The Prevalence, phenotypes and fertility treatment outcomes of polycystic ovary syndrome among infertile women in Ghana: A multi-centre observational study

PCOS Phenotypes and Fertility Outcomes in Ghana

Abstract

Background: Polyendocrine metabolic ovarian syndrome (PMOS) represents a significant but understudied cause of anovulatory infertility in sub-Saharan Africa (SSA). Regionally, specific data on its prevalence and phenotypic distribution in SSA are scarce, despite its recognized impact on fertility.
Objective: To determine the prevalence and phenotypic distribution of polycystic ovary syndrome (PMOS) among women seeking infertility care in Kumasi, Ghana, and to evaluate dominant follicle selection following ovulation induction.
Methods: In a multi-centre observational study with a cross‑sectional component and nested longitudinal follow‑up, women aged 20–40 years presenting for infertility evaluation at three fertility centres in Kumasi were consecutively screened using the Rotterdam criteria. Women diagnosed with PMOS underwent ovulation induction with clomiphene citrate or letrozole. Dominant follicle selection was monitored via transvaginal ultrasonography. Firth’s penalized logistic regression was used to identify independent predictors of dominant follicle selection, accounting for complete separation and sparse data in BMI and phenotype categories.
Results: Among 1,537 women seeking infertility care, 251 met Rotterdam criteria for PMOS, giving a clinic-based prevalence of 16.3% (95% CI: 14.5–18.2) with Phenotype D being most prevalent (51.8%). Dominant follicle selection occurred in 82.9% (199/240; 95% CI:
78.2–87.7) of women undergoing ovulation induction. Clomiphene citrate and letrozole showed similar follicular response rates in this non‑randomized cohort although letrozole use was limited. Firth’s penalized logistic regression identified Obesity class III (BMI ≥40 kg/m²) as the only BMI category independently associated with dominant follicle selection (aOR = 0.01; 95% CI: 0.00–0.21; p = 0.005). A linear ordinal BMI analysis confirmed that BMI variation significantly reduced the odds of dominant follicle selection (aOR = 0.26; 95% CI: 0.15–0.46; p < 0.001).
Conclusion: PMOS was common among women seeking infertility care in three specialist fertility facilities in Kumasi, Ghana, and phenotype D predominated. Ovulation induction with clomiphene citrate or letrozole was frequently associated with dominant follicle selection, but pregnancy and live‑birth outcomes were not assessed, hence, findings should be interpreted as reflecting an intermediate ovulatory endpoint rather than definitive fertility success. Severe obesity (BMI ≥40 kg/m²) was independently associated with a significantly reduced likelihood of dominant follicle selection, highlighting the clinical importance of weight management in this population and the need for phenotype-informed, weight-sensitive fertility care in the region.