Genomic analyses implicate hormonal and metabolic dysregulation in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) and its underlying features remain poorly understood. In this genetic study (N=544,513), we expand the number of genetic loci from 16 to 29 and additionally identify 31 associated plasma proteins. Many risk-increasing loci were associated with later age at menopause, underscoring the reproductive longevity related to an increased oocyte number and/or availability across the lifespan. Hormonal regulation in the aetiology of this condition, through metabolic and reproductive features, was emphasised. The proteomic analysis highlighted metabolic biology known to be related to PCOS. A polygenic risk score was associated with adverse cardio-metabolic outcomes, with differing relevance of testosterone and BMI in women and men. Finally, while oligo- and anovulatory infertility are features of PCOS, we observed no impact of PCOS susceptibility on childlessness. We suggest that PCOS susceptibility confers balanced pleiotropic influences on fertility in women, and life-long adverse metabolic consequences in both sexes.