For Asians with PCOS, ovarian reserve remains high even at advanced maternal age

Asian women with polycystic ovary syndrome (PCOS) may have longer reproductive potential, with a high ovarian reserve that is maintained through older age and translates to increased success with assisted reproductive technology (ART) treatments, according to a retrospective study.

In a multiethnic cohort of Singaporean women, those with PCOS had significantly higher levels of anti-Müllerian hormone (AMH) compared with their normo-ovulatory counterparts (44.4 vs 19.3 pmol/l; p<0.001). Cubic spline model plots showed that AMH levels remained relatively stable and high even beyond age 40 years in the PCOS group, while an age-related decline occurred in the control group. [Hum Reprod Open 2025;doi:10.1093/hropen/hoaf062]

Overall success rates with ART were higher in the PCOS group than in the control group. The cumulative pregnancy rate following one ovarian stimulation cycle of ART stayed consistently above 50 percent across increasing maternal age (31–35 years: 56.7 percent; ≥36 years: 55.9 percent) in the PCOS group but decreased with age in the control group (31–35 years: 46 percent; ≥36 years: 28.6 percent)

Compared with control, PCOS was associated with 78-percent higher cumulative pregnancy rates for women aged ≥36 years undergoing ART (adjusted relative risk [aRR], 1.78, 95 percent confidence interval [CI], 1.24–2.54), especially for those undergoing in-vitro fertilization (aRR, 2.01, 95 percent CI, 1.40–3.14).

“This study demonstrates the potential in studying PCOS as a human model for reproductive longevity as evidenced by the enhanced reproductive outcomes. Asian women with PCOS benefit from a longer ovarian lifespan due to a high ovarian reserve persisting as they age, thus increasing the likelihood of conceiving even at advanced maternal ages,” the authors said.

However, they acknowledged that the significant difference observed in cumulative pregnancy rates between the PCOS and the control groups did not extend to live birth rates, potentially due to the modest sample size after age stratification. This could also be attributed to the limitation of a retrospective study design where all live births were not documented, “as women could opt to deliver other than in the hospital where they had their IVF treatments,” and the fact that preimplantation genetic testing for aneuploidy was not routinely carried out given that it was not allowed in Singapore.

“In addition, the age limit (45 years old) and cap on the number of ART cycles were only lifted by local health regulations in early 2020. Therefore, the impact of advanced maternal age may be an important determinant of live birth outcomes despite having more oocytes. However, it is interesting to note that in this study population, miscarriage rates were observed to be lower in the ≥36-year-old group (21.4 percent in the PCOS group vs 23.8 percent in the normo-ovulatory group), although the difference was not statistically significant,” the authors noted.

The study included 1,249 women seen at a tertiary-care centre in Singapore, of which 212 had PCOS. Compared with the normo-ovulatory control group, the PCOS group were younger (31.7 vs 34.4 years), less likely to be Chinese (48.1 percent vs 64.9 percent), and had higher BMI (26.2 vs 23.4 kg/m²).

“Investigating the potential extension of reproductive lifespan in women with PCOS holds paramount importance, as it can contribute valuable insights to their unique reproductive trajectories [and] as average childbearing age continues to increase worldwide,” the authors said.

“Finally, this is one of a handful of studies to describe AMH levels within a multi-ethnic Singaporean cohort, with Chinese women having consistently higher AMH levels as compared with Indian and Malay women. As with similar cohort studies, raising the awareness of ethnic-specific ovarian reserve would equip women and medical practitioners with important information for a timely diagnosis to guide family planning,” they added. [Am J Obs Gynecol 2025;232:5453; Front Endocrinol (Lausanne) 2021;12:735116]