Background Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, strongly associated with obesity and insulin resistance. Despite its global significance, research on PCOS within the United Arab Emirates (UAE) context remains limited. This study explores the relationship between Body Mass Index (BMI) and the incidence of PCOS and insulin resistance in UAE women. Methods This retrospective observational study included 111 women, divided into PCOS and control groups. Data were collected from medical records at Thumbay University Hospital, Ajman, UAE, covering demographic, clinical, and biochemical parameters. BMI was calculated, and various hormonal and metabolic markers were analyzed. Statistical analyses, including Receiver Operating Characteristic (ROC) curve analysis, were performed to identify BMI thresholds predictive of PCOS and insulin resistance. Results Significant differences were observed between the PCOS and control groups in BMI, waist circumference, and metabolic markers, including fasting insulin and lipid profiles. The study identified a BMI cut-off of 27.2 kg/m2 for predicting PCOS (sensitivity: 60.7%, specificity: 94.5%). For predicting insulin resistance within the PCOS group, the optimal BMI cut-off was 28.0 kg/m2 (sensitivity: 64.3%, specificity: 90.9%). Conclusion BMI showed moderate predictive ability for PCOS and insulin resistance among women in the UAE. The BMI thresholds identified in this study may serve as a simple, non-invasive indicator to aid in the identification of women at increased risk of PCOS and related metabolic disturbances in this population.

Recent studies have highlighted the association between polycystic ovary syndrome (PCOS) and cardiometabolic diseases, leading to an improved understanding of the underlying mechanistic factors. PCOS significantly increases cardiovascular risk by predisposing individuals to various subclinical and clinical conditions, including atherosclerosis and type 2 diabetes mellitus. Additionally, it interacts synergistically with other traditional cardiovascular risk factors, such as obesity, hyperlipidemia, and insulin resistance. Several molecular mechanisms involving genetics, epigenetics, adipokine secretion, hyperandrogenemia, and hyperinsulinemia play a role in the relationship between PCOS and these comorbidities. For instance, androgen excess has been implicated in the development of hypertension, type 2 diabetes mellitus, endothelial dysfunction, and ultimately, broader cardiovascular disease. A deeper understanding of these underlying mechanisms facilitates the development of diagnostic, preventative, and therapeutic strategies directed at reducing cardiometabolic morbidity. This narrative review summarizes the current evidence, explores the potential clinical implications of these findings, and discusses emerging therapies to reduce cardiometabolic morbidity in women with PCOS.

Overweight and obesity—chronic illnesses in which an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass resulting in adverse metabolic, biomechanical, and psychosocial health consequences—negatively impact female fertility. Adverse conception outcomes are multifactorial, ranging from poor oocyte quality and implantation issues to miscarriages and fetal health issues. However, with the advent of novel pharmacologic agents, significant weight loss can be achieved, improving the chances of healthy pregnancies, and their use should be considered during periconceptual counseling. There are currently 6 FDA-approved medications for weight loss: 2 GLP1-receptor agonists (GLP1-RAs) liraglutide and semaglutide, 1 dual GLP-1 and gastric inhibitory peptide agonist (GLP1-GIP) tirzepatide, Contrave (naltrexone/bupropion), Qsymia (phentermine/Topamax), and Xenical (orlistat). GLP1-RAs reduce food cravings, appetite, and “food noise” and improve insulin sensitivity and satiety, all of which lead to significant weight loss, ranging from 6 to 30

The use of preimplantation genetic testing for aneuploidy (PGT-A) allows for the selection of euploid embryos and has been thought to improve outcomes in ART, particularly in women ≥ 35 years old. However, little is known regarding PGT-A utilization among minority women in the United States (US). The objective of this study was to determine the trend of utilization of PGT-A in the US among minority women. We conducted a retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database. We included initial autologous ART cycles performed between 2014 and 2020. We assessed the rate of PGT-A utilization by race/ethnicity. This study included 150,604 PGT-A and 287,979 non-PGT-A initial autologous cycles. The overall trend of PGT-A utilization, regardless of race/ethnicity, increased from 11.5 to 49.0

OBJECTIVE:To investigate whether the perceived advantages of preimplantation genetic testing for aneuploidy (PGT-A) are attributable to genetic testing itself or to transferring a thawed frozen embryo into a receptive endometrium. We compared live-birth and cumulative live-birth outcomes across three groups: primary frozen embryo transfer (FET) with PGT-A, FET without PGT-A, and fresh transfers in initial autologous assisted reproductive technology (ART) cycles. METHODS:We performed a retrospective analysis from the 2014-2020 Society for Assisted Reproductive Technology Clinic Outcome Reporting System database, comparing success rates of primary FET with PGT-A, FET without PGT-A, and fresh transfers. Live birth, cumulative live birth, and miscarriage rates were compared, with primary transfer defined as the first transfer after the index retrieval. Live-birth rate was defined as the likelihood of live birth from the first transfer; cumulative live-birth rate was the likelihood of a live birth from all transfers within 1 year of the initial retrieval. Multivariate logistic regression determined the association of live birth with FET with PGT-A, FET without PGT-A, and fresh transfers while controlling for various demographic and clinical factors. RESULTS:We examined 263,521 first autologous ART cycles between 2014 and 2020 that resulted in primary embryo transfer. The live-birth rate was 56.0% for FET with PGT-A, 48.3% for FET without PGT-A, and 39.8% for fresh transfers ( P <.001). Cumulative live-birth rates were similar between the two frozen strategies (74.1% with PGT-A vs 74.0% without PGT-A, P =.66); both were higher than fresh transfers (60.0%, P <.001). In patients younger than age 38 years, cumulative live-birth rates were higher for FETs without PGT-A ( P <.01). In those 38 years and older, PGT-A was associated with higher cumulative success ( P <.001). Regression analysis demonstrated that FET, regardless of PGT-A use, was associated with higher odds of live birth across all age groups, whereas PGT-A conferred additional benefit only in patients aged 35 years or older, with increasing advantage with advancing age. CONCLUSION:Primary FETs were associated with better outcomes than fresh transfers. Although PGT-A use improved outcomes for older patients, no overall benefit was seen in younger patients. These findings bring into question the perceived advantage of PGT-A over FETs without PGT-A, particularly in those younger than age 38 years, in whom FET without PGT-A demonstrated a higher cumulative live-birth rate compared with cycles with PGT-A. These data highlight the need for cautious consideration of PGT-A utilization for initial transfer, especially in younger age groups.

This review evaluates the role of ovarian and endometrial biomarkers in predicting outcomes in assisted reproductive technology (ART). It highlights established ovarian biomarkers such as the anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH), alongside emerging ones like growth differentiation factor 9 (GDF9), bone morphogenetic protein 15 (BMP15), connexin, and granulosa cell gene profiles. Additionally, the paper explores endometrial biomarkers such as ERA, BCL6, and immune markers, as well as the potential for genomic and proteomic technologies in customizing implantation. It concludes that while many of these biomarkers show promise, their clinical integration requires rigorous research and validation to confirm their safety and utility in ART.

OBJECTIVE:To assess the effects of demographic shifts, changes in contemporaneous clinical practices, and technologic innovation on assisted reproductive technology (ART) success rates by conducting an analysis of cumulative live-birth rates across different time periods, age groups, and infertility diagnoses. METHODS:We conducted a retrospective cohort study of autologous linked cycles comparing cumulative live-birth rates over successive cycles from patients undergoing their first retrieval between 2014 and 2019 in the SART CORS (Society for Assisted Reproductive Technology Clinic Outcome Reporting System) database. All cycles reported for these individuals up to 2020 were included for analysis. We compared cumulative live-birth rates stratified by age and infertility cause with published data from the 2004-2009 SART CORS database. RESULTS:From 2014 to 2019, 447,042 patients underwent their first autologous index retrieval, resulting in 1,007,374 cycles and 252,215 live births over the period of 2014 to 2020. In contrast, between 2004 and 2008, 246,740 patients underwent 471,208 cycles, resulting in 140,859 births by 2009. Noteworthy shifts in demographics were observed, with an increase in people of color seeking reproductive technology (57.9% vs 51.7%, P<.001). There was also an increase in patients with diminished ovarian reserve and ovulatory disorders and a decrease in endometriosis, tubal, and male factor infertility (P<.001). Previously associated with decreased odds of live birth, frozen embryo transfer and preimplantation genetic testing showed increased odds in 2014-2020. Preimplantation genetic testing rose from 3.4% to 36.0% and was associated with a lower cumulative live-birth rate for those younger than age 35 years (P<.001) but a higher cumulative live-birth rate for those aged 35 years or older (P<.001). Comparing 2014-2020 with 2004-2009 shows that the overall cumulative live-birth rate improved for patients aged 35 years or older and for all infertility diagnoses except ovulatory disorders (P<.001). CONCLUSION:This analysis provides insights into the changing landscape of ART treatments in the United States over the past two decades. The observed shifts in demographics, clinical practices, and technology highlight the dynamic nature of an evolving field of reproductive medicine. These findings may offer insight for clinicians to consider in counseling patients and to inform future research endeavors in the field of ART.

OBJECTIVE: To assess the effects of demographic shifts, changes in contemporaneous clinical practices, and technologic innovation on assisted reproductive technology (ART) success rates by conducting an analysis of cumulative live-birth rates across different time periods, age groups, and infertility diagnoses. METHODS: We conducted a retrospective cohort study of autologous linked cycles comparing cumulative live-birth rates over successive cycles from patients undergoing their first retrieval between 2014 and 2019 in the SART CORS (Society for Assisted Reproductive Technology Clinic Outcome Reporting System) database. All cycles reported for these individuals up to 2020 were included for analysis. We compared cumulative live-birth rates stratified by age and infertility cause with published data from the 2004–2009 SART CORS database. RESULTS: From 2014 to 2019, 447,042 patients underwent their first autologous index retrieval, resulting in 1,007,374 cycles and 252,215 live births over the period of 2014 to 2020. In contrast, between 2004 and 2008, 246,740 patients underwent 471,208 cycles, resulting in 140,859 births by 2009. Noteworthy shifts in demographics were observed, with an increase in people of color seeking reproductive technology (57.9% vs 51.7%, P<.001). There was also an increase in patients with diminished ovarian reserve and ovulatory disorders and a decrease in endometriosis, tubal, and male factor infertility (P<.001). Previously associated with decreased odds of live birth, frozen embryo transfer and preimplantation genetic testing showed increased odds in 2014–2020. Preimplantation genetic testing rose from 3.4% to 36.0% and was associated with a lower cumulative live-birth rate for those younger than age 35 years (P<.001) but a higher cumulative live-birth rate for those aged 35 years or older (P<.001). Comparing 2014–2020 with 2004–2009 shows that the overall cumulative live-birth rate improved for patients aged 35 years or older and for all infertility diagnoses except ovulatory disorders (P<.001). CONCLUSION: This analysis provides insights into the changing landscape of ART treatments in the United States over the past two decades. The observed shifts in demographics, clinical practices, and technology highlight the dynamic nature of an evolving field of reproductive medicine. These findings may offer insight for clinicians to consider in counseling patients and to inform future research endeavors in the field of ART.

Healthcare racial disparities in assisted reproductive technology (ART) remain an ongoing and challenging issue in the United States, affecting various aspects of medical care, ranging from access to treatment outcomes. The persistent nature of this problem has been underscored by a retrospective study that spanned a 15-year period (1). Using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database, this study analyzed 122,721 autologous ART cycles to compare access and outcomes between Black and White women.

This JAMA Insights discusses ovarian aging and provides strategies to address infertility due to ovarian aging.

Abstract Background The landscape of assisted reproductive technology (ART) has seen a significant shift towards frozen-thawed embryo transfers (FET) over fresh transfers, driven by technological advancements and clinical considerations. This study aimed to compare live birth outcomes between primary FET and fresh transfers, focusing on cycles without preimplantation genetic testing (PGT), using United States national data from the SART CORS database spanning from 2014 to 2020. Methods We performed a retrospective cohort study of autologous first ART cycles without PGT comparing primary embryo transfer (frozen thaw vs. fresh) success rates from the 2014–2020 SARTCORS database. Live-birth rates (LBR) and cumulative live-birth rates (CLBR) were compared between first FET versus first fresh embryo transfer from an index retrieval. Multivariate logistic regression (MLR) determined association between live birth outcomes and method of transfer. In a subsequent sub-analysis, we compared these two embryo transfer methods among patients with either diminished ovarian reserve (DOR) or male factor infertility. Results 228,171 first ART cycles resulted in primary embryo transfer. 62,100 initial FETs and 166,071 fresh transfers were compared. Initial FETs demonstrated higher LBR and CLBR compared to fresh transfers (LBR 48.3% vs. 39.8%, p < 0.001; CLBR 74.0% vs. 60.0%, p < 0.0001). MLR indicated greater chances of live birth with FET across all age groups, with adjusted odds ratio (aOR) of live-birth incrementally increasing with advancing age groups. For DOR cycles, LBR and CLBR were significantly higher for FET compared to fresh (33.9% vs. 26.0%, p < 0.001, 44.5% vs. 37.6%, p < 0.0001), respectively. MF cycles also demonstrated higher LBR and CLBR with FET (52.3% vs. 44.2%, p < 0.001, 81.2% vs. 68.9%, p < 0.0001), respectively. MLR demonstrated that in DOR cycles, initial FET was associated with greater chance of live birth in age groups ≥ 35yo (p < 0.01), with aOR of live birth increasingly considerably for those > 42yo (aOR 2.63, p < 0.0001). Conclusions Overall LBR and CLBR were greater for first FET than fresh transfers with incremental increases in odds of live birth with advancing age, suggesting the presence of a more favorable age-related change in endometrial receptivity present in frozen-thawed cycles. For both DOR and MF cycles, LBR and CLBR after primary transfer were greater for first FET than fresh. However, this was particularly evident in older ages for DOR cycles. This suggests that supraphysiologic stimulation in older DOR cycles may be detrimental to endometrial receptivity, which is in part corrected for in FET cycles.

The Disparities in Assisted Reproductive Technology (DART) hypothesis, initially described in 2013 and further modified in 2022, is a conceptual framework to examine the scope and depth of underlying contributing factors to the differences in access and treatment outcomes for racial and ethnic minorities undergoing ART in the United States. In 2009, the World Health Organization defined infertility as a disease of the reproductive system, thus recognizing it as a medical problem warranting treatment. Now, infertility care is largely recognized as a human right. However, disparities in Reproductive Endocrinology and Infertility (REI) care in the US persist today. While several studies and review articles have suggested possible solutions to racial and ethnic disparities in access and outcomes in ART, few have accounted for and addressed the multiple complex factors contributing to these disparities on a systemic level. This review aims to acknowledge and address the myriad of contributing factors through the DART hypothesis which converge in racial/ethnic disparities in ART and considers possible solutions to effect large scale societal change by narrowing these gaps within the next decade.

Objective To disaggregate the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) age category of “ > 42” and compare age-stratified cumulative live birth rates (CLBR) > 42 years old. Design Retrospective cohort study of autologous linked ART cycles. Setting United States (US) National ART Database. Patient(s) Women > 42 years old without a history of prior ART cycles who underwent ART between 2014–2020 as reported to the SART CORS database. Intervention(s) Disaggregate the SART CORS age category of “ > 42” into age-stratified cumulative live birth rates (CLBR). Main Outcome Measure(s) Age-stratified cumulative live birth rates (CLBR) for women ≥ 43 years old. Results Between 2014–2020, 24,650 women > 42 years old without history of prior ART underwent 58,132 cycles, resulting in 1,982 live births. Women ages 43, 44, 45, 46, 47, 48, 49, ≥ 50 achieved maximal CLBR of 9.7%, 8.6%, 5.0%, 3.6%, 2.5%, 1.5%, 2.7%, 1.3%, respectively. CLBR for women between 43–45 were significantly higher compared to those 46 and older ( p < 0.05). Among women 46 and older, CLBR were not significantly different. Women ages 43 and 44 did not exhibit a significant increase in CLBR beyond the 5th cycle. Age 45 and 46 reached CLBR plateau by the 3rd cycle. Age ≥ 47 CLBR plateaued after the first cycle. After adjusting for age, race/ethnicity, BMI, nulliparity, etiology of infertility, number of oocytes retrieved, embryos transferred, blastocyst transfer, use of ICSI, PGT, and ART treatment cycle number, there was no association between markers of ovarian reserve (day 3 FSH and random AMH levels) and live birth for women > 42. Conclusions While CLBR of autologous cycles from women 42 or younger generally plateau by cycle number 5, age-stratified cycles from women > 42 plateau after fewer cycles to maximize CLBR. Patient and physician expectations for maximum CLBR beyond 42 may be practically based on fewer planned cycles before reaching an age-specific CLBR plateau than may have been previously expected.

BACKGROUND: Racial and ethnic disparities in utilization and clinical outcomes following fertility care with in vitro fertilization in the United States are well-documented. Given the cost of fertility care, lack of in-surance is a barrier to access across all races and ethnicities.OBJECTIVE: This study aimed to determine how state insurance mandates are associated with racial and ethnic disparities in in vitro fertilization utilization and clinical outcomes.STUDY DESIGN: This was a cohort study using data from the Society for Assisted Reproductive Technology Clinical Outcome Reporting System from 2014 to 2019 for autologous in vitro fertilization cycles. The primary outcomes were utilization-defined as the number of in vitro fertilization cycles per 10,000 reproductive-aged women-and cumulative live birth-defined as the delivery of at least 1 liveborn neonate resulting from a single stimulation cycle and its corresponding fresh or thawed transfers.RESULTS: Most (72.9%) of the 1,096,539 cycles from 487,191 women occurred in states without an insurance mandate. Although utilization was higher across all racial and ethnic groups in mandated states, the increase in utilization was greatest for non-Hispanic Asian and non-Hispanic White women. For instance, in the most recent study year (2019), the utilization rates for non-Hispanic White women compared with non-Hispanic Black/African American women were 23.5 cycles per 10,000 women higher in nonmandated states and 56.2 cycles per 10,000 women higher in mandated states. There was no significant interaction between race and ethnicity and insurance mandate status on any of the clinical outcomes (all P- values for interaction terms > .05).CONCLUSION: Racial and ethnic disparities in utilization of in vitro fertilization and clinical outcomes for autologous cycles persist regardless of state health insurance mandates.

Polycystic ovarian syndrome (PCOS) is a widespread syndrome that poses unique challenges and constraints to the field of assisted reproductive technology. This condition is the most common cause of anovulation among infertile couples. Debate exists over the best therapeutic course of action when patients with PCOS proceed to IVF. In this review, we evaluate the best-performing and safest methods of IVF preparation, ovarian stimulation, trigger method for maturation of stimulated egg growth, and planning for embryo transfer. Pre-IVF considerations include being aware of individual AMH and vitamin D levels as well as BMI prior to selecting an ovarian stimulation protocol. Numerous supplements such as myo-inositol complement the benefits of lifestyle change and may enhance IVF performance including oocyte yield and pregnancy rate. Concerning stimulation protocols, antagonist cycles with the judicious use of GnRH agonist trigger, pre-treatment with metformin and vitamin D repletion may help mitigate the accompanied risk of ovarian hyperstimulation syndrome (OHSS). Following ovarian stimulation, PCOS patients typically undergo programmed frozen embryo transfer (FET) cycles which are more conducive for women with irregular cycles, but likely carry a higher risk of hypertensive disorders of pregnancy. However, newer stimulated FET protocols using Letrozole may offer improved outcomes. Overall, patients with PCOS require careful individual tailoring of their IVF cycle to achieve optimal results.