Serum Androstenedione Predicts Ovarian Response in Normal-BMI PCOS in Thi-Qar Province

Abstract

Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility and a major source of variability in ovarian response during in vitro fertilization (IVF). Anti-Müllerian hormone (AMH) and antral follicle count  (AFC) are  the  established  pre-stimulation  predictors  but do  not directly capture the androgenic biochemistry that defines PCOS.To assess basal serum A4 as a predictor of ovarian response  operationalized as the follicular  output  rate  (FORT),  total  oocytes  retrieved,  and  excessive response  (≥  20  oocytes)    among  normal-BMI  women  with  PCOS undergoing  controlled  ovarian  stimulation  (COS)A  prospective  single- center cohort study enrolled normal-BMI (18.5–24.9 kg/m²) women aged 20–38  years  with  PCOS  by  Rotterdam  criteria, undergoing  first-cycle gonadotropin-releasing  hormone  (GnRH)  antagonist  COS  for  IVF  or intracytoplasmic sperm injection (ICSI). Basal day-2 to day-3 serum A4, AMH,  AFC.  Outcomes  were  FORT,  total  oocytes  retrieved,  mature (metaphase II) oocytes, and excessive response.  Mean basal A4 was 3.8 ± 1.4 ng/mL. A4 correlated with FORT (Spearman r = 0.59, p < 0.001) and total oocytes retrieved (r = 0.54, p < 0.001). For prediction of excessive response,  A4  achieved  an  area  under the  curve  (AUC)  of 0.84  (95% confidence  interval  [CI]  0.78–0.90), outperforming  AMH  (AUC  0.73, 0.65–0.81; DeLong p = 0.02). A combined A4 + AMH + AFC model reached AUC 0.89 (0.84–0.94; DeLong p = 0.01 versus AMH alone). In normal-BMI PCOS, basal serum A4 is an independent predictor of ovarian response and adds incremental discrimination beyond AMH and AFC for excessive  response.  A4  deserves  consideration  in  pre-stimulation  risk stratification.