Wen Xinling, Wang Li, Lv Shulan
Department of Anesthesiology and Operation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Front Endocrinol (Lausanne). 2024 Dec 12;15:1400880. doi: 10.3389/fendo.2024.1400880. eCollection 2024.
Polycystic ovary syndrome (PCOS) is an important factor contributing to infertility in reproductive-aged women. Hyperandrogenism (HA) plays an important role in the pathogenesis of PCOS. This study was conducted to explore the follicular development and endometrial receptivity of different androgen phenotypes in reproductive-aged patients with PCOS.
A total of 268 PCOS patients with infertility were recruited and divided into two groups according to the different androgen phenotypes in this study: abnormal menstruation and hyperandrogenism (AM-HA group, = 127) and abnormal menstruation and polycystic ovarian morphology (AM-PCOM group, = 141). The follicular development, endometrial receptivity, pregnancy rate, and live birth rate during the natural menstrual cycle were compared between the two groups.
The number of dominant follicles, number of ovulations, and normal ovulation rate in the AM-HA group were significantly lower compared with those in the AM-PCOM group ( < 0.05). The endometrial thickness (ET), endometrial volume (EV), vascularization index (VI), flow index (FI), and vascularization flow index (VFI) on days 14 to 24 of the menstrual cycle before ovulation were significantly lower in the AM-HA group than in the AM-PCOM group ( < 0.05). The endometrial VI, FI, and VFI, the integrin αvβ3, and VEGF concentrations in the uterine fluid during the implantation window were significantly lower in the AM-HA group compared with the AM-PCOM group ( < 0.05). However, no statistically significant differences were observed in the uterine artery blood flow parameters, ET and EV, between the two groups ( > 0.05). The biochemical pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate in the AM-HA group were significantly lower compared with those in the AM-PCOM group ( < 0.05).
PCOS patients with the AM-HA phenotype were vulnerable to ovulation disorders and impaired endometrial receptivity, which resulted in reduced pregnancy rate. Treatment with HA is likely to become an effective approach for improving endometrial receptivity and fecundity disorders in patients with PCOS.
多囊卵巢综合征（PCOS）是导致育龄期女性不孕的重要因素。高雄激素血症（HA）在PCOS的发病机制中起重要作用。本研究旨在探讨PCOS育龄期患者不同雄激素表型的卵泡发育及子宫内膜容受性。
本研究共纳入268例PCOS不孕患者，根据不同雄激素表型分为两组：月经异常合并高雄激素血症组（AM-HA组，n = 127）和月经异常合并多囊卵巢形态组（AM-PCOM组，n = 141）。比较两组自然月经周期中的卵泡发育、子宫内膜容受性、妊娠率和活产率。
AM-HA组的优势卵泡数、排卵数及正常排卵率均显著低于AM-PCOM组（P < 0.05）。AM-HA组在排卵前月经周期第14至24天的子宫内膜厚度（ET）、子宫内膜容积（EV）、血管化指数（VI）、血流指数（FI）及血管化血流指数（VFI）均显著低于AM-PCOM组（P < 0.05）。AM-HA组在着床窗期的子宫内膜VI、FI及VFI、子宫液中整合素αvβ3及血管内皮生长因子（VEGF）浓度均显著低于AM-PCOM组（P < 0.05）。然而，两组间子宫动脉血流参数、ET及EV差异无统计学意义（P > 0.05）。AM-HA组的生化妊娠率、临床妊娠率、持续妊娠率及活产率均显著低于AM-PCOM组（P < 0.05）。
具有AM-HA表型的PCOS患者易发生排卵障碍及子宫内膜容受性受损，导致妊娠率降低。针对HA的治疗可能成为改善PCOS患者子宫内膜容受性及生育障碍的有效方法。
