Kisspeptin levels dynamically change during COH in PCOS patients, correlating with reduced pregnancy and live birth rates

Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility, often leading to ovarian hyperresponse during controlled ovarian hyperstimulation (COH) in assisted reproductive technology. Current standard-of-care protocols struggle to balance oocyte yield with optimal embryo quality and pregnancy outcomes in these patients. Kisspeptin is a crucial upstream regulator of the hypothalamic-pituitary-ovarian axis (HPOA), playing a vital role in reproductive function. Understanding its dynamics during COH in PCOS could identify a novel predictive biomarker for treatment success.

This prospective cohort study enrolled 100 patients undergoing IVF-ET treatment, divided into a PCOS group (n=50) and a control group (n=50). Serum samples were collected at four key time points: the day of starting Gn treatment (dGn), the fifth day of Gn stimulation (d5Gn), the day of hCG injection (dhCG), and the day of oocyte pickup (dOPU). Follicular fluid (FF) samples were also obtained on dOPU. Researchers compared baseline characteristics, Kisspeptin levels, COH outcomes, and pregnancy outcomes between the groups. Correlation and ROC curve analyses were performed to assess predictive value.

Serum and FF Kisspeptin levels were significantly higher in the PCOS group at all measured time points (P<0.001). Both groups exhibited significantly elevated Kisspeptin levels on dOPU compared to dGn (P<0.001). Correlation analysis revealed that serum and FF Kisspeptin levels positively correlated with AFC (antral follicle count), AMH (anti-Müllerian hormone), E2 (estradiol) on dhCG, the number of retrieved oocytes, and the number of available embryos. Conversely, Kisspeptin levels were negatively correlated with the TQE (top-quality embryo) rate (P<0.01). Although the PCOS group yielded higher numbers of retrieved oocytes and available embryos, their TQE rate was lower. The most striking finding related to clinical outcomes:

The cumulative pregnancy rate in the PCOS group was significantly lower at 40.00% compared to 60.00% in controls (P = 0.046), and the live birth rate was markedly reduced at 8.54% versus 35.06% in controls (P = 0.014). ROC curve analysis suggested that serum Kisspeptin levels on dOPU had a certain predictive value for pregnancy outcomes.