Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China.
Front Endocrinol (Lausanne). 2022 Dec 19;13:1079502. doi: 10.3389/fendo.2022.1079502. eCollection 2022.
We aim to explore the effects of follicular output rate (FORT) on cumulative clinical pregnancy rate (CCPR) and cumulative live birth rate (CLBR) in polycystic ovary syndrome (PCOS) patients with different characteristics undergoing fertilization (IVF) treatment.
This retrospective study analyzed 454 patients with PCOS undergoing their first IVF cycle at our center from January 2016 to December 2020. FORT was calculated as pre-ovulatory follicle count (PFC) × 100/antral follicle count (AFC). Multivariate regression analyses were conducted to explore the relationships between FORT and CCPR and CLBR. Curve fitting and threshold effect analyses were established to find nonlinear relationships. Effect modification in different subgroups were examined by stratification analyses.
Based on the FORT values, individuals were classified into the following three groups: low-FORT group, middle-FORT group and high-FORT group. Multivariate regression analyses revealed that FORT was an independent factor affecting the CCPR and CLBR significantly (OR = 1.015, 95% CI: 1.001, 1.030 and OR = 1.010, 95% CI:1.001, 1.020). Curve fitting and threshold effect analyses showed that the CCPR and CLBR had a positive correlation with FORT when the FORT was less than 70% (OR = 1.039, 95% CI: 1.013, 1.065 and OR = 1.024, 95% CI: 1.004, 1.044). Stratification analyses showed that the CLBR increased by 1.3% with each additional unit of FORT for patients with hyperandrogenic manifestations (OR = 1.013, 95% CI: 1.001, 1.025). Compared with the low-FORT group, in the high-FORT group, CCPR increased 1.251 times for patients with polycystic ovarian morphology, while CCPR and CLBR increased 1.891 times and 0.99 times for those with ovulation disorder, respectively (OR = 2.251, 95% CI: 1.008, 5.028 and OR = 2.891, 95% CI: 1.332, 6.323 and OR = 1.990, 95% CI: 1.133, 3.494).
In patients with PCOS, cumulative IVF outcomes have a positive correlation with FORT when the FORT is less than 70%. For PCOS patients with polycystic ovarian morphology, ovulation disorder or hyperandrogenic manifestations, a high FORT could be conductive to achieving better pregnancy outcomes.
我们旨在探讨滤泡输出率（FORT）对不同特征的多囊卵巢综合征（PCOS）患者接受体外受精（IVF）治疗后累积临床妊娠率（CCPR）和累积活产率（CLBR）的影响。
本回顾性研究分析了 2016 年 1 月至 2020 年 12 月在我院接受首次 IVF 周期的 454 例 PCOS 患者。FORT 通过预排卵卵泡计数（PFC）×100/窦卵泡计数（AFC）计算。采用多变量回归分析探讨 FORT 与 CCPR 和 CLBR 之间的关系。通过曲线拟合和阈值效应分析来寻找非线性关系。通过分层分析来检验不同亚组中的效应修饰。
根据 FORT 值，将个体分为以下三组：低 FORT 组、中 FORT 组和高 FORT 组。多变量回归分析显示，FORT 是 CCPR 和 CLBR 的独立影响因素（OR=1.015，95%CI：1.001，1.030 和 OR=1.010，95%CI：1.001，1.020）。曲线拟合和阈值效应分析显示，当 FORT 小于 70%时，CCPR 和 CLBR 与 FORT 呈正相关（OR=1.039，95%CI：1.013，1.065 和 OR=1.024，95%CI：1.004，1.044）。分层分析显示，对于有高雄激素表现的患者，FORT 每增加一个单位，CLBR 增加 1.3%（OR=1.013，95%CI：1.001，1.025）。与低 FORT 组相比，在高 FORT 组中，多囊卵巢形态患者的 CCPR 增加 1.251 倍，而排卵障碍患者的 CCPR 和 CLBR 分别增加 1.891 倍和 0.99 倍（OR=2.251，95%CI：1.008，5.028 和 OR=2.891，95%CI：1.332，6.323 和 OR=1.990，95%CI：1.133，3.494）。
在 PCOS 患者中，当 FORT 小于 70%时，累积 IVF 结局与 FORT 呈正相关。对于有多囊卵巢形态、排卵障碍或高雄激素表现的 PCOS 患者，高 FORT 可能有助于获得更好的妊娠结局。
