A Slower Age-Related Decline in Treatment Outcomes After the First Ovarian Stimulation for in vitro Fertilization in Women With Polycystic Ovary Syndrome
A Slower Age-Related Decline in Treatment Outcomes After the First Ovarian Stimulation for in vitro Fertilization in Women With Polycystic Ovary Syndrome
复制标题
多囊卵巢综合症女性首次体外受精卵巢刺激后，治疗结果与年龄相关的下降速度较慢
DOI：
10.3389/fendo.2019.00834
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发表时间：
2019-12-05
影响因子：
5.2
通讯作者：
Guo, Yihong
中科院分区：
文献类型：
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作者：
Li, Jing;Liu, Xiaocong;Guo, Yihong
背景资料：多囊卵巢综合征（PCOS）患者比非PCOS患者具有更好的卵巢储备和与年龄相关的内分泌紊乱改善。年龄对体外受精（IVF）治疗结局的影响与累积活产率（CLBR）相关，目前尚不清楚。目的：探讨年龄对多囊卵巢综合征（PCOS）患者体外受精（IVF）首次促排卵后CLBR的影响。方法：这项回顾性队列研究包括3，502例PCOS患者和18，596例输卵管因素不孕症患者，他们接受了第一个IVF周期和随后的冷冻胚胎移植（ET）尝试。主要结局是与单个刺激周期相关的CLBR，次要结局包括新鲜ET周期的着床率、临床妊娠率、活产率（LBR）、大于胎龄儿（LGA）率、小于胎龄儿（SGA）率和早产（PTB）率。结果如下：40岁以上PCOS患者的种植率（27.8 vs. 15.7%，P < 0.05）、临床妊娠率（51.4 vs. 26.1%，P < 0.05）、LBR（42.3 vs. 18.2%，P < 0.05）和CLBR（50.0 vs. 21.5%，P < 0.05）均高于40岁以上非PCOS患者。这些比率在35 - 40岁的PCOS患者和40岁以上的PCOS患者之间具有可比性（P分别为0.263、0.385和0.112）。PCOS患者的种植率、临床妊娠率和CLBR随年龄的变化慢于非PCOS患者（均P < 0.05）。在小于35岁的PCOS患者中，BMI与CLBR呈负相关[aOR：0.961（0.939-0.985）; P < 0.05];然而，在35岁以上的PCOS患者中，（P = 0.353）、年龄[aOR：0.891（0.803-0.990）; P < 0.05]和获卵数[aOR：1.093（1.002-1.078）; P < 0.05]与CLBR显著相关。35岁以上PCOS组与非PCOS组的LGA、LGA、PTB差异无统计学意义（均P > 0.05）。结论：PCOS患者治疗结果随年龄的下降比非PCOS患者慢。对于40岁以上的患者，PCOS患者比非PCOS患者具有生殖优势。与年轻的PCOS患者（<35岁）相比，年龄较大的PCOS患者（≥35岁）在IVF治疗前花时间减肥可能获益较少，立即开始辅助生殖治疗至关重要。
Background: Polycystic ovary syndrome (PCOS) patients have a better ovarian reserve and age-related improvement in endocrine disturbances than non-PCOS patients. The effects of age on in vitro fertilization (IVF) treatment outcomes associated with cumulative live birth rate (CLBR) remain unclear. Objectives: To study the effect of age on CLBR after the first ovarian stimulation in IVF in PCOS patients. Method: This retrospective cohort study included 3,502 PCOS patients and 18,596 patients with tubal factor infertility, who underwent their first IVF cycles and subsequent frozen embryo transfer (ET) attempts. The primary outcome was CLBR associated with a single stimulation cycle and secondary outcomes included the implantation rate, clinical pregnancy rate, live birth rate (LBR), large for gestational age (LGA) rate, small for gestational age (SGA) rate, and preterm birth (PTB) rate of fresh ET cycles. Results: PCOS patients over 40 years had a higher implantation rate (27.8 vs. 15.7%, P < 0.05), clinical pregnancy rate (51.4 vs. 26.1%, P < 0.05), LBR (42.3 vs. 18.2%, P < 0.05), and CLBR (50.0 vs. 21.5%, P < 0.05) than non-PCOS patients over 40 years. These rates were comparable between PCOS patients aged 35 to 40 years and those aged over 40 years (P = 0.263, 0.385, and 0.112, respectively). The changes in the implantation rate, clinical pregnancy rate, and CLBR by age were slower for PCOS patients than for non-PCOS patients (all P < 0.05). Among PCOS patients less than 35 years, BMI was negatively associated with CLBR [aOR: 0.961 (0.939–0.985); P < 0.05]; however, among PCOS patients over 35 years, instead of BMI (P = 0.353), age [aOR: 0.891 (0.803–0.990); P < 0.05] and the number of oocytes retrieved [aOR: 1.093 (1.002–1.078); P < 0.05] were significantly associated with CLBR. No significant differences in LGA, LGA, or PTB were detected between PCOS and non-PCOS patients over 35 years (all P > 0.05). Conclusions: The declines in treatment outcomes with age are slower for PCOS patients than for non-PCOS patients. For patients over 40 years, PCOS patients have reproductive advantages over non-PCOS patients. In contrast to younger PCOS patients (<35 years), older PCOS patients (≥35 years) may benefit less from taking time to lose weight before IVF treatment, and the immediate initiation of assisted reproductive treatment is essential.