Zhiqin Bu, Xiaofei Ge, Jing Sun, Keyan Wang
To provide an updated and comprehensive assessment of euploid embryo rates in polycystic ovarian syndrome (PCOS) women compared with non-PCOS counterparts undergoing preimplantation genetic testing for aneuploidy (PGT-A), and to evaluate early spontaneous miscarriage (ESM) rates across different PCOS phenotypes following single vitrified euploid blastocyst transfer cycles. This retrospective cohort study (2017–2023) included women with PCOS and non-PCOS controls. Two cohorts were analyzed: first PGT-A cycles and first single vitrified euploid blastocyst transfers. ESM and euploidy rates were assessed, and regression analyses were performed to identify factors associated with miscarriage. In the PCOS group, a total of 1,274 blastocysts were biopsied, of which 580 were euploid, yielding a euploidy rate of 45.53% (580/1,274), which was significantly higher than the 39.86% (1,935/4,854) observed in non-PCOS women ( P < 0.001). Additionally, 345 PCOS and 1,650 non-PCOS frozen-thawed embryo transfer cycles involving the first single vitrified euploid blastocyst were included in the analysis. ESM rates were 14.48% (21/145) in the polycystic ovarian morphology (PCOM)+ ovulation disorder (OD) subgroup, 18.75% (6/32) in the PCOM+ Hyperandrogenism (HA) subgroup, and 31.70% (13/41) in the PCOM + OD+HA subgroup. After adjusting for covariates, the PCOM + OD+HA phenotype remained an independent risk factor for ESM (adjusted OR: 2.164; 95% CI: 1.209–6.247; P = 0.036). The high ESM rate observed in PCOS patients may be attributable to their endocrine abnormalities. These findings suggest that non-genetic, environmental factors—rather than genetic factors—warrant greater attention in future strategies aimed at reducing ESM in this population.