Associations of lipid metabolic parameters with cumulative live birth rate in PCOS patients undergoing IVF/ICSI and development of a nomogram-based predictive model.

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women, many of whom require in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) for infertility. Dyslipidemia frequently coexists with PCOS and may independently affect reproductive outcomes, yet evidence on its association with cumulative live birth rate (CLBR) remains limited. This study aimed to investigate the relationship between lipid metabolism parameters and CLBR in PCOS patients undergoing their first IVF/ICSI cycle, and to construct and validate a nomogram for individualized CLBR prediction.

METHODS

This retrospective analysis included 413 PCOS patients under 40 years old who underwent their first IVF/ICSI cycle between January 2022 and May 2024. The cohort was randomly split into a training set (n = 290) and a validation set (n = 123) at a 7:3 ratio. Lasso regression with 10-fold cross-validation was used for variable selection, followed by leave-one-variable-out sensitivity analysis. Multivariate logistic regression was then applied to build the prediction model. Internal validation employed bootstrap resampling with 1,000 iterations. Model performance was assessed by AUC, calibration curves, and decision curve analysis. A nomogram was constructed for clinical application.

RESULT: Multivariate analysis identified high-quality embryo rate (OR = 1.025, 95% CI: 1.010-1.041, P = 0.001) and high-quality blastocyst rate (OR = 1.014, 95% CI: 1.002-1.026, P = 0.025) as independent protective factors. Elevated triglycerides (TG) (OR = 0.734, 95% CI: 0.555-0.969, P = 0.029) and higher BMI (OR = 0.915, 95% CI: 0.838-1.000, P = 0.049) were independent risk factors for reduced CLBR. The model achieved AUCs of 0.804 and 0.760 in the training and validation sets, respectively. Calibration was satisfactory (Brier score = 0.152), and DCA confirmed positive net benefit.

CONCLUSION

Dyslipidemia, primarily elevated TG, is independently associated with lower CLBR in PCOS patients undergoing IVF/ICSI. Our nomogram incorporates TG, apolipoprotein A, BMI, trigger-day estradiol and progesterone, high-quality embryo rate and high-quality blastocyst rate. This tool may serve as a foundation for future external validation and exploratory risk stratification, though clinical application requires prospective multicenter studies.