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. 2025 Feb 28;25(1):222.
doi: 10.1186/s12884-025-07342-4.

Hyperandrogenism increases late spontaneous miscarriage in polycystic ovary syndrome women due to cervical insufficiency? A propensity-score matching study

Keyan Wang  1 , Zhiqin Bu  2 , Xiaofei Ge  2 , Fang Wang  2 , Menghui Zhang  2 , Yihong Guo  3
Affiliations

Hyperandrogenism increases late spontaneous miscarriage in polycystic ovary syndrome women due to cervical insufficiency? A propensity-score matching study

Keyan Wang et al. BMC Pregnancy Childbirth. .

Abstract

Background: The potential effects of hyperandrogenism (HA) on pregnancy outcomes among polycystic ovary syndrome (PCOS) patients are still unknown. The aim of this study was to explore the impact of HA on miscarriage rate after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment in PCOS patients.

Methods: Women diagnosed with PCOS who underwent the first autologous IVF/ICSI cycles using gonadotropin-releasing hormone agonist (GnRH-a) protocols for ovarian stimulation during the period from January 2016 to December 2022 were included. Women were divided into the HA and non-HA group according to Hyperandrogenemia (serum testosterone level > 0.48 ng/mL), and/or the presence of hirsutism. Pregnancy outcomes were compared before and after propensity-score matching (PSM). Multiple logistic regression models were performed to demonstrate the independent impact of HA on pregnancy outcomes.

Results: A total of 3066 patients were included. PCOS women with HA experienced a notably higher rates of late spontaneous miscarriage (LSM) as compared to those without HA before and after PSM (8.8% versus 3.5%, P < 0.001; 8.9% versus 3.9%, P = 0.001, respectively), but comparable rates of clinical pregnancy, early spontaneous miscarriage, and live birth. After adjusting for possible confounding factors, the logistic regression confirmed that HA was independently associated with the increased risk of LSM (adjusted OR: 2.540, 95% confidence interval: 1.326-4.672, P = 0.003). For the specific reasons for LSM, cervical insufficiency accounted for a larger proportion in women with HA than their counterparts without HA (15/32 versus 7/33, P = 0.029).

Conclusions: Androgen excess is postulated to play a role in late miscarriage via increased likelihood of cervical insufficiency.

Trial registration: N/A.

Keywords: Cervical insufficiency; Hyperandrogenism; Late spontaneous miscarriage; Polycystic ovarian syndrome; Propensity score matching.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study adhered to the Declaration of Helsinki regarding medical protocol and ethics, and the Ethics Review Committee of the First Hospital of Zhengzhou University approved the study(2023-KY-1049-002). Written informed consent was waived due to the retrospective nature of the study, in accordance with the national legislation and institutional requirements. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the retrospective cohort study Note: HA = hyperandrogenism
Fig. 2
Fig. 2
Relationship between HA status and IVF/ICSI outcomes in PCOS women Note: HA = hyperandrogenism; IVF = in vitro fertilization; ICSI = intracytoplasmic sperm injection; aOR = adjusted odds ratio; CI; confidence interval. Adjusted variables included female age, BMI, infertility type, fertilization method, stage of embryos transferred, and number of embryos transferred
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