Anemia in Reproductive-Age Women: Implications for Fertility
To synthesize recent evidence (last 5–10 years) on (1) anemia/iron deficiency
patterns in PCOS and (2) how iron status relates to fertility and assisted reproduction
outcomes.
A focused literature review was performed of recent peer-reviewed clinical
and translational studies evaluating iron indices (hemoglobin, ferritin, transferrin,
hepcidin) in PCOS and studies linking iron deficiency or low ferritin to infertility or
conception outcomes. Findings were narratively synthesized for poster presentation.
Contemporary PCOS literature increasingly describes dysregulated iron
homeostasis, frequently characterized by lower hepcidin and higher ferritin/iron
markers in many cohorts, suggesting a tendency toward iron loading in subsets of
PCOS—potentially mediated by insulin resistance, hyperandrogenism, and reduced
menstrual iron loss. Recent clinical studies report altered hepcidin and related iron
parameters in women with PCOS compared with controls, supporting biologic
plausibility for iron-related ovarian oxidative stress and endocrine disruption. Fertilityfocused evidence indicates that low ferritin/iron deficiency is associated with infertility
in some populations, and iron repletion has been linked to improved conception and
pregnancy outcomes in infertility care. These data collectively suggest a U-shaped risk:
both depleted and excessive iron stores may be unfavorable for ovulation,
oocyte/embryo competence, and endometrial receptivity.
Iron abnormalities are relevant to fertility counseling in PCOS, but the
direction of imbalance varies by phenotype and bleeding pattern. Screening with CBC
plus ferritin (and consideration of inflammation-adjusted interpretation) may help
identify treatable ID/IDA while avoiding unnecessary iron supplementation in those with
Anemia in Reproductive-Age Women: Implications for Fertility
high ferritin. Prospective PCOS-specific trials are needed to define optimal iron targets
for natural conception and ART outcomes.