{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:20:42Z","timestamp":1785237642691,"version":"3.55.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aims to investigate the risk factors associated with cervical insufficiency (CI) in women with polycystic ovarian syndrome (PCOS) who have undergone <jats:italic>in vitro<\/jats:italic> fertilization and embryo transfer (IVF-ET) treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study included 746 women diagnosed with PCOS. These women successfully achieved pregnancy through IVF-ET between 2016 and 2023 and subsequently delivered at Peking University Third Hospital. Women were categorized into a study group and a control group based on the presence of CI. Additionally, stratified analyses were performed within each group according to whether fresh or frozen embryos were used for transfer, to investigate the clinical characteristics and risk factors associated with CI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In women with PCOS undergoing IVF-ET, BMI (OR=1.195, 95% CI: 1.043-1.290, P&amp;lt;0.001), AMH (OR=1.158, 95% CI: 1.092-1.227, P&amp;lt;0.001), frequency of hysteroscopy operations (OR=1.587, 95% CI: 1.202-2.094, P=0.001), prior gravidity (OR=1.956, 95% CI: 1.459-2.621, P&amp;lt;0.001), and occurrence of twin pregnancies (OR=3.028, 95% CI: 1.563-5.865, P=0.001) were found to be positively associated with the incidence of CI. The cut-off value of BMI and AMH were respectively 22.25kg\/m<jats:sup>2<\/jats:sup> and 9.965ng\/ml. Different IVF-ET protocols and hysteroscopic operation within 6 months before pregnancy is not a risk factor for CI. Among women with PCOS undergoing fresh embryo transfer, elevated androstenedione levels (OR=3.250, 95% CI: 1.129-9.359, P=0.029) were identified as a risk factor for CI. In contrast, for women with PCOS undergoing frozen embryo transfer, multiple factors including BMI (OR=1.254, 95% CI: 1.134-1.388, P&amp;lt;0.001), AMH levels (OR=1.232, 95% CI: 1.144-1.327, P&amp;lt;0.001), frequency of hysteroscopy procedures (OR=1.603, 95% CI: 1.155-2.224, P=0.005) and prior gravidity (OR=2.423, 95% CI: 1.674-3.508, P&amp;lt;0.001), were associated with an increased risk of CI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study analysed risk factors for cervical insufficiency in women with PCOS who underwent IVF-ET treatment, such as BMI, AMH, frequency of hysteroscopy operations, prior gravidity, twin pregnancy. Providing a basis for the identification and prediction of people at high risk of cervical insufficiency.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1498443","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T04:10:42Z","timestamp":1750911042000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk factors of cervical insufficiency in women with PCOS undergoing IVF-ET treatment: a case-control study"],"prefix":"10.3389","volume":"16","author":[{"given":"Xueqing","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shenglong","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongqing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"B1","article-title":"Laparoscopic cervicoisthmic cerclage for the treatment of cervical incompetence:case reports","volume":"60","author":"DaCosta","year":"2011","journal-title":"West Indian Med J"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2018.08.009","article-title":"No. 373-cervical insufficiency and cervical cerclage","volume":"41","author":"Brown","year":"2019","journal-title":"J Obstet Gynaecol Can"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/det262","article-title":"Prevalence of polycystic ovary syndrome in women in China: a large community-based study","volume":"28","author":"Li","year":"2013","journal-title":"Hum Reprod"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deh098","article-title":"Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome(PCOS)","volume":"19","year":"2004","journal-title":"Hum Reprod"},{"key":"B5","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1186\/s12884-016-1094-6","article-title":"Co-morbidity of cervical incompetence with polycystic ovarian syndrome (PCOS) negatively impacts prognosis: A retrospective analysis of 178 patients","volume":"16","author":"Wang","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/des193","article-title":"Prevalence of cervical insufficiency in polycystic ovarian syndrome","volume":"27","author":"Feigenbaum","year":"2012","journal-title":"Hum Reprod"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1674-1889.2018.05.017","article-title":"Confusion in diagnosis and treatment of cervical insufficiency","volume":"37","author":"Guo","year":"2018","journal-title":"Int Reprod Health\/Fam Plan"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(19)30193-7","article-title":"Association between maternal pre-pregnancy obesity and preterm birth according to maternal age and race or ethnicity: a population-based study","volume":"7","author":"Liu","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s12958-020-00693-x","article-title":"Development and validation of a model for individualized prediction of cervical insufficiency risks in patients undergoing IVF\/ICSI treatment","volume":"19","author":"Wu","year":"2021","journal-title":"Reprod Biol Endocrinol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"138.e1","DOI":"10.1016\/j.ajog.2019.03.011","article-title":"Influence of metabolic syndrome on female fertility and in vitro fertilization outcomes in PCOS women","volume":"221","author":"He","year":"2019","journal-title":"Am J Obstet Gynecol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogc.2015.01.008","article-title":"Pregnancy risks associated with obesity","volume":"42","author":"Mission","year":"2015","journal-title":"Obstet Gynecol Clin North Am"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2010.01.011","article-title":"Cervical remodeling during pregnancy and parturition","volume":"21","author":"Timmons","year":"2010","journal-title":"Trends Endocrinol Metab"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.2017.96.issue-8","article-title":"Cervical collagen is reduced in non-pregnant women with a history of cervical insufficiency and a short cervix","volume":"96","author":"Sundtoft","year":"2017","journal-title":"Acta Obstet Gynecol Scand"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-3498","article-title":"Cervical length and androgens in pregnant women with polycystic ovary syndrome: has metformin any effect","volume":"101","author":"Shetelig L\u00f8vvik","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmu008","article-title":"Androgens in pregnancy: roles in parturition","volume":"20","author":"Makieva","year":"2014","journal-title":"Hum Reprod Update"},{"key":"B16","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1210\/edrv-5-4-498","article-title":"Female hirsutism: pathophysiological considerations and therapeutic implications","volume":"5","author":"Biffignandi","year":"1984","journal-title":"Endocr Rev"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.788000","article-title":"Elevated anti-m\u00fcllerian hormone is an independent risk factor for preterm birth among patients with overweight polycystic ovary syndrome","volume":"12","author":"Du","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1016\/j.fertnstert.2019.09.039","article-title":"High antim\u00fcllerian hormone levels are associated with preterm delivery in patients with polycystic ovary syndrome","volume":"113","author":"Hu","year":"2020","journal-title":"Fertil Steril"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.5468\/ogs.2018.61.1.127","article-title":"The expression of M\u00fcllerian inhibiting substance\/anti-M\u00fcllerian hormone type II receptor in myoma and adenomyosis","volume":"61","author":"Kim","year":"2018","journal-title":"Obstet Gynecol Sci"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3892\/ijo.2012.1370","article-title":"Expression of M\u00fcllerian inhibiting substance type II receptor and antiproliferative effects of MIS on human cervical cancer","volume":"40","author":"Song","year":"2012","journal-title":"Int J Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32843-5","article-title":"Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial","volume":"393","author":"Wei","year":"2019","journal-title":"Lancet"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705334","article-title":"Transfer of fresh versus frozen embryos in ovulatory women","volume":"378","author":"Shi","year":"2018","journal-title":"N Engl J Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.placenta.2022.11.011","article-title":"Clinical outcomes and placental pathological characteristics after fresh embryo transfer and frozen-thawed embryo transfer with different endometrial preparation protocols","volume":"131","author":"Liu","year":"2023","journal-title":"Placenta"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-020-05863-1","article-title":"The association between operative hysteroscopy prior to assisted reproductive technology and cervical insufficiency in second trimester","volume":"303","author":"G\u00f6k\u00e7e","year":"2021","journal-title":"Arch Gynecol Obstet"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1498443\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T04:10:43Z","timestamp":1750911043000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1498443\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,26]]},"references-count":24,"alternative-id":["10.3389\/fendo.2025.1498443"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1498443","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,26]]},"article-number":"1498443"}}