Association of hyperuricemia with higher miscarriage rates and lower live birth rates in women undergoing IVF/ICSI

BACKGROUND: Hyperuricemia (HUA) has become popular globally, being an important risk factor for various metabolic diseases. Elevated serum uric acid (UA) levels cause adverse reproductive outcomes in women with polycystic ovary syndrome undergoing assisted reproductive technology (ART). However, its impact on reproductive outcomes in the general population is unknown. METHOD: This retrospective study was conducted on a general population of infertility patients at a single center (March 2016-April 2023). Overall, 2189 first transfer cycles were screened for inclusion. HUA was defined as serum UA ≥ 360 µmol/L. Variables identified by LASSO regression analysis were entered into logistic regression models to calculate odds ratios. Generalized additive models were employed to examine the nonlinear relationship between serum UA as a continuous variable with outcomes. The primary outcome was live birth rate (LBR). RESULTS: ) women but not in overweight individuals. CONCLUSION: Elevated UA levels are linked to lower LBR and higher miscarriage risk in ART, especially in younger, non-obese women where HUA is an independent risk factor. Though not affecting embryo quality or implantation, HUA may impair pregnancy maintenance. Even in older or overweight patients, UA monitoring remains important. Routine assessment and tailored management-particularly greater attention to pregnancy loss and cautious use of programmed FET in poorly controlled cases-may help improve ART outcomes.