Fertility of women with polycystic ovary syndrome in late reproductive age

Abstract

Abstract.

Background. Age is regarded as a key factor in women’s fertility and the main predictor of ovarian reserve. Declines in oocyte number and quality (i.e., “ovarian aging”) are primary reasons for deteriorating reproductive outcomes with advancing female age. After the age of 35, woman’s fertility declines. Age-related infertility is one of the biggest challenges in reproductive medicine; even with assisted reproductive technologies the live-birth rate in women ≥40 years is still very low per treatment cycle. However, not all women of the same age have identical ovarian reserves. By the opinion of some researchers, achievable pregnancy and live birth rates in advanced-aged women is frequently underestimated. Polycystic Ovary Syndrome is the most common reproductive pathology which is associated with reduced fertility, pregnancy complications and adverse neonatal outcome as well. Several studies suggest that symptoms of polycystic ovary syndrome tend to improve after the age of 40. Hormone levels begin to rebalance, ovulation may restart and therefore, women with polycystic ovary syndrome might have a better ovarian reserve in late reproductive age than women without this syndrome. As a consequence, it might make it easier to achieve pregnancy. Thus, it is hypothesized by several authors that age-related decline in fertility is slower in women with polycystic ovary syndrome. However, the influence of age on other fertility outcomes (clinical pregnancy and live birth rates) is not clear. It is also unclear whether the influence of age-related decline on fertility treatment outcomes is different in women with polycystic ovary syndrome than in those without this disorder. Due to the complexity and heterogeneity of polycystic ovarian syndrome many women with fertility problems remain underdiagnosed. Effective understanding and dissemination of evidence-based management of this disorder is therefore vital. Frustratingly, the research and literature addressing the issue of fertility status of women with polycystic ovary syndrome in late reproductive years is scarce and controversial.

The main goal of our study is to overview the current literature on the fertility status of women with polycystic ovary syndrome in their late reproductive age and describe the potential pregnancy complications in this group of women. We also aimed to highlight the various pathologies that are associated with polycystic ovary syndrome, discuss their key metabolic molecular pathways and explore their impact on fertility.

Search strategy: Literature search was performed through databases of PubMed, Web of Science, Medline, Embase and Cochrein Library, using appropriate search terms alone or in combination. There were no date and language restrictions. We have also searched relevant articles from the list of references.

Key words: Polycystic ovary syndrome; Fertility; Metabolic syndrome; Pregnancy complication; Late reproductive age; Live birth rate.