An Explainable and Fair AI Tool for PCOS Risk Assessment: Calibration, Subgroup Equity, and Interactive Clinical Deployment

This paper presents a fairness-audited and interpretable machine learning framework for predicting polycystic ovary syndrome (PCOS), designed to evaluate model performance and identify diagnostic disparities across patient subgroups. The framework integrated SHAP-based feature attributions with demographic audits to connect predictive explanations with observed disparities for actionable insights. Probabilistic calibration metrics (Brier Score and Expected Calibration Error) are incorporated to ensure reliable risk predictions across subgroups. Random Forest, SVM, and XGBoost models were trained with isotonic and Platt scaling for calibration and fairness comparison. A calibrated Random Forest achieved a high predictive accuracy of 90.8%. SHAP analysis identified follicle count, weight gain, and menstrual irregularity as the most influential features, which are consistent with the Rotterdam diagnostic criteria. Although the SVM with isotonic calibration achieved the lowest calibration error (ECE = 0.0541), the Random Forest model provided a better balance between calibration and interpretability (Brier = 0.0678, ECE = 0.0666). Therefore, it was selected for detailed fairness and SHAP analyses. Subgroup analysis revealed that the model performed best among women aged 25-35 (accuracy 90.9%) but underperformed in those under 25 (69.2%), highlighting age-related disparities. The model achieved perfect precision in obese women and maintained high recall in lean PCOS cases, demonstrating robustness across phenotypes. Finally, a Streamlit-based web interface enables real-time PCOS risk assessment, Rotterdam criteria evaluation, and interactive 'what-if' analysis, bridging the gap between AI research and clinical usability.