In-vitro fertilization outcomes in females of advanced maternal age with polycystic ovarian syndrome

Abstract

Purpose: The aim of the study was to evaluate in vitro fertilization (IVF) outcomes in women of advanced maternal age (≥35 years) diagnosed with polycystic ovarian syndrome (PCOS), compared with age-matched women without PCOS. Given that advancing age is associated with declining ovarian reserve and fertility potential, this research sought to determine whether the hormonal and ovarian characteristics of PCOS confer any advantage in IVF outcomes within this population. Methodology: A retrospective quantitative analysis was conducted by collecting 267 entries from 174 IVF cycles performed at an Assisted Reproductive Technology (ART) Clinic at the main public hospital in Malta between January 2021 and 2024. Key outcome measures included oocyte yield, number of embryos created, clinical pregnancy rates, and viable pregnancy rates at 12 weeks gestation, meaning the pregnancy was still ongoing by the end of the first trimester. Results: Women with PCOS demonstrated significantly higher serum anti-Mullerian hormone (AMH) levels and oocyte yields (mean 12.35 vs. 6.67), alongside increased embryos and clinical pregnancy rates (29.2% vs. 17.8%; p = 0.016), compared with non-PCOS counterparts. However, viable pregnancy rates at 12 weeks didn’t differ significantly (p = 0.615), which could be influenced by the small sample size of sub-groups. Conclusions: Although women of advanced maternal age with PCOS exhibited a preserved ovarian reserve and enhanced initial IVF response, these advantages didn’t translate into higher sustained pregnancy outcomes. Implications for Practice: While further research can improve practice, it is evident that clinicians should provide individualized counselling and design tailored ovarian stimulation protocols for women with PCOS of advanced maternal age to optimize treatment outcomes while mitigating the risk of early pregnancy loss.