The correlation between serum fructose levels and pregnancy outcomes in IVF patients with and without PCOS: a case-control study.

Background: Excessive fructose intake can impact pregnancy health. Additionally, Polycystic ovary syndrome (PCOS) is associated with both elevated fructose levels and adverse pregnancy outcomes. Therefore, it is significant to investigate whether serum fructose levels influence pregnancy outcomes in patients with or without PCOS.

Methods: This case-control study included 270 participants (PCOS, n = 135; non-PCOS, n = 135). The serum fructose levels of consecutively treated women undergoing in vitro fertilization - embryo transfer treatment at the Center of reproductive medicine in Shengjing hospital of China Medical University, from June 2020 to June 2021, were measured. Pregnancies were monitored until the ultimate outcome was determined. The antenatal, delivery, and neonatal outcomes were extracted from hospital records.

Results: In patients with PCOS, those who experienced miscarriage had significantly higher serum fructose levels (P = 0.011). The incidence of miscarriage increased as the serum fructose quartiles increased in patients with PCOS (P = 0.010). There was a significant correlation between serum fructose levels and miscarriage (r = 0.258, P = 0.002). The results of multivariate logistic regression analysis remain consistent (odd ratio [OR] = 10.138, P = 0.005). Conversely, in women without PCOS, those who prematurely delivered had significantly higher serum fructose levels (P = 0.001). The incidence of preterm delivery increased as the serum fructose quartiles increased in patients without PCOS (P < 0.001). There was a significant correlation between serum fructose levels and preterm delivery (r = 0.311, P < 0.001) in non-PCOS group. The multivariate logistic regression analysis indicated the identical results (OR = 18.359, P = 0.008). The area under the curve for fructose-mediated prediction of miscarriage in PCOS was 0.686, while for prediction of preterm birth in non-PCOS individuals, the area under the curve was 0.731.

Conclusions: Serum fructose levels are positively associated with miscarriage risk in patients with PCOS. Within the non-PCOS cohort, fructose levels are linked to preterm birth. Further investigation is warranted to comprehensively elucidate the underlying mechanisms, thus enhancing our profound understanding.