Non-linear saturation threshold of gonadotropin dose on cumulative live birth rates in advanced-age women with polycystic ovary syndrome: a retrospective cohort study - Summary - 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
To quantify the non-linear threshold effect of total gonadotropin (Gn) dose on cumulative live birth rates (CLBR) in older women with PCOS, emphasizing its clinical significance, and to characterize the endometrial thickness (EMT) dose-response relationship.
Key Findings:
CLBR was significantly lower in the advanced-age group (44.40%) compared to younger cohorts (63.90%–69.40%, P < 0.001).
Total Gn dose and EMT independently predicted CLBR in the advanced-age subgroup.
A non-linear dose-response relationship was confirmed, with saturation at 1,600 IU; below this threshold, each 100-IU increase was associated with higher odds of CLBR (aOR: 1.059, P = 0.034).
EMT showed a stable positive linear association with CLBR (aOR: 1.088, P = 0.016).
The nomogram demonstrated moderate discrimination (AUC = 0.74) and adequate calibration (P = 0.108).
Interpretation:
The study indicates that advanced-age PCOS patients have lower CLBR, and there exists a non-linear association between total Gn dose and CLBR, with a plateau effect at 1,600 IU. EMT positively correlates with CLBR, suggesting implications for clinical practice.
Limitations:
Retrospective design may introduce selection bias, potentially affecting the validity of the findings.
Findings may reflect confounding by indication regarding Gn dosing.
Generalizability may be limited to the specific population studied.
Conclusion:
Moderate stimulation with attention to endometrial preparation may be beneficial for advanced-age PCOS patients, given the identified threshold effects of Gn dosing, reinforcing the need for tailored treatment strategies.
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