal outcomes.

Utilize a nomogram incorporating age, EMT, transfer type, AFC, and Gn dose for personalized treatment planning.
Monitor endometrial thickness closely to optimize chances of successful implantation.

Clinical Scorecard: Threshold Effects of Gonadotropin Dosing on Cumulative Live Birth Rates in Older Women with Polycystic Ovary Syndrome: A Retrospective Analysis