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American Journal of Obstetrics and Gynecology

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Elevated serum uric acid level is associated with adverse reproductive outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization or intracytoplasmic sperm injection embryo transfer cycles: a retrospective cohort study - 17/02/23

Doi : 10.1016/j.ajog.2022.11.1287 
Haiyan Yang, MD a, Guiquan Wang, MD b, Chang Liu, MD a, Lin Ding, MD c, Yan Li, MD a, Yi Chen d, Yili Teng, MD a, Zhihui Xu, MD a, Zhenhong Ye, MD e, f, g, h, Yue Zhao, PhD e, f, g, h, Liangshan Mu, MD, PhD i, ⁎
a Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China 
b Center for Reproductive Medicine, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China 
c Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China 
d The First School of Medicine, Wenzhou Medical University, Wenzhou, China 
e Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China 
f National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China 
g Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China 
h Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China 
i Reproductive Medicine Center, Zhongshan Hospital, Fudan University, Shanghai, China 

∗Corresponding authors: Liangshan Mu, MD, PhD. ; Yue Zhao, PhD.

Abstract

Background

Serum uric acid levels are elevated in polycystic ovary syndrome, however, the relationship between serum uric acid level and reproductive outcomes in women with polycystic ovary syndrome remains unclear.

Objective

This study aimed to investigate the association between serum uric acid level and the reproductive outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization or intracytoplasmic sperm injection embryo transfer cycles.

Study Design

This was a retrospective cohort study performed at a university-affiliated reproductive medicine center. A total of 1903 women with polycystic ovary syndrome undergoing their first in vitro fertilization or intracytoplasmic sperm injection embryo transfer cycles between January 2010 and January 2021 were initially included. The trends for reproductive outcomes in polycystic ovary syndrome across quartiles of serum uric acid levels were assessed. A logistic regression analysis was performed to obtain the odds ratios for in vitro fertilization outcomes based on the quartiles of serum uric acid with or without adjusting for potential confounding variables. Using generalized additive models, serum uric acid was further treated as its original continuous property to visualize its nonlinear relationship with in vitro fertilization outcomes. The live birth rate was the main outcome.

Results

After exclusions, a total of 883 women with polycystic ovary syndrome with their first fresh-embryo transfer cycles were included. In quartiles of serum uric acid levels, there was a significant decreasing trend in the live birth rate from the lowest quartile (Q1: 61.8%) to the highest (Q4: 45.9%) (Ptrend=.002). The percentage of low birthweight increased from Q1 (22.3%) to Q4 (31.7%) (Ptrend=.049). Compared with those in Q1, women in Q4 showed a significant lower probability of live birth and clinical pregnancy and a higher risk for low birthweight (all P<.05). Both the unadjusted and adjusted generalized additive models indicated that as the serum uric acid level increased, the probability of clinical pregnancy and the live birth rate exhibited an overall decreasing profile, and the risk for low birthweight showed an increasing profile.

Conclusion

An elevated serum uric acid level is associated with decreased probabilities of live birth and clinical pregnancy and an increased risk for low birthweight in women with polycystic ovary syndrome. However, these associations may be confounded by other factors and more well-designed studies are needed to confirm these findings in the future.

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Key words : live birth, low birthweight, polycystic ovary syndrome, reproductive outcomes, uric acid


Plan


 H.Y. and G.W. contributed equally to this article.
 The authors report no conflict of interest.
 This study was funded by the National Natural Science Foundation of China under grant number 82001503, the Wenzhou Municipal Science and Technology Bureau Foundation of Wenzhou, Zhejiang, China, under grant number Y20220055, and the Health Department of Zhejiang province under grant number 2021KY785.
 The data that support the findings of this study are available from the corresponding authors upon reasonable request.
 Cite this article as: Yang H, Wang G, Liu C, et al. Elevated serum uric acid level is associated with adverse reproductive outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization or intracytoplasmic sperm injection embryo transfer cycles: a retrospective cohort study. Am J Obstet Gynecol 2023;228:324.e1-10.


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Vol 228 - N° 3

P. 324.e1-324.e10 - mars 2023 Retour au numéro
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