The impact of age on clinical features and fertility outcomes in patients with polycystic ovary syndrome: a secondary analysis based on the PCOSAct trial

TL;DR

This study shows that PCOS symptoms and outcomes change with age, with older women facing more metabolic issues and higher early pregnancy loss risks.

Contribution

The study reveals age-specific shifts in PCOS clinical features and fertility outcomes, advocating for age-stratified management.

Findings

Older PCOS patients show increased metabolic risks like dyslipidemia and atherogenic indices.

Ovulation induction success increases with age, but so does the risk of first-trimester threatened abortion.

Younger women exhibit higher androgen levels, while older women show more metabolic disturbances.

Abstract

This study aimed to investigate age-related variations in baseline characteristics and reproductive outcomes among women with polycystic ovary syndrome (PCOS).

A secondary analysis of the PCOSAct trial included 936 participants stratified into four age groups: 20–24, 25–29, 30–34, and 35–40 years. Differences in anthropometric measures, sex hormones, metabolic parameters, and pregnancy outcomes were analyzed using correlation and multiple logistic regression.

With increasing age, linear trends revealed increases in hirsutism score, systolic blood pressure, triglycerides, dyslipidemia, metabolic syndrome, and atherogenic indices (P-trend<0.05). Conversely, luteinizing hormone (LH), LH/FSH ratio, total testosterone, free testosterone, anti-Müllerian hormone (AMH), and HDL levels decreased (P-trend<0.05). Age independently correlated with these metabolic and endocrine shifts (all P<0.05). Advanced age was associated with higher ovulation induction success (adjusted OR = 1.058, 95% CI:1.006–1.114, P = 0.030) but also an increased risk of first-trimester threatened abortion (adjusted OR = 1.11, 95% CI:1.009–1.210, P = 0.031). No significant associations were observed with clinical pregnancy or live birth.

The clinical presentation of PCOS evolves significantly with advancing age. It is typically characterized by a shift from a state of hyperandrogenism and reproductive abnormalities in younger women to a profile increasingly dominated by progressive metabolic disturbances and cardiovascular risks in later years. Although ovulation response improves in older patients, they face a higher risk of early pregnancy loss. This underscores the necessity of implementing age-stratified clinical management for individuals with PCOS.