Infertility patients with highest androgen levels had lowest pregnancy rates in study
High androgen hormone levels were associated with the lowest pregnancy rates among patients with polycystic ovary syndrome (PCOS), suggests a study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). PCOS often includes growths resembling cysts on one or both ovaries, sporadic ovulation resulting in reduced fertility and irregular periods, and high androgen levels leading to increased body or facial hair. The authors concluded that evaluating androgen levels in PCOS patients could help physicians more effectively guide them and treat their infertility.
The study was conducted by Jessica L. Chan, M.D., Cedars-Sinai Medical Center, and colleagues. It appears in Obstetrics and Gynecology.
Background
Experts classify PCOS into four main types, according to its features. Three types feature high androgen levels and one does not. Previous studies have found that compared to people with PCOS who have lower androgen levels, people with PCOS who have high androgen levels are more likely to have insulin resistance (difficulty moving glucose from the blood into cells), irregular menstrual cycles, and metabolic syndrome—conditions such as high blood pressure, high blood sugar levels, and high triglyceride levels that raise the risk of heart disease, diabetes, and stroke.
Little research has been conducted on the potential influence of androgen levels on pregnancy outcomes in people with PCOS.
Results
For the current study, researchers compared data from two prior NICHD-funded studies, Pregnancy in Polycystic Ovary Syndrome I and II. In these studies, researchers treated PCOS patients trying to achieve pregnancy with drugs to induce ovulation.
Of the 1,376 participants in both studies, 1,249 had PCOS with higher androgen levels and 127 had lower androgen levels.
Participants with higher androgen levels took longer to achieve pregnancy than those with lower androgen levels (41.8 months versus 33.9 months). Lower proportions of participants with higher androgen levels achieved pregnancy (29.9 percent versus 40.2 percent) and had live births (20.1 percent versus 33.1 percent).
Participants with higher androgen levels also had a higher average body mass index (35.5 versus 31.9) and lower fasting insulin levels (21.6 versus 14.7 micro-international units per milliliter).
Significance
“As it may take longer to conceive with the type of PCOS that includes high levels of androgens, these patients may be advised to start trying to conceive sooner or to seek fertility care more expeditiously,” Dr. Chan said.
The authors concluded that evaluating androgen levels and other features of PCOS may allow physicians to more effectively guide PCOS patients who are trying to become pregnant.
Reference
Chan, JL, et al. Correlation of polycystic ovarian syndrome phenotypes with pregnancy and neonatal outcomes. Obstetrics and Gynecology. 2024.
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