Abstract Objectives: To investigate pregnancy outcomes after frozen-thawed embryo transfer (FET) according to polycystic ovary syndrome (PCOS) phenotypes. Design: Retrospective study. Setting: University-based centre for reproductive medicine. Participants: 8903 patients who underwent FET between January 2017 and October 2019. Methods: All patients were divided into PCOS and control groups, with the former categorised into four phenotype groups (PCOS phenotypes A, B, C, D) based on Rotterdam criteria. All patient data were retrospectively collected and evaluated. Main outcome measures: Pregnancy outcomes after FET consisted of biochemical, clinical and ectopic pregnancies, abortion, premature delivery and live birth. Results: Women with PCOS phenotype A experienced an increased incidence of biochemical pregnancy, clinical pregnancy and premature delivery compared to those with PCOS phenotype D and in the control group (P < 0.001, P = 0.005, P = 0.006, respectively), while incidences of ectopic pregnancy and live birth were comparable between all groups (P > 0.05). We found significantly higher abortion (P = 0.010) and lower ongoing pregnancy (P = 0.023) rates for women with PCOS phenotypes A and D compared to those in the control group. After adjusting for potential confounders, PCOS phenotypes A and D (vs. control) were associated with an elevated risk of abortion (adjusted odds ratio [OR], 1.476, 95% confidence interval [CI], 1.077–2.024, P = 0.016; adjusted OR, 1.348, 95% CI, 1.080–1.682, P = 0.008, respectively). Conclusions: For the first time, our study demonstrates that women with PCOS phenotypes A and D show an increased risk of abortion after FET.

ABSTRACT Objectives:To characterize the expression of ANGPTL4 in ovarian granulosa cells (GCs) and its association with polycystic ovary syndrome. Design: A retrospective study. Setting: University-based center for reproductive medicine. Participants:This study included 104 PCOS patients and 112 control women undergoing in vitro fertilization-embryo transfer (IVF-ET) from the reproductive hospital affiliated with Shandong University between 2019 and 2021. Methods: The mRNA expression of ANGPTL4 in GCs were assessed by reverse transcription and real-time quantitative (RT-q)PCR, then clinical information for these patients were reviewed and analyzed. Main outcome measures: ANGPTL4 expression in GCs in participants, correlation between ANGPTL4 expression level and metabolic characteristics of patients and predictive value of ANGPTL4 expression for PCOS. Results:The RT-qPCR results showed that ANGPTL4 expression in the control group is significantly lower than that in the PCOS group(P=0.000). It indicated positive association with AMH(r=0.211), HOMA-IR(r=0.174), LDL/HDL(r=0.176), ApoB/ApoAI(r=0.155) and TC/HDL(r=0.189). Additionally, the ANGPTL4 expression in the ovarian granulosa cells might be a independent factor in PCOS(OR:3.345, 95%CI:1.951–5.734) and served as a good predictor for PCOS (AUC0.704, 95%CI 0.633-0.774,P＜0.001). Conclusions:For the first time our study revealed on the higher ANGPTL4 expression in ovarian GCs with PCOS, and its association with glucose and lipid metabolism showed that ANGPTL4 might be a predictor for PCOS and play an important role in metabolism and pathogenesis of PCOS. Funding: National Key R&D Program of China (2018YFC1003202, 2016YFC1000604) and Taishan scholar project special funds (No. ts201712103). Key words: polycystic ovary syndrome, angiopoietin-like protein 4, mRNA, ovarian granulosa cell, glycolipid metabolism