Impact of Central Obesity on Women with Polycystic Ovary Syndrome Undergoing In Vitro Fertilization.
Impact of Central Obesity on Women with Polycystic Ovary Syndrome Undergoing In Vitro Fertilization.
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DOI：
10.1089/biores.2017.0040
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发表时间：
2018
影响因子：
--
通讯作者：
Zhang Q
中科院分区：
文献类型：
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作者：
Li Y;Lin H;Pan P;Yang D;Zhang Q
中心性肥胖（CO）是多囊卵巢综合征（PCOS）的特征性表现，其存在可能加重PCOS引起的疾病。本研究采用回顾性病例对照研究的方法，探讨CO对PCOS不孕患者体外受精（IVF）的影响。选择188例接受IVF的PCOS不孕妇女，分为CO组（n = 70，腰围[WC] ≥80 cm）和非中心性肥胖（NCO）组（n = 118，腰围<80 cm）。比较两组患者的基线特征、促排卵参数、实验室检查参数及妊娠结局。在控制体重指数（BMI）后，WC与空腹胰岛素（r = 0.210，p = 0.007）、稳态模型评估的胰岛素抵抗（r = 0.249，p = 0.006）和游离雄激素指数（r = 0.249，p = 0.006）呈正相关。与NCO组相比，CO组内分泌代谢紊乱明显增加，促性腺激素用量明显增加，促排卵持续时间明显延长（p < 0.05），但血清雌二醇峰值明显降低（p < 0.01），获卵数明显减少（p = 0.032）。CO组活产率和着床率显著较低（分别为53.8%和86.8%，p = 0.001; 24.3%和36.3%，p = 0.019），早期自然流产率较高（38.5%和7.5%，p = 0.002）。对于多变量分析，通过调整年龄、BMI、胰岛素抵抗和高雄激素血症（HA），CO是早期流产的显著独立危险因素（调整后的相对比值= 16.87，95%置信区间= 2.15-132.70，p = 0.007）。CO与胰岛素抵抗、高胰岛素血症和HA相关，与BMI无关，并与接受IVF的PCOS不孕妇女的不良妊娠结局相关。
Central obesity (CO) is a defining characteristic of polycystic ovary syndrome (PCOS) and PCOS-induced disorders are likely to be exacerbated in the presence of CO. This study aims to evaluate the impact of CO on infertile women with PCOS undergoing in vitro fertilization (IVF).It is a retrospective and case–control study. One hundred eighty-eight infertile PCOS women undergoing IVF were divided into CO group (n = 70, waist circumference [WC] ≥80 cm) and noncentral obesity (NCO) group (n = 118, WC <80 cm). Baseline characteristics, parameters of ovarian stimulation and laboratory, and pregnancy outcomes were compared between two groups. After controlling for body mass index (BMI), WC positively correlated with fasting insulin (r = 0.210, p = 0.007), homeostatic model assessment for insulin resistance (r = 0.249, p = 0.006) and free androgen index (r = 0.249, p = 0.006). Compared with NCO group, CO group had significantly increased endocrine and metabolic disorders and needed significantly higher dose of gonadotropins, longer duration of ovarian stimulation (p < 0.05), but had significantly lower peak serum estradiol level (p < 0.01) and less oocytes retrieved (p = 0.032). CO group had significantly lower live birth and implantation rates (53.8% vs. 86.8%, p = 0.001; and 24.3% vs. 36.3%, p = 0.019, respectively) and higher early spontaneous miscarriage rate (38.5% vs. 7.5%, p = 0.002). For the multivariate analysis, by adjusting for age, BMI, insulin resistance, and hyperandrogenism (HA), CO was significantly independent risk factor for early miscarriage (adjusted relative ratio = 16.87, 95% confidence interval = 2.15–132.70, p = 0.007). CO is associated with insulin resistance, hyperinsulinemia, and HA independent of BMI and is associated with poor pregnancy outcome in infertile women with PCOS undergoing IVF.