The impact of age on clinical features and fertility outcomes in patients with polycystic ovary syndrome: a secondary analysis based on the PCOSAct trial

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Objective: This study aimed to investigate age-related variations in baseline characteristics and reproductive outcomes among women with polycystic ovary syndrome (PCOS). Methods: A secondary analysis of the PCOSAct trial included 936 participants stratified into four age groups: 20-24, 25-29, 30-34, and 35-40 years. Differences in anthropometric measures, sex hormones, metabolic parameters, and pregnancy outcomes were analyzed using correlation and multiple logistic regression. Results: With increasing age, linear trends revealed increases in hirsutism score, systolic blood pressure, triglycerides, dyslipidemia, metabolic syndrome, and atherogenic indices (P-trend<0.05). Conversely, luteinizing hormone (LH), LH/FSH ratio, total testosterone, free testosterone, anti-Müllerian hormone (AMH), and HDL levels decreased (P-trend<0.05). Age independently correlated with these metabolic and endocrine shifts (all P<0.05). Advanced age was associated with higher ovulation induction success (adjusted OR = 1.058, 95% CI:1.006-1.114, P = 0.030) but also an increased risk of first-trimester threatened abortion (adjusted OR = 1.11, 95% CI:1.009-1.210, P = 0.031). No significant associations were observed with clinical pregnancy or live birth. Conclusion: The clinical presentation of PCOS evolves significantly with advancing age. It is typically characterized by a shift from a state of hyperandrogenism and reproductive abnormalities in younger women to a profile increasingly dominated by progressive metabolic disturbances and cardiovascular risks in later years. Although ovulation response improves in older patients, they face a higher risk of early pregnancy loss. This underscores the necessity of implementing age-stratified clinical management for individuals with PCOS.

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