{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T07:50:14Z","timestamp":1791532214948,"version":"4.3.4"},"reference-count":49,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82204469"],"award-info":[{"award-number":["82204469"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82371670"],"award-info":[{"award-number":["82371670"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To evaluate the bidirectional mediation effects of body mass index (BMI) and inflammatory markers (neutrophil\u2010to\u2010lymphocyte ratio [NLR], systemic immune\u2010inflammation index [SII], platelet\u2010to\u2010lymphocyte ratio [PLR]) on assisted reproductive technology (ART) outcomes in women with polycystic ovary syndrome (PCOS).<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A historical cohort study. This analysis is exploratory and hypothesis\u2010generating rather than confirmatory.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Department of Reproductive Medicine, Nanjing Women's Hospital of Nanjing Medical University, China.<\/jats:p>\n <\/jats:sec>\n \n Population<\/jats:title>\n \n A total of 966 women with PCOS undergoing ART, categorized by BMI: underweight (\n n<\/jats:italic>\n \u2009=\u200938), normal weight (\n n<\/jats:italic>\n \u2009=\u2009547), overweight (\n n<\/jats:italic>\n \u2009=\u2009282), and obesity (\n n<\/jats:italic>\n \u2009=\u200999).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Multivariable regression, restricted cubic splines, and bidirectional causal mediation analysis using the Quasi\u2010Bayesian approach with 1000 simulations were performed.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n Number of oocytes retrieved, high\u2010quality embryos, available embryo rate, and clinical pregnancy outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Oocytes retrieved decreased from 14.50 (IQR 12.00\u201320.75) in underweight to 12.00 (IQR 9.00\u201316.00) in obese women (\n p<\/jats:italic>\n \u2009<\u20090.001). High\u2010quality embryos declined from 4.00 (IQR 0.25\u20136.00) to 1.00 (IQR 0.00\u20133.50) across BMI categories (\n p<\/jats:italic>\n \u2009<\u20090.001). All inflammatory markers showed consistent negative dose\u2013response relationships with available embryo rate (all\n p<\/jats:italic>\n \u2009<\u20090.001). NLR mediated 9.2% (95% CI: 2.3%\u201320.0%) of BMI's effect on high\u2010quality embryos. BMI mediated 26.6% (95% CI: 13.3%\u201362.3%) of NLR's effect on high\u2010quality embryos and 58.6% (95% CI: 5.6%\u2013528.4%) on available embryos. SII and PLR showed minimal mediation effects (<\u20095%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n These findings are exploratory and hypothesis\u2010generating. In this single\u2010centre cohort of women with PCOS, higher BMI and higher peripheral inflammatory indices were associated with fewer oocytes retrieved and fewer high\u2010quality embryos, and BMI and NLR appeared to lie on shared, bidirectionally related pathways, with the larger share attributable to BMI.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1471-0528.70344","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T07:13:01Z","timestamp":1791529981000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bidirectional Mediation Effects of Body Mass Index and Inflammatory Markers on Assisted Reproductive Outcomes in Women With Polycystic Ovary Syndrome"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6432-3966","authenticated-orcid":false,"given":"Xin","family":"Li","sequence":"first","affiliation":[{"name":"Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University Nanjing Women and Children's Healthcare Hospital Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9960-2033","authenticated-orcid":false,"given":"Ting","family":"Luan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University Nanjing Women and Children's Healthcare Hospital Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7820-9152","authenticated-orcid":false,"given":"Xiufeng","family":"Ling","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University Nanjing Women and Children's Healthcare Hospital Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8032-2995","authenticated-orcid":false,"given":"JuanJuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University Nanjing Women and Children's Healthcare Hospital Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9295-8037","authenticated-orcid":false,"given":"Chun","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University Nanjing Women and Children's Healthcare Hospital Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"issue":"3","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1007\/s00404-024-07607-x","article-title":"Global Prevalence of Polycystic Ovary Syndrome in Women Worldwide: A Comprehensive Systematic Review and Meta\u2010Analysis","volume":"310","author":"Salari N.","year":"2024","journal-title":"Archives of Gynecology and Obstetrics"},{"issue":"6","key":"e_1_2_13_3_1","article-title":"Immunological and Metabolic Causes of Infertility in Polycystic Ovary Syndrome","volume":"11","author":"Kicinska A. 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