Haozhe Miao MD , Huiming Yang MD , Mengfei Yin MD , Yixuan Wang MD , Yuan Fang MD , Min Yang MD , Jialin Zou MD , Wenwen Zhang MD , Lingling Zhang MD , Chendan Liu MD , Yue Wang MD , Ze Wang MD , Yunhai Yu MD, PhD , Daimin Wei MD, PhD
{"title":"月经异常对多囊卵巢综合征妇女临床特征和试管婴儿妊娠结果的影响","authors":"Haozhe Miao MD , Huiming Yang MD , Mengfei Yin MD , Yixuan Wang MD , Yuan Fang MD , Min Yang MD , Jialin Zou MD , Wenwen Zhang MD , Lingling Zhang MD , Chendan Liu MD , Yue Wang MD , Ze Wang MD , Yunhai Yu MD, PhD , Daimin Wei MD, PhD","doi":"10.1016/j.xagr.2024.100332","DOIUrl":null,"url":null,"abstract":"<div><h3>BACKGROUND</h3><p>The diagnostic criteria and phenotypes in polycystic ovary syndrome are heterogeneous. Currently, it is unclear how to assess a patient's prognosis based on the onset time of menstruation disturbance. Evidence on this topic is scarce and has mainly focused on menstrual patterns.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess the association between the onset time of menstrual disturbance and clinical features and in vitro fertilization pregnancy outcomes in patients with polycystic ovary syndrome.</p></div><div><h3>STUDY DESIGN</h3><p>Our study was a secondary analysis of data collected as part of a randomized controlled trial conducted to compare live birth rates between fresh embryo transfer and frozen embryo transfer in 1508 individuals with polycystic ovary syndrome. Here, 1500 participants were classified into 2 groups according to the onset time of menstrual disturbance: immediately after menarche (early group) and after at least 1 year of regular menstruation (late group). We compared the prepregnancy clinical features, variables of ovarian stimulation, pregnancy outcomes after the initial cycle of embryo transfer, and perinatal and neonatal complications in the 2 groups.</p></div><div><h3>RESULTS</h3><p>Compared with the late group, the early group had more antral follicles (32.00 [range, 27.25–39.50] vs 28.00 [range, 24.00–36.00]; <em>P</em><.001), an elevated level of antimüllerian hormone (7.02 ng/mL [range, 3.60–11.47] vs 5.66 ng/mL [range, 3.65–8.92]; <em>P</em>=.024), a higher level of baseline luteinizing hormone (10.01±5.93 vs 8.51±5.53 IU/l; <em>P</em><.001) and luteinizing hormone–to–follicle-stimulating hormone ratio (1.51 [range, 1.00–2.32] vs 1.45 [range, 0.92–2.13]; <em>P</em><.001), lower levels of fasting glucose (5.47 mmol/L [range, 5.11–5.73] vs 5.50 mmol/L [range, 5.17–5.76]; <em>P</em><.001), and insulin at 2 hours after 75-g oral glucose tolerance test (56.85 µU/mL [range, 34.63–94.54] vs 59.82 µU/mL [range, 33.56–94.67]; <em>P</em>=.027), a higher level of high-density lipoprotein (1.26 mmol/L [range, 1.04–1.37] vs 1.21 mmol/L [range, 1.07–1.45]; <em>P</em>=.006). During in vitro fertilization, the early group had a higher level of peak estradiol (4596.50 pg/mL [range, 2639.25–6321.00] vs 3954.00 pg/mL [range, 2378.75–6113.50]; <em>P</em>=.013), and luteinizing hormone (2.52 IU/L [range, 1.40–4.21] vs 1.93 IU/L [range, 0.91–3.32]; <em>P</em>=.010) on the day of human chorionic gonadotropin trigger. There was no statistically significant difference observed in the number of oocytes and embryos, the rates of pregnancy and live birth, and the risks of obstetrical and neonatal between the 2 groups.</p></div><div><h3>CONCLUSION</h3><p>An early onset of menstrual disturbance in patients with polycystic ovary syndrome may be associated with slightly more severe reproductive features and slightly milder metabolic features. Nonetheless, the outcomes of in vitro fertilization and the initial cycle of embryo transfer were comparable between the 2 groups.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000261/pdfft?md5=ca17a9118bb0b913dc4f86d2f1a2216e&pid=1-s2.0-S2666577824000261-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Menstrual abnormalities effects on clinical features and in vitro fertilization pregnancy outcomes in women with polycystic ovarian syndrome\",\"authors\":\"Haozhe Miao MD , Huiming Yang MD , Mengfei Yin MD , Yixuan Wang MD , Yuan Fang MD , Min Yang MD , Jialin Zou MD , Wenwen Zhang MD , Lingling Zhang MD , Chendan Liu MD , Yue Wang MD , Ze Wang MD , Yunhai Yu MD, PhD , Daimin Wei MD, PhD\",\"doi\":\"10.1016/j.xagr.2024.100332\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>BACKGROUND</h3><p>The diagnostic criteria and phenotypes in polycystic ovary syndrome are heterogeneous. Currently, it is unclear how to assess a patient's prognosis based on the onset time of menstruation disturbance. Evidence on this topic is scarce and has mainly focused on menstrual patterns.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess the association between the onset time of menstrual disturbance and clinical features and in vitro fertilization pregnancy outcomes in patients with polycystic ovary syndrome.</p></div><div><h3>STUDY DESIGN</h3><p>Our study was a secondary analysis of data collected as part of a randomized controlled trial conducted to compare live birth rates between fresh embryo transfer and frozen embryo transfer in 1508 individuals with polycystic ovary syndrome. Here, 1500 participants were classified into 2 groups according to the onset time of menstrual disturbance: immediately after menarche (early group) and after at least 1 year of regular menstruation (late group). We compared the prepregnancy clinical features, variables of ovarian stimulation, pregnancy outcomes after the initial cycle of embryo transfer, and perinatal and neonatal complications in the 2 groups.</p></div><div><h3>RESULTS</h3><p>Compared with the late group, the early group had more antral follicles (32.00 [range, 27.25–39.50] vs 28.00 [range, 24.00–36.00]; <em>P</em><.001), an elevated level of antimüllerian hormone (7.02 ng/mL [range, 3.60–11.47] vs 5.66 ng/mL [range, 3.65–8.92]; <em>P</em>=.024), a higher level of baseline luteinizing hormone (10.01±5.93 vs 8.51±5.53 IU/l; <em>P</em><.001) and luteinizing hormone–to–follicle-stimulating hormone ratio (1.51 [range, 1.00–2.32] vs 1.45 [range, 0.92–2.13]; <em>P</em><.001), lower levels of fasting glucose (5.47 mmol/L [range, 5.11–5.73] vs 5.50 mmol/L [range, 5.17–5.76]; <em>P</em><.001), and insulin at 2 hours after 75-g oral glucose tolerance test (56.85 µU/mL [range, 34.63–94.54] vs 59.82 µU/mL [range, 33.56–94.67]; <em>P</em>=.027), a higher level of high-density lipoprotein (1.26 mmol/L [range, 1.04–1.37] vs 1.21 mmol/L [range, 1.07–1.45]; <em>P</em>=.006). During in vitro fertilization, the early group had a higher level of peak estradiol (4596.50 pg/mL [range, 2639.25–6321.00] vs 3954.00 pg/mL [range, 2378.75–6113.50]; <em>P</em>=.013), and luteinizing hormone (2.52 IU/L [range, 1.40–4.21] vs 1.93 IU/L [range, 0.91–3.32]; <em>P</em>=.010) on the day of human chorionic gonadotropin trigger. There was no statistically significant difference observed in the number of oocytes and embryos, the rates of pregnancy and live birth, and the risks of obstetrical and neonatal between the 2 groups.</p></div><div><h3>CONCLUSION</h3><p>An early onset of menstrual disturbance in patients with polycystic ovary syndrome may be associated with slightly more severe reproductive features and slightly milder metabolic features. 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引用次数: 0
摘要
背景多囊卵巢综合征的诊断标准和表型各不相同。目前,还不清楚如何根据月经紊乱的发生时间来评估患者的预后。本研究旨在评估多囊卵巢综合征患者月经紊乱发生时间与临床特征和体外受精妊娠结局之间的关联。研究设计我们的研究是对随机对照试验收集的数据进行的二次分析,该试验旨在比较新鲜胚胎移植和冷冻胚胎移植对 1508 名多囊卵巢综合征患者的活产率。在此,我们根据月经紊乱的发生时间将 1500 名参与者分为两组:月经初潮后立即发病组(早期组)和月经规律至少 1 年后发病组(晚期组)。我们比较了两组患者的孕前临床特征、卵巢刺激变量、胚胎移植初始周期后的妊娠结局以及围产期和新生儿并发症。00 [range, 27.25-39.50] vs 28.00 [range, 24.00-36.00]; P<.001),抗苗勒氏管激素水平升高(7.02 ng/mL [range, 3.60-11.47] vs 5.66 ng/mL [range, 3.65-8.92]; P=.024),黄体生成素基线水平升高(10.01±5.93 vs 8.001)、较低的空腹血糖水平(5.47 mmol/L [range, 5.11-5.73] vs 5.50 mmol/L [range, 5.17-5.76]; P<.001)、75 克口服葡萄糖耐量试验后 2 小时的胰岛素(56.85 µU/mL [范围,34.63-94.54] vs 59.82 µU/mL [范围,33.56-94.67];P=.027)、更高水平的高密度脂蛋白(1.26 mmol/L [范围,1.04-1.37] vs 1.21 mmol/L [范围,1.07-1.45];P=.006)。在体外受精期间,早期组的雌二醇峰值水平更高(4596.50 pg/mL [range, 2639.25-6321.00] vs 3954.00 pg/mL [range, 2378.75-6113.50];P=.013)和促黄体生成素(2.52 IU/L [范围,1.40-4.21] vs 1.93 IU/L [范围,0.91-3.32];P=.010)。结论 多囊卵巢综合征患者月经紊乱的早期发生可能与稍严重的生殖特征和稍轻微的代谢特征有关。尽管如此,两组患者体外受精和胚胎移植初始周期的结果相当。
Menstrual abnormalities effects on clinical features and in vitro fertilization pregnancy outcomes in women with polycystic ovarian syndrome
BACKGROUND
The diagnostic criteria and phenotypes in polycystic ovary syndrome are heterogeneous. Currently, it is unclear how to assess a patient's prognosis based on the onset time of menstruation disturbance. Evidence on this topic is scarce and has mainly focused on menstrual patterns.
OBJECTIVE
This study aimed to assess the association between the onset time of menstrual disturbance and clinical features and in vitro fertilization pregnancy outcomes in patients with polycystic ovary syndrome.
STUDY DESIGN
Our study was a secondary analysis of data collected as part of a randomized controlled trial conducted to compare live birth rates between fresh embryo transfer and frozen embryo transfer in 1508 individuals with polycystic ovary syndrome. Here, 1500 participants were classified into 2 groups according to the onset time of menstrual disturbance: immediately after menarche (early group) and after at least 1 year of regular menstruation (late group). We compared the prepregnancy clinical features, variables of ovarian stimulation, pregnancy outcomes after the initial cycle of embryo transfer, and perinatal and neonatal complications in the 2 groups.
RESULTS
Compared with the late group, the early group had more antral follicles (32.00 [range, 27.25–39.50] vs 28.00 [range, 24.00–36.00]; P<.001), an elevated level of antimüllerian hormone (7.02 ng/mL [range, 3.60–11.47] vs 5.66 ng/mL [range, 3.65–8.92]; P=.024), a higher level of baseline luteinizing hormone (10.01±5.93 vs 8.51±5.53 IU/l; P<.001) and luteinizing hormone–to–follicle-stimulating hormone ratio (1.51 [range, 1.00–2.32] vs 1.45 [range, 0.92–2.13]; P<.001), lower levels of fasting glucose (5.47 mmol/L [range, 5.11–5.73] vs 5.50 mmol/L [range, 5.17–5.76]; P<.001), and insulin at 2 hours after 75-g oral glucose tolerance test (56.85 µU/mL [range, 34.63–94.54] vs 59.82 µU/mL [range, 33.56–94.67]; P=.027), a higher level of high-density lipoprotein (1.26 mmol/L [range, 1.04–1.37] vs 1.21 mmol/L [range, 1.07–1.45]; P=.006). During in vitro fertilization, the early group had a higher level of peak estradiol (4596.50 pg/mL [range, 2639.25–6321.00] vs 3954.00 pg/mL [range, 2378.75–6113.50]; P=.013), and luteinizing hormone (2.52 IU/L [range, 1.40–4.21] vs 1.93 IU/L [range, 0.91–3.32]; P=.010) on the day of human chorionic gonadotropin trigger. There was no statistically significant difference observed in the number of oocytes and embryos, the rates of pregnancy and live birth, and the risks of obstetrical and neonatal between the 2 groups.
CONCLUSION
An early onset of menstrual disturbance in patients with polycystic ovary syndrome may be associated with slightly more severe reproductive features and slightly milder metabolic features. Nonetheless, the outcomes of in vitro fertilization and the initial cycle of embryo transfer were comparable between the 2 groups.
AJOG global reportsEndocrinology, Diabetes and Metabolism, Obstetrics, Gynecology and Women's Health, Perinatology, Pediatrics and Child Health, Urology