State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, P R China.
Am J Obstet Gynecol. 2013 Aug;209(2):139.e1-9. doi: 10.1016/j.ajog.2013.05.007. Epub 2013 May 6.
We sought to assess the association between polycystic ovary syndrome (PCOS) and ectopic pregnancy after in vitro fertilization-embryo transfer (ET).
In this retrospective cohort study, we included 5339 women who had clinical pregnancies after in vitro fertilization treatment (PCOS, 205 women; non-PCOS, 5134 women) at Nanjing Medical University (China) between 2007 and 2011. Fresh and cryo-thawed ET cycles were analyzed respectively. The primary outcome measure was the occurrence of ectopic pregnancy. Multivariate logistic regression analysis was used to adjust for important confounders.
In fresh ET cycles of women who were undergoing controlled ovarian hyperstimulation (COH; n = 3303), women with PCOS had 3.06 times higher risk of ectopic pregnancy compared with those without PCOS (7.0% vs 2.4%; adjusted odds ratio [aOR], 3.06; 95% confidence interval [CI], 1.34-6.96). In the stratified analysis, for women without PCOS, the high estradiol group (>4085 pg/mL) had higher ectopic pregnancy rates compared with the low estradiol group (≤4085 pg/mL; 3.4% vs 2.0%; aOR, 1.99; 95% CI, 1.19-3.35); however, for women with PCOS, both high and low estradiol groups had high ectopic pregnancy rates (5.6% vs 7.7%; aOR, 0.92; 95% CI, 0.15-5.67). In cryo-thawed ET cycles without COH (n = 2036), the ectopic rates between women with and without PCOS were similar (2.2% vs 2.0%; aOR, 0.94; 95% CI, 0.22-4.07).
PCOS was associated with an increased risk of ectopic pregnancy after COH in fresh ET cycles, but not in cryo-thawed ET cycles. A possible explanation is that, compared with women without PCOS, women with PCOS appear to hold a lower threshold of hyperphysiologic estradiol level that triggers the occurrence of ectopic pregnancy after COH.
我们旨在评估体外受精-胚胎移植（IVF-ET）后多囊卵巢综合征（PCOS）与异位妊娠的关系。
在这项回顾性队列研究中，我们纳入了 2007 年至 2011 年期间在中国南京医科大学接受体外受精治疗后出现临床妊娠的 5339 名妇女（PCOS，205 例；非 PCOS，5134 例）。分别分析新鲜和冷冻解冻 ET 周期。主要结局指标为异位妊娠的发生。采用多变量 logistic 回归分析调整重要混杂因素。
在接受控制性卵巢过度刺激（COH；n=3303）的新鲜 ET 周期中，与非 PCOS 妇女相比，PCOS 妇女异位妊娠的风险高 3.06 倍（7.0% vs. 2.4%；调整优势比[aOR]，3.06；95%置信区间[CI]，1.34-6.96）。在分层分析中，对于非 PCOS 妇女，高雌二醇组（>4085 pg/mL）的异位妊娠率高于低雌二醇组（≤4085 pg/mL；3.4% vs. 2.0%；aOR，1.99；95%CI，1.19-3.35）；然而，对于 PCOS 妇女，高和低雌二醇组的异位妊娠率均较高（5.6% vs. 7.7%；aOR，0.92；95%CI，0.15-5.67）。在无 COH 的冷冻解冻 ET 周期（n=2036）中，PCOS 妇女与非 PCOS 妇女的异位妊娠率相似（2.2% vs. 2.0%；aOR，0.94；95%CI，0.22-4.07）。
在新鲜 ET 周期的 COH 后，PCOS 与异位妊娠的风险增加相关，但在冷冻解冻 ET 周期中不相关。一种可能的解释是，与非 PCOS 妇女相比，PCOS 妇女在 COH 后发生异位妊娠的生理雌激素水平阈值似乎较低。
