Association of integrated nutritional guidance and mindfulness-based stress reduction with fertility outcomes in women with polycystic ovary syndrome

Objective To evaluate the association of an integrated nutritional guidance and mindfulness-based stress reduction (MBSR) program with fertility outcomes, metabolic parameters, and psychological well-being in women with polycystic ovary syndrome (PCOS). Methods This single-center retrospective cohort study analyzed medical records of 326 women with PCOS who received fertility care between January 2023 and December 2024. Women were classified as integrated care (n=163) or conventional care (n=163) according to the clinical pathway received. The primary outcomes were clinical pregnancy and the proportion of women achieving at least one confirmed ovulation. Propensity-score matching (PSM) was performed to address measured treatment-selection differences, and missing psychological outcomes were handled using multiple imputation. Results Clinical pregnancy was observed in 35.0% (57/163) of the integrated-care group and 19.6% (32/163) of the conventional-care group (OR = 2.20, 95% CI 1.33-3.64, p=0.002), while 72.4% versus 58.3% achieved at least one confirmed ovulation (OR = 1.88, 95% CI 1.18-2.98, p=0.007). After 1:1 PSM (145 matched pairs), the associations remained for clinical pregnancy (33.8% vs. 21.4%; matched OR = 1.90, 95% CI 1.11-3.27, exact McNemar p=0.025) and confirmed ovulation (71.7% vs. 60.0%; matched OR = 1.77, 95% CI 1.05-2.99, exact McNemar p=0.040). Model-estimated changes also favored integrated care for body weight (-2.7 kg, 95% CI -3.5 to -1.9), HOMA-IR (ratio of relative changes 0.70, 95% CI 0.62-0.79), total testosterone (-0.2 nmol/L, 95% CI -0.3 to -0.1), GAD-7 (-1.51, 95% CI -2.30 to -0.72), and PHQ-9 (-1.03, 95% CI -1.74 to -0.32). Conclusions Receipt of integrated nutritional guidance and MBSR was associated with higher clinical pregnancy and confirmed-ovulation proportions and with more favorable metabolic and psychological changes than conventional care. Because treatment allocation was non-randomized, these findings should be interpreted as associations and require prospective confirmation.