Wang X Y, Xu J N, Li M, Zhang C L, Zhang S D
Reproductive Medicine Center, Henan Provincial People's Hospital, Zhengzhou 450003, China.
Zhonghua Fu Chan Ke Za Zhi. 2025 Jun 25;60(6):439-449. doi: 10.3760/cma.j.cn112141-20250312-00087.
To investigate the effect of pre-pregnancy body mass index (BMI) on the cumulative live birth rate (CLBR) and perinatal outcomes in women with polycystic ovary syndrome (PCOS) undergoing first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI). The clinical data of 1 013 patients with PCOS who received first IVF/ICSI treatment in Reproductive Medicine Center, Henan Provincial People's Hospital from January 2017 to June 2020 were retrospectively analyzed. According to BMI China standard, they were divided into: normal weight group (18.5≤BMI<24.0 kg/m, 388 cases), overweight group (24.0≤BMI<28.0 kg/m, 367 cases), obese group (BMI≥28.0 kg/m, 258 cases). The effect of BMI on CLBR was analyzed by univariate analysis, multivariate logistic regression analysis and smooth curve fitting. The role of homeostasis model assessment of insulin resistance index (HOMA-IR) in the process of BMI on CLBR was analyzed by mediation analysis. Among three groups, female age, basal level of follicle stimulating hormone, type of infertility and ovulation induction regimens were similar (all >0.05). The infertility duration, basal testosterone level, HOMA-IR, the ovulation induction time and the total gonadotropin dosage increased with BMI (all <0.01), anti-Müllerian hormone, basal luteinizing hormone level, the number of retrieved oocytes and available embryos decreased with BMI (all <0.05). CLBR decreased with BMI increasing [84.08% (301/358) vs 74.26% (251/338) vs 71.88% (161/224); <0.001]. The incidence of hypertensive disorder in pregnancy was highest in obese group, while premature rupture of membranes rate, premature delivery rate, low birth weight rate and macrosomia birth rate were the lowest in normal weight group. After adjusting for confounding factors, both smooth curve fitting and multiple logistic regression analysis revealed a significant trend: CLBR declined with increasing BMI (=0.93, 95%: 0.89-0.97; =0.002), with a reduction of 41% (=0.59, 95%: 0.39-0.91; =0.020) in overweight group, and a reduction of 48% (=0.52, 95%: 0.32-0.83; =0.010) in obese group. HOMA-IR mediated the effect of BMI on CLBR by 27.5% (<0.05). High BMI before IVF/ICSI in PCOS patients negatively impacts CLBR and raises maternal and infant risks during pregnancy and the perinatal period. 27.5% of the effect of BMI on CLBR is mediated by HOMA-IR. Thus, PCOS patients should manage their BMI and enhance insulin sensitivity prior to pregnancy.
探讨多囊卵巢综合征（PCOS）患者首次接受体外受精或卵胞浆内单精子注射（IVF/ICSI）前的孕前体重指数（BMI）对累积活产率（CLBR）及围产期结局的影响。回顾性分析2017年1月至2020年6月在河南省人民医院生殖医学中心首次接受IVF/ICSI治疗的1013例PCOS患者的临床资料。根据中国BMI标准，将其分为：正常体重组（18.5≤BMI<24.0kg/m，388例）、超重组（24.0≤BMI<28.0kg/m，367例）、肥胖组（BMI≥28.0kg/m，258例）。采用单因素分析、多因素logistic回归分析及平滑曲线拟合分析BMI对CLBR的影响。通过中介分析探讨胰岛素抵抗指数稳态模型评估（HOMA-IR）在BMI影响CLBR过程中的作用。三组患者的年龄、基础卵泡刺激素水平、不孕类型及促排卵方案相似（均>0.05）。不孕时间、基础睾酮水平、HOMA-IR、促排卵时间及总促性腺激素用量随BMI增加而升高（均<0.01），抗苗勒管激素、基础黄体生成素水平、获卵数及可用胚胎数随BMI降低（均<0.05）。CLBR随BMI升高而降低[84.08%（301/358） vs 74.26%（251/338） vs 71.88%（161/224）；<0.001]。肥胖组妊娠高血压疾病发生率最高，而胎膜早破率、早产率、低出生体重率及巨大儿出生率在正常体重组最低。校正混杂因素后，平滑曲线拟合及多因素logistic回归分析均显示显著趋势：CLBR随BMI升高而下降（β=0.93，95%CI：0.89-0.97；P=0.002），超重组降低41%（β=0.59，95%CI：0.39-0.91；P=0.020），肥胖组降低48%（β=0.52，95%CI：0.32-0.83；P=0.010）。HOMA-IR介导BMI对CLBR影响的27.5%（P<0.05）。PCOS患者IVF/ICSI前高BMI对CLBR有负面影响，并增加孕期及围产期母婴风险。BMI对CLBR影响的27.5%由HOMA-IR介导。因此，PCOS患者孕前应控制BMI并提高胰岛素敏感性。
