Background: Women with polycystic ovary syndrome (PCOS) have a higher ovarian reserve and 9 number of oocytes retrieved than women with tubal infertility. To assess whether women of 10 advanced age (≥35 years) with PCOS have the same cumulative live birth rate (CLBR) as their age-11 matched controls with tubal factor infertility and to determine the influencing factors on the CLBRs 12 of aged women. 13
Methods: A total of 190 women of advanced age (≥35 years) with PCOS and 627 women with tubal 14 factor infertility were included in our study. All patients underwent their first fresh cycles and 15 subsequent frozen cycles in our centre from 2007 to 2018. To determine independent influencing 16 factors on the CLBRs of these aged patients, a multivariable Cox regression model of CLBR 17 according to the transfer cycle type was constructed. 18
Results: The Cox regression model of the CLBRs indicated that there was no significant difference 19 between the PCOS group and the tubal infertility group in terms of advanced age (HR, 0.96; 95% CI, 20 0.77~1.20). The CLBR significantly decreased for women of advanced reproductive age up to 37 21 years of age (HR, 0.65; 95% CI, 0.53~0.80). The CLBR increased by 31% when more than ten 22 oocytes were retrieved (HR, 1.31; 95% CI, 1.08~1.59). In addition to age and the number of oocytes, 23 the addition of recombinant LH was an independent factor that increased the CLBRs of the women of 24 advanced age (HR, 1.25; 95% CI, 1.03~1.53). 25
Conclusions: Despite the higher number of oocytes retrieved in PCOS patients, the reproductive 26 window is not extended for PCOS patients compared with tubal factor infertility patients. Age, the 27 number of oocytes retrieved and supplementation with LH play crucial roles in the CLBRs of 28 patients of advanced age (≥35 years).