A retrospective study of the relationship between low-density lipoprotein cholesterol and pregnancy outcomes after assisted reproductive technology treatments in women with diabetes mellitus and infertility

This study aimed to investigate the role of low-density lipoprotein cholesterol as a key parameter in improving pregnancy outcomes after assisted reproductive technology treatments in women with diabetes mellitus. To investigate the relationship between low-density lipoprotein cholesterol and pregnancy outcomes after assisted reproductive technology treatments in women with diabetes and infertility. 474 female patients diagnosed with diabetes were included in this study. The patients were divided into the high LDL-C group (≥3 mmol/L) and the low LDL-C group (<3 mmol/L). According to the protocol of ovarian stimulation, the clinical characteristics in ART cycles and pregnancy outcomes were compared separately. The data were analyzed after propensity score matching. In the GnRH antagonist protocol group, there were no significant differences in baseline characteristics between the high- and low-LDL-C groups. Nevertheless, ART treatment characteristics and pregnancy outcomes did not differ significantly between the two groups (P > 0.05). However, the rate of early miscarriage in GnRH antagonist protocol-FET cycles had a significantly positive association with LDL-C level (P=0.0004).In the long-acting GnRH agonist protocol group, there were no significant differences in baseline characteristics between the high- and low-LDL-C groups; however, total cholesterol, triglycerides, and AST/ALT levels were significantly higher in the high-LDL-C group (P<0.05). Although the clinical pregnancy rate of fresh embryo cycles in the high-LDL-C group was considerably higher than that of the low-LDL-C group(P=0.001), there was a statistical difference in the early miscarriage rate between the two groups. (P<0.05). This study demonstrates that in infertile women with diabetes mellitus undergoing ART, elevated pre-treatment LDL-C is a significant and modifiable marker associated with an increased risk of early miscarriage and a reduced live birth rate. The impact of LDL-C varies by ovarian stimulation protocol. These findings underscore the importance of integrating pre-conception lipid management into the clinical pathway and adopting a protocol-specific risk assessment to optimize pregnancy outcomes.