Xia Qing, Xie Liangzhen, Wu Qi, Cong Jing, Ma Hongli, Li Jian, Cai Wangyu, Wu Xiaoke
Department of Obstetrics and Gynaecology, Heilongjiang University of Chinese Medicine, Harbin 150001, China.
Department of Obstetrics and Gynaecology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100010, China.
Heliyon. 2023 Jan 18;9(1):e13024. doi: 10.1016/j.heliyon.2023.e13024. eCollection 2023 Jan.
What is the association between elevated baseline LH/FSH ratio and reproductive outcomes, especially ovulatory response, among Chinese women with polycystic ovary syndrome (PCOS) after ovulation induction.
This was a secondary analysis of a multicenter randomized trial in 1000 women with PCOS from 21 sites (27 hospitals) in Mainland China. LH and FSH levels before ovulation induction and the main outcomes including ovulation, biochemical pregnancy, clinical pregnancy, miscarriage, and live birth were measured. A linear regression model, logistic regression models and Cox proportional hazard regression model were used to estimate the association between LH/FSH ratios and reproductive outcomes in PCOS.
LH/FSH ratio was significantly associated with age, body mass index (BMI), total testosterone (TT), estradiol (E2), free testosterone (FT), and antimullerian hormone (AMH). Anovulatory women had significantly higher LH/FSH ratio than ovulatory women (P = 0.003), especially in women with young age (P = 0.023), high BMI (P = 0.002), low E2 (P = 0.002), FT (P = 0.010), TT (P < 0.001) and AMH(P = 0.032). Women with elevated LH/FSH ratio were associated with lower ovulation (LH/FSH≥1 OR = 0.42, 95% CI, 0.26-0.68; LH/FSH≥2 OR = 0.32, 95% CI, 0.20-0.54; LH/FSH≥3 OR = 0.40, 95% CI 0.21-0.74) when compared with LH/FSH<1. The association was held after adjustment for treatment with or without the confounding factors. Although no association between LH/FSH ratio and biochemical pregnancy, women with 1 ≤ LH/FSH<2 were associated with higher clinical pregnancy (OR = 1.71; 95% CI, 1.09-2.67) and live birth (OR = 1.73; 95% CI, 1.09-2.75) compared to women with LH/FSH<1. Women with 2 ≤ LH/FSH<3 were associated with lower miscarriage rate (OR = 0.38; 95% CI, 0.16-0.93).
Elevated baseline LH/FSH ratio in women with PCOS was associated with poor ovulatory response, but women were more likely to achieve clinical pregnancy and live birth than women with normal LH/FSH. It suggests LH and FSH in women with PCOS may play a role in successful pregnancy despite of negative impact in ovulation.
在中国多囊卵巢综合征（PCOS）女性中，排卵诱导后基线促黄体生成素/促卵泡生成素（LH/FSH）比值升高与生殖结局尤其是排卵反应之间存在何种关联。
这是一项对来自中国大陆21个地点（27家医院）的1000例PCOS女性进行的多中心随机试验的二次分析。测量了排卵诱导前的LH和FSH水平以及主要结局，包括排卵、生化妊娠、临床妊娠、流产和活产。使用线性回归模型、逻辑回归模型和Cox比例风险回归模型来估计PCOS中LH/FSH比值与生殖结局之间的关联。
LH/FSH比值与年龄、体重指数（BMI）、总睾酮（TT）、雌二醇（E2）、游离睾酮（FT）和抗苗勒管激素（AMH）显著相关。无排卵女性的LH/FSH比值显著高于有排卵女性（P = 0.003），尤其是在年龄较小（P = 0.023）、BMI较高（P = 0.002）、E2较低（P = 0.002）、FT较低（P = 0.010）、TT较低（P < 0.001）和AMH较低（P = 0.032）的女性中。与LH/FSH<1的女性相比，LH/FSH比值升高的女性排卵率较低（LH/FSH≥1时，OR = 0.42，95%CI，0.26 - 0.68；LH/FSH≥2时，OR = 0.32，95%CI，0.20 - 0.54；LH/FSH≥3时，OR = 0.40，95%CI 0.21 - 0.74）。在调整有无混杂因素的治疗后，这种关联依然存在。虽然LH/FSH比值与生化妊娠之间无关联，但与LH/FSH<1的女性相比，1≤LH/FSH<2的女性临床妊娠率较高（OR = 1.71；95%CI，1.09 - 2.67）和活产率较高（OR = 1.73；95%CI，1.09 - 2.75）。2≤LH/FSH<3的女性流产率较低（OR = 0.38；95%CI，0.16 - 0.93）。
PCOS女性基线LH/FSH比值升高与排卵反应不良相关，但与LH/FSH正常的女性相比，她们更有可能实现临床妊娠和活产。这表明PCOS女性的LH和FSH尽管对排卵有负面影响，但可能在成功妊娠中发挥作用。
