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[高雄激素血症对接受体外受精/卵胞浆内单精子注射-胚胎移植的多囊卵巢综合征女性妊娠结局的影响]

[Effect of hyperandrogenism on pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer].

作者信息

Jiang L L, Pan P, Jiao X D, Qiu Q, Li Y, Zhang Q X

机构信息

Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2023 Apr 11;103(14):1042-1048. doi: 10.3760/cma.j.cn112137-20220926-02032.

Abstract

To explore the effects of hyperandrogenism (HA) on pregnancy outcomes in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET). A retrospective study was conducted on infertile women with PCOS undergoing IVF/ICSI-ET from January 2017 to June 2021 in our center. Patients were divided into HA group and NON-HA group according to the levels of testosterone. Propensity score matching (PSM) was used to balance the influence of female age and IVF/ICSI-ET for patients with gonadotropin-releasing hormone (GnRH)antagonist protocol and GnRH agonist protocol, separately. After the PSM procedure, 191 cases in HA group and 382 cases in NON-HA group, were included. Hormone levels and pregnancy outcomes were compared in the two groups. The female age was comparable in two groups [HA: (29.6±3.7) vs NON-HA: (29.5±3.6), =0.665]. The basal luteinizing hormone [(10.82±6.73) vs (7.76±5.30) IU/L], testosterone [(3.27±0.97) vs (1.60±0.59) nmol/L], free androgen index (7.13 vs 2.77), anti-mullerian hormone [(11.37±5.74) vs (9.67±4.67) ng/ml], fasting glucose [(5.18±0.49) vs (5.06±0.42) mmol/L], 1h glucose [(9.34±2.42) vs (7.99±2.21) nmol/L], 2 h glucose [(7.66±2.17) vs (6.64±1.84) nmol/L], 2 h insulin [(129.81±145.49) vs (97.51±86.92) mU/L], total cholesterol [(5.35±0.89) vs (4.92±0.92) mmol/L], triglycerides [(1.55±1.28) vs (1.33±0.77) mmol/L], and low density lipoprotein cholesterol levels [(3.38±0.66) vs (3.14±0.71) mmol/L] were significantly higher in HA group, compared with NON-HA group (<0.05). The initiated gonadotropin dose was higher in HA group than that in NON-HA group [(126.96±33.65) vs (137.60±38.12) U, =0.001], but moderate-severe ovarian hyperstimulation syndrome (OHSS) rate was similar in two groups (>0.05). The rates of implantation, clinical pregnancy, miscarriage, and live birth were comparable between the two groups (>0.05). Also, in the subgroups, the rates of implantation, clinical pregnancy, live birth, and miscarriage were similar in HA group and NON-HA group. The risks of hormonal abnormality and glucose-lipid metabolic disorder were higher in PCOS women with HA, whereas satisfactory pregnancy outcomes could be achieved under proper ovarian stimulation undergoing IVF/ICSI-ET.

摘要

探讨高雄激素血症(HA)对接受体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)的多囊卵巢综合征(PCOS)女性妊娠结局的影响。对2017年1月至2021年6月在本中心接受IVF/ICSI-ET的PCOS不孕女性进行回顾性研究。根据睾酮水平将患者分为HA组和非HA组。采用倾向评分匹配(PSM)分别平衡接受促性腺激素释放激素(GnRH)拮抗剂方案和GnRH激动剂方案的患者的年龄及IVF/ICSI-ET的影响。PSM后,HA组纳入191例,非HA组纳入382例。比较两组的激素水平和妊娠结局。两组女性年龄相当[HA组:(29.6±3.7)岁 vs 非HA组:(29.5±3.6)岁,P = 0.665]。HA组基础促黄体生成素[(10.82±6.73)vs(7.76±5.30)IU/L]、睾酮[(3.27±0.97)vs(1.60±0.59)nmol/L]、游离雄激素指数(7.13 vs 2.77)、抗苗勒管激素[(11.37±5.74)vs(9.67±4.67)ng/ml]、空腹血糖[(5.18±0.49)vs(5.06±0.42)mmol/L]、1小时血糖[(9.34±2.42)vs(7.99±2.21)nmol/L]、2小时血糖[(7.66±2.17)vs(6.64±1.84)nmol/L]、2小时胰岛素[(129.81±145.49)vs(97.51±86.92)mU/L]、总胆固醇[(5.35±0.89)vs(4.92±0.92)mmol/L]、甘油三酯[(1.55±1.28)vs(1.33±0.77)mmol/L]及低密度脂蛋白胆固醇水平[(3.38±0.66)vs(3.14±0.71)mmol/L]均显著高于非HA组(P<0.05)。HA组启动的促性腺激素剂量高于非HA组[(126.96±33.65)vs(137.60±38.12)U,P = 0.001],但两组中重度卵巢过度刺激综合征(OHSS)发生率相似(P>0.05)。两组的着床率、临床妊娠率、流产率及活产率相当(P>0.05)。此外,在亚组中,HA组和非HA组的着床率、临床妊娠率、活产率及流产率相似。HA的PCOS女性激素异常及糖脂代谢紊乱风险较高,而在适当的卵巢刺激下接受IVF/ICSI-ET可获得满意的妊娠结局。

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