The clinical value of ultrasound parameters combined with clinical indicators in predicting embryo implantation rates in polycystic ovary syndrome patients at different body mass index levels.

OBJECTIVE: To evaluate the predictive value of endometrial and uterine artery blood flow parameters, combined with clinical indicators, for embryo implantation outcomes in PCOS patients undergoing IVF-ET across different BMI categories. METHODS: We retrospectively analyzed 129 PCOS patients who underwent IVF-ET at our hospital from June 2022 to June 2025. Participants were stratified into four BMI groups. Transvaginal ultrasound parameters and clinical data were statistically analyzed. RESULTS: Significant differences were observed in endometrial thickness, morphological patterns, blood flow distribution, and uterine artery blood flow parameters across different BMI groups. The obese group exhibited a tendency toward thinner endometrium, a lower proportion of type A endometrial morphology, reduced endometrial perfusion, and a higher uterine artery resistance index. Logistic regression analysis identified high endometrial blood flow grade, abundant endometrial blood flow, and a greater number of high-quality embryos as protective factors for successful embryo implantation following IVF-ET in patients with PCOS (all P<0.05). Conversely, advanced age was associated with an increased risk of implantation failure (P<0.05). ROC curve analysis demonstrated that a multivariable model incorporating endometrial blood flow grade, endometrial blood flow quantity, number of high-quality embryos, and age had strong predictive performance for implantation success (AUC = 0.917). CONCLUSION: Weight management before assisted reproduction is clinically important. Overweight patients should monitor endometrial and uterine artery blood flow parameters and receive targeted interventions to improve pregnancy outcomes.