Clinical factors associated with recurrent pregnancy loss status in women with polyendocrine metabolic ovarian syndrome.

BACKGROUND: Women with polyendocrine metabolic ovarian syndrome (PMOS) may have an increased susceptibility to recurrent pregnancy loss (RPL), but the clinical factors associated with RPL status remain incompletely characterized. This study aimed to identify factors associated with RPL status and to develop an internally validated discriminative model in women with PMOS. METHODS: This retrospective, single-center study included 235 women with PMOS and at least one documented pregnancy between January 2022 and December 2025. Participants were classified into the RPL group (n = 70) or non-RPL group (n = 165). Univariable and multivariable logistic regression analyses were performed. Model discrimination, calibration, and internal validity were evaluated using receiver operating characteristic analysis and bootstrap resampling. RESULTS: Older age (adjusted odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.01-1.12), higher body mass index (OR = 1.10, 95% CI: 1.02-1.19), infertility history (OR = 2.01, 95% CI: 1.11-3.64), higher luteinizing hormone/follicle-stimulating hormone ratio (OR = 1.77, 95% CI: 1.18-2.67), higher homeostasis model assessment of insulin resistance (OR = 1.41, 95% CI: 1.15-1.73), and higher D-dimer concentration (OR = 6.06, 95% CI: 1.92-19.15) were independently associated with higher odds of RPL status. Previous live birth was inversely associated with RPL status (OR = 0.35, 95% CI: 0.18-0.68). The model achieved an apparent area under the curve of 0.846 (95% CI: 0.791-0.901) and a bootstrap-corrected value of 0.831. CONCLUSIONS: Reproductive, endocrine, metabolic, and coagulation-related factors were associated with RPL status in women with PMOS. The resulting model showed good internal discrimination but requires external prospective validation before clinical application.