Obstructive sleep apnea as a predictive indicator for in vitro fertilization and embryo transfer outcomes in patients with polycystic ovary syndrome: a prospective cohort study

Abstract

Purpose: This study aimed to investigate the impact of obstructive sleep apnea (OSA) on in vitro fertilization (IVF) and embryo transfer outcomes in infertile patients with polycystic ovary syndrome (PCOS). Methods: We conducted a prospective observational cohort study of 360 infertile PCOS patients scheduled for IVF with either fresh or frozen embryo transfer at The Reproductive Medical Center of Peking University Third Hospital between January 2019 and September 2022. All participants underwent home sleep apnea test (HSAT) prior to IVF treatment. We collected clinical characteristics and reproductive outcomes, analyzing the association between OSA and IVF results using univariate and logistic regression analyses. Results: Among the 360 PCOS patients, OSA prevalence was 30.0%. Univariate analysis revealed significantly lower clinical pregnancy and live birth rates during the first embryo transfer cycle in PCOS&OSA patients compared to non-OSA PCOS patients. Logistic regression confirmed OSA as an independent risk factor for reduced live birth rates in PCOS patients undergoing IVF. PCOS&OSA patients also demonstrated lower anti-Müllerian hormone (AMH) levels and higher rates of insulin resistance, hyperlipidemia, and metabolic syndrome. These metabolic disturbances associated with OSA likely contribute to poorer IVF outcomes in PCOS patients. Conclusion: Our findings demonstrate a negative association between OSA and IVF outcomes in PCOS patients, particularly regarding clinical pregnancy and live birth rates. Reproductive endocrine and metabolic disorders appear to play a critical role in these adverse outcomes.