Effect of obstructive sleep apnea on in vitro fertilization outcomes in women with polycystic ovary syndrome

Study Objectives: Polycystic ovary syndrome (PCOS) confers a high risk of obstructive sleep apnea (OSA). Here we investigated the effect of OSA on first in vitro fertilization (IVF) cycle metrics and outcomes in patients with PCOS. Methods: This was a prospective cohort study of patients with PCOS undergoing their first IVF at a single tertiary center between October 1, 2021, and September 30, 2022. Patients were screened for OSA before IVF and grouped accordingly. Clinical and IVF cycle data were compared between groups. Results: OSA was found in 37.2% of 156 patients with PCOS, with longer infertility duration (4.3 +/- 2.5 vs. 3.4 +/- 2.0 years) and lower levels of anti-Mueurollerian and luteinizing hormones than patients without OSA (6.44 +/- 2.96 vs 8.69 +/- 4.03 mg/L and 6.30 +/- 5.02 vs 8.46 +/- 6.09 U/L). Antral follicle count was lower in patients with OSA (28.9 +/- 12.4 vs 33.2 +/- 12.9). During ovarian stimulation, patients with OSA required significantly higher doses of gonadotropin (2080.8 +/- 1008.7 vs 1682.8 +/- 619.9 U) and had lower peak estradiol level (4473.5 +/- 2693.0 vs 5455.7 +/- 2955.1 pmol/L) and fewer retrieved oocytes, high -quality, and available embryos (17.8 +/- 7.2 vs 21.9 +/- 10.5, 4.5 +/- 4.4 vs 6.2 +/- 4.6, 5.2 +/- 4.3 vs 7.4 +/- 5.0). Eleven patients were excluded for having no embryos or missing transfer. Therefore, we analyzed the outcome of the first embryo transfer in 145 patients. The biochemical and clinical pregnancy rates were lower in patients with OSA than patients without OSA (51.9% vs 66.7% and 42.3% vs 60.2%). OSA was independently associated with clinical pregnancy rate after controlling for several confounders (P = .043). Conclusions: OSA impairs female fertility in patients with polycystic ovary syndrome, suggesting an adverse effect on in vitro fertilization cycle stimulation characteristics and clinical outcomes.