Non-linear saturation threshold of gonadotropin dose on cumulative live birth rates in advanced-age women with polycystic ovary syndrome: a retrospective cohort study
Abstract
Background: Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility. Despite a high antral follicle count, advanced-age PCOS patients experience a marked decline in cumulative live birth rates (CLBR) after assisted reproductive technology. The dose-response relationship between total gonadotropin (Gn) dose and CLBR in this population remains poorly defined. This study aimed to quantify the non-linear threshold effect of total Gn dose, characterize the endometrial thickness (EMT) dose-response relationship, and develop a predictive nomogram.
Methods: This retrospective cohort study analyzed 2449 PCOS patients stratified by age quartiles. Univariate and multivariable logistic regression identified predictors of CLBR for the entire cohort and the advanced-age subgroup (≥35 years). For the advanced-age group, restricted cubic splines (RCS) evaluated non-linear associations between total Gn dose and CLBR; piecewise linear regression identified saturation thresholds. RCS and conditional marginal effects analyzed EMT-CLBR relationships. A nomogram was constructed from multivariable predictors and validated internally with 1000 bootstrap resamples. Model performance was assessed via AUC-ROC, calibration curves, Hosmer-Lemeshow test, and decision curve analysis.
Results: CLBR was significantly lower in the advanced-age group (44.40%) than in younger cohorts (63.90%-69.40%, P P = 0.019), with saturation at 1, 600 IU. Below this threshold, each 100-IU increase…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,449 participants or records.
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