PCOS linked to delayed childbirth and higher infertility rates

PCOS linked to delayed childbirth and higher infertility rates | Image Credit: © izkes - © izkes - stock.adobe.com.

Reduced parity and a later age at birth are common in women with polycystic ovary syndrome (PCOS) vs those without PCOS, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

Reproductive impact of PCOS

Approximately 10% to 13% of women are impacted by PCOS, which has been linked to multiple adverse reproductive, metabolic, and psychological health outcomes. This includes more regular menstrual cycles with increasing age, which investigators have hypothesized may lead to peak fertility later in life.²

“This hypothesis is strengthened by an apparent later menopausal age in women with PCOS, suggesting that the ovarian follicle pool lasts longer. In addition, infertility and infertility treatment may contribute to later age at childbirth among these women,” wrote investigators.¹

Assessing reproductive health

The trial was conducted to evaluate the maternal age at birth among women with PCOS vs those without PCOS. Data was obtained from the Australian Longitudinal Study of Women's Health, a cohort study evaluating the health of Australian women.

Participants of the current analysis included women aged 18 to 23 years at study recruitment and 43 to 48 years by survey 9. With 14,247 participants completing the first survey in 1996, the response rate was approximately 41% to 42%. By survey 9 in 2021, the survey was completed by 6512 patients.

Childbirth data from different surveys were combined in a birth event dataset, including all births from 20 weeks’ gestation. Relevant outcomes included the number of children, parity, maternal age, and advanced maternal age at first childbirth. Patients dropping out before survey 4 were excluded from the analysis.

PCOS diagnosis criteria

PCOS was determined by patients responding “yes” to a question asking if they had been diagnosed or treated for PCOS within the past 3 years in any survey from survey 4 to survey 9. PCOS diagnosed in survey 4 was considered an early diagnosis, while those in later surveys were considered late diagnoses.

Background characteristics were recorded in survey 9. This survey was also used to determine if participants had previous fertility issues, including in vitro fertilization use.

Higher infertility rates among women with PCOS

A PCOS diagnosis was reported in 9.9% of women responding to survey 9. These women had a higher mean body mass index at baseline and at survey 9. Additionally, 51% of these women reported infertility when aged 43 to 48 years, vs 21% of those without PCOS. Similar rates were observed when excluding male factor infertility.

When assessing women with infertility, increased rates of not seeking help were observed among women without PCOS, at 26% vs 15% in those with PCOS. Rates of never trying to conceive did not differ between groups, but ovulation induction was more common in women with PCOS vs without PCOS, at 4.9% vs 2.2%, respectively.

Parity and age at childbirth

Nulliparity rates were 23% and 19%, respectively. Additionally, women with PCOS were aged an average 29.53±5.49 years at first childbirth, vs 28.78±5.48 years in women without PCOS. Women with PCOS also had a longer interconception interval.

An adjusted odds ratio (aOR) of 1.34 was reported for advanced maternal age at first childbirth in women with PCOS. Additionally, an aOR of 1.26 was reported among patients with all-cause infertility. No associations were found for body mass index or prior hypertension diagnosis.

These results indicated higher nulliparity and advanced maternal age at first childbirth among women with PCOS. Investigators also noted increased odds of advanced maternal age from later PCOS diagnosis vs earlier diagnosis.

“This work affirms International PCOS Guideline recommendations for early PCOS diagnosis and reproductive life planning to limit the impacts of infertility in women with PCOS,” wrote investigators.

References

1. Forslund M, Teede H, Melin J, et al. Fertility and age at childbirth in polycystic ovary syndrome: results from a longitudinal population-based cohort study. Am J Obstet Gynecol. 2025;232:545.e1-10. doi:10.1016/j.ajog.2024.11.010
2. Teede HJ, Thien Tay C, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. European Journal of Endocrinology. 2023;189(2):G43-G64. doi:10.1093/ejendo/lvad096