High BMI and Insulin Resistance Are Risk Factors for Spontaneous Abortion in Patients With Polycystic Ovary Syndrome Undergoing Assisted Reproductive Treatment: A Systematic Review and Meta-Analysis

Abstract

BackgroundThe risk of spontaneous abortion in patients with polycystic ovary syndrome (PCOS) undergoing assisted reproductive treatment (ART) is higher than that in patients without PCOS, however, no definitive risk factors have been confirmed to associate with the high spontaneous abortion rate in PCOS patients undergoing ART. This study was performed to assess the impact of relevant risk factors on spontaneous abortion in patients with PCOS. Clinical questions were formulated and organized according to the PICOS principle.MethodsA systematic review and meta-analysis were conducted on all published studies on PCOS and spontaneous abortion in Embase, PubMed, Web of Science and Cochrane Library. Related risk factors included body mass index (BMI), age, insulin resistance (IR), hyperandrogenism, and chromosome aberrations. All patients were diagnosed as PCOS using the Rotterdam criteria. The primary endpoint was miscarriage and live birth rate. Fixed-effect models were used to analyze homogeneous data, and subgroup and sensitivity analyses were performed on heterogeneous data. The source of heterogeneity was evaluated, and the random effect model was used to summarize the heterogeneity.ResultsAmong 1836 retrieved articles, 22 were eligible and included in the analysis with 11182 patients. High BMI (OR = 1.48, 95% CI [1.32, 1.67], MD = 1.35, 95% CI [0.58,2.12]) and insulin resistance (MD = 0.32, 95% CI [0.15, 0.49]) were associated with an increased risk of spontaneous abortion in PCOS patients undergoing ART. Older age (OR = 0.29, 95% CI [0.29, 0.44], MD = 2.01, 95% CI [0.04, 4.18]), embryonic chromosomal aberrations (OR = 0.75, 95%CI [0.31,1.77]), and hyperandrogenism (MD = 0.10, 95% CI [- 0.02, 0.22]) were not associated with the high spontaneous abortion rate in patients with PCOS. A subgroup analysis of BMI showed that there was no statistically significant difference in the effect between overweight and obesity on spontaneous abortion in PCOS patients undergoing ART (OR = 1.34, 95% [0.97, 1.85]).ConclusionHigh BMI and insulin resistance are two risk factors for an increased risk of spontaneous abortion in PCOS patients undergoing ART, and losing weight and mitigating insulin resistance may decrease the spontaneous abortion rate in these patients undergoing ART.

Increased risk of abortion after frozen-thawed embryo transfer in women with polycystic ovary syndrome phenotypes A and D

“…However, this was not found in our study. A recent systematic review and meta-analysis also showed that HA does not increase the risk of abortion in patients with PCOS 18 .…”

“…Abortion is a common complication of pregnancy. The aetiology of abortion is complex: obesity 17 , insulin resistance 18 , hyperandrogenism 19 , the quality of oocytes and endometrial abnormalities might be associated with the occurrence of abortion [20][21][22] . As reported in prior studies, women with PCOS are associated with an increased risk of abortion 23,24 .…”

Potential Risk Factors for Isolated Hypothyroxinemia in Women of Childbearing Age—Results from Retrospective Analysis

“…Therapeutic options comprise dietary modification or medications, both of which improve insulin sensitivity [37,38]. It can be added that insulin resistance increases the risk of spontaneous abortion after assisted reproduction technology treatment [39,40].…”

Effects of atorvastatin on the insulin resistance in women of polycystic ovary syndrome

“…Endometrial hyperplasia is prone to occur under the stimulation of estrogen and insulin for a long time, leading to a significant decrease in pregnancy rate of PCOS patients. [ 6 , 7 ] So, improving insulin resistance is very necessary for PCOS women. The mechanisms of insulin resistance are very complex, they are usually related to obesity, metabolic abnormalities, gene expression and so on.…”