Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, USA.
Department of Global and Community Health, George Mason University, Fairfax, VA, USA.
Paediatr Perinat Epidemiol. 2021 Mar;35(2):174-183. doi: 10.1111/ppe.12726. Epub 2020 Oct 26.
Obesity, a body mass index (BMI) ≥30 kg/m , is linked to infertility, potentially through a greater risk of anovulation due to elevated androgens. Yet, previous studies have not directly assessed the impact of adiposity, or body fat, on anovulation in the absence of clinical infertility.
To characterise the associations between adiposity and anovulation among women menstruating on a regular basis.
Women from the EAGeR trial (n = 1200), a randomised controlled trial of low-dose aspirin and pregnancy loss among women trying to conceive, were used to estimate associations between adiposity and incident anovulation. Participants completed baseline questionnaires and anthropometry, and provided blood specimens. Women used fertility monitors for up to six consecutive menstrual cycles, with collection of daily first morning voids for hormone analysis in the first two menstrual cycles for prospective assessment of anovulation. Anovulation was assessed by urine pregnanediol glucuronide or luteinising hormone concentration or the fertility monitor. Weighted mixed-effects log-binomial regression was used to estimate associations between measures of adiposity and incident anovulation, adjusted for free (bioavailable) testosterone, anti-Mullerian hormone (AMH), serum lipids, and demographic and life style factors.
343 (28.3%) women experienced at least one anovulatory cycle. Anovulation risk was higher per kg/m greater BMI (relative risk [RR] 1.03, 95% confidence interval (CI) 1.01, 1.04), cm waist circumference (RR 1.01, 95% CI 1.00, 1.02), mm subscapular skinfold (RR 1.02, 95% CI 1.01, 1.03), and mm middle upper arm circumference (RR 1.04, 95% CI 1.01, 1.06) adjusted for serum free testosterone, AMH, lipids, and other factors.
Adiposity may be associated with anovulation through pathways other than testosterone among regularly menstruating women. This may account in part for reported associations between greater adiposity and infertility among women having menstrual cycles regularly. Understanding the association between adiposity and anovulation might lead to targeted interventions for preventing infertility.
肥胖（BMI≥30kg/m²）与不孕有关，这可能是由于升高的雄激素导致排卵障碍的风险增加。然而，以前的研究并未直接评估在没有临床不孕的情况下，体脂或体脂肪对排卵障碍的影响。
描述在月经规律的女性中，体脂与排卵障碍之间的关联。
使用 EAGeR 试验（n=1200）的女性参与者来估计体脂与偶发性排卵障碍之间的关联，EAGeR 试验是一项关于低剂量阿司匹林与妊娠丢失的随机对照试验，研究对象为试图怀孕的女性。参与者完成了基线问卷和人体测量，并提供了血液样本。女性使用生育监测器进行了多达六个连续的月经周期，在前两个月经周期中每天收集第一次晨尿进行激素分析，以前瞻性评估排卵障碍。通过尿孕烷二醇葡萄糖醛酸或黄体生成素浓度或生育监测器评估排卵障碍。使用加权混合效应二项式回归来估计体脂测量与偶发性排卵障碍之间的关联，调整了游离（生物可利用）睾酮、抗苗勒管激素（AMH）、血清脂质以及人口统计学和生活方式因素。
343（28.3%）名女性经历了至少一个无排卵周期。BMI 每增加 1kg/m²（相对风险 [RR] 1.03，95%置信区间 [CI] 1.01，1.04）、腰围每增加 1cm（RR 1.01，95% CI 1.00，1.02）、肩胛下角皮褶厚度每增加 1mm（RR 1.02，95% CI 1.01，1.03）和中上臂围每增加 1mm（RR 1.04，95% CI 1.01，1.06），与血清游离睾酮、AMH、脂质和其他因素调整后，排卵障碍的风险更高。
在月经规律的女性中，体脂与排卵障碍的关联可能与睾酮以外的途径有关。这可能部分解释了报告中较大体脂与月经规律的女性不孕之间的关联。了解体脂与排卵障碍之间的关联可能会导致针对预防不孕的靶向干预措施。
