Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, Oulu, Finland.
Hum Reprod. 2014 Mar;29(3):628-33. doi: 10.1093/humrep/det437. Epub 2013 Dec 8.
To what extent do self-reported oligo-amenorrhea and hirsutism affect reproductive performance (childlessness, age at first delivery, family size and miscarriage rates)?
At the age of 44, among women with both self-reported oligo-amenorrhea and hirsutism the prevalence of childlessness was not significantly different from non-symptomatic women but they had a smaller family size than non-symptomatic women.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by oligo-amenorrhea or amenorrhea, hyperandrogenism and hirsutism and it is the most frequent cause of anovulatory infertility, but there are few studies on the reproductive capacity of women with PCOS. In our previous population-based cohort study the women with self-reported oligo-amenorrhea and hirsutism were found to have more infertility problems and smaller family size than non-symptomatic women at the age of 31.
STUDY DESIGN, SIZE, DURATION: A prospective population-based cohort study. The population of the study is derived from the prospective Northern Finland Birth Cohort 1966 (NFBC1966), comprising all expected births from the year 1966 in the two northernmost provinces of Finland (n = 12 058). Of them, 5889 were females. Enrollment in this database begun at the 24th gestational week and so far data have been collected from the subjects at the ages of 1, 14 and 31 years.
PARTICIPANTS/MATERIALS, SETTING, METHODS: A postal questionnaire including questions about oligo-amenorrhea and hirsutism was sent to all women at the age of 31 (n = 5608, response rate 81%, n = 4535) and a clinical examination was performed (attendance rate 76.5%). Those who reported both hirsutism and oligo-amenorrhea were defined as women with both symptoms (n = 153). Data on pregnancies/deliveries were obtained from the Finnish Medical Birth Register (FMBR) in 2010 when the women were 44 years old.
Women with both symptoms had delivered at least one child as often as non-symptomatic women [75.2 versus 79.0%, adjusted odds ratio (OR) 0.86, 95% confidence intervals (CI) 0.57-1.30], were of similar age [mean (SD)] at first delivery [27.7 (4.81) versus 27.3 (4.71)] and had similar incidence of miscarriages. However, non-symptomatic women had more often ≥2 deliveries (61.6 versus 52.9%, adjusted OR 0.70, 95% CI 0.49-1.00, P = 0.048) and had larger family size [mean (SD)] [2.4 (1.4) versus 1.9 (0.8), P < 0.001]. Women with both symptoms had been treated more often for infertility than non-symptomatic women (6.1 versus 2.4%, adjusted OR 2.74, 95% CI 1.14-6.60, P = 0.024).
LIMITATIONS, REASONS FOR CAUTION: The diagnosis of oligo-amenorrhea and hirsutism was based on a questionnaire, suggesting a risk of information bias in reporting the symptoms. However, we have previously shown that self-reported oligo-amenorrhea and hirsutism can distinguish most women with the typical profile of PCOS. Only the women who had delivered at least once were recorded in the FMBR, thus excluding from the study those who had experienced miscarriages and/or infertility treatments but did not have a live birth. This feature could potentially decrease the differences in incidence of miscarriages and/or infertility treatment between symptomatic and non-symptomatic subjects.
This is one of the few studies, in which the impact of self-reported oligo-amenorrhea and hirsutism on lifetime reproductive success can be measured. Our results suggest that even at more advanced age, women with both symptoms do not quite match the parity of healthy non-symptomatic women, and that infertility treatment does not always restore normal reproductive capacity in these women. Obese women with both symptoms had the worst prognostic as regards reproduction, which emphasizes the importance of life intervention and preventive politics against obesity in this group of women.
STUDY FUNDING/COMPETING INTEREST(S): This work was supported by grants from the Finnish Medical Society Duodecim, the North Ostrobothnia Regional Fund, the Academy of Finland, University Hospital Oulu, Biocenter, University of Oulu, Finland, the European Commission and the Medical Research Council, UK, the National Institute for Health Research (NIHR). None of the authors has any conflict of interest to declare.
自我报告的卵巢功能不全和多毛症在多大程度上影响生殖性能（不孕、首次分娩年龄、家庭规模和流产率）？
在 44 岁时，自我报告有多囊卵巢综合征（PCOS）症状的女性与无症状女性相比，不孕的比例没有显著差异，但她们的家庭规模较小。
多囊卵巢综合征（PCOS）是一种常见的内分泌紊乱疾病，其特征为卵巢功能不全或闭经、高雄激素血症和多毛症，是无排卵性不孕最常见的原因，但关于 PCOS 女性生殖能力的研究较少。在我们之前的基于人群的队列研究中，与无症状女性相比，自我报告有多囊卵巢综合征症状的女性在 31 岁时更容易出现生育问题和较小的家庭规模。
研究设计、大小、持续时间：一项前瞻性基于人群的队列研究。该研究的人群来自前瞻性的芬兰北部出生队列 1966 年（NFBC1966），包括芬兰最北部两个省 1966 年预期出生的所有婴儿（n=12058），其中 5889 人为女性。该数据库的登记始于妊娠第 24 周，迄今为止，已在参与者 1 岁、14 岁和 31 岁时收集了数据。
参与者/材料、地点、方法：向所有 31 岁的女性（n=5608，回复率 81%，n=4535）发送了包括多囊卵巢综合征症状的问卷，并进行了临床检查（出勤率 76.5%）。报告有多毛症和卵巢功能不全的女性被定义为同时存在两种症状的女性（n=153）。2010 年，当女性 44 岁时，从芬兰医疗出生登记处（FMBR）获得了妊娠/分娩数据。
有两种症状的女性与无症状女性一样，至少有一次分娩（75.2%与 79.0%，调整后的优势比（OR）0.86，95%置信区间（CI）0.57-1.30），首次分娩的年龄相似[平均值（SD）] [27.7（4.81）与 27.3（4.71）]，流产率相似。然而，无症状女性的分娩次数更多[61.6%与 52.9%，调整后的 OR 0.70，95% CI 0.49-1.00，P=0.048]，家庭规模更大[平均值（SD）] [2.4（1.4）与 1.9（0.8），P<0.001]。与无症状女性相比，有两种症状的女性更常因不孕接受治疗[6.1%与 2.4%，调整后的 OR 2.74，95% CI 1.14-6.60，P=0.024]。
局限性、谨慎原因：卵巢功能不全和多毛症的诊断是基于问卷，因此在报告症状时存在信息偏倚的风险。然而，我们之前已经表明，自我报告的卵巢功能不全和多毛症可以区分大多数具有典型多囊卵巢综合征特征的女性。只有至少分娩过一次的女性才会被芬兰医疗出生登记处记录，因此排除了那些经历过流产和/或不孕治疗但没有活产的女性。这一特征可能会降低症状性和无症状性受试者之间流产率和/或不孕治疗率的差异。
这是为数不多的研究之一，可以衡量自我报告的卵巢功能不全和多毛症对终生生殖成功的影响。我们的研究结果表明，即使在年龄较大时，有两种症状的女性也不完全符合健康无症状女性的生育能力，不孕治疗并不能在这些女性中恢复正常的生殖能力。有两种症状且肥胖的女性预后最差，这强调了对这组女性进行生活干预和预防肥胖政策的重要性。
研究资金/利益冲突：这项工作得到了芬兰医学学会 Duodecim、北奥斯特罗波的尼亚地区基金、芬兰科学院、奥卢大学医院、生物中心、奥卢大学、芬兰、英国医学研究理事会、欧洲委员会和英国国家卫生研究所（NIHR）的资助。所有作者均无利益冲突声明。
