Impact Of Metabolic And Endocrinal Disorder On The Pregnancy Outcome In Infertile PCOS

Part Ⅰ.The Analysis of Treatment Outcome of PCOS With Infertility By IVF/ICSI-ET.Objective:Retrospective analysis of the data from Reproductive Center of Dalian Maternal and Child Health Hospital that included the PCOS patients,the outcome of conventional long protocol down regulation in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET),to analyze the characteristics of PCOS patients with different BMI and ages.Methods:According to different BMI,divided the PCOS patients into normal group(BMI<24),overweight(24≤BMI<28)and obesity group(BMI≥28);According to the theory of tiangui,the subjects were divided into 3 groups according to the female reproductive stage and age,Group A(age ≤28 years),group B(28 years<age≤35 years)and group C(age>35 years).To observe the baseline characteristics of PCOS patients with different BMI and ages:Age,infertility years,BMI,basal E2,LH,FSH,LH/FSH level,Gn starting dose,Gn medication days;Controlled Ovarian Hyperstimulation index:E2 on hCG day,maximum follicular diameter,The diameter is greater than or equal to 20 the number of follicles,the number of retrieved oocytes,the fertilization rate,the number of fertilization(2PN),embryo number,severe OHSS incidence;Pregnancy outcome index:Implantation rate,pregnancy rate,clinical pregnancy rate,pregnancy rate,pregnancy loss rate,live birth rate,ectopic pregnancy rate;Obstetric outcome:birth weight and gestational age.The results are compared and analyzed.Results:(1)Different ages,different BMI groups,In group PCOS,Gn had high initial dosage,few days of medication,high LH,high LH/FSH,low FSH,compared with the control group(p<0.05);.E2 level on hCG day of PCOS group,the largest follicle diameter,D is more than or equal to the number of follicles in 20mm,the number of oocytes increased,compared with control group(p<0.05).(2)with the increase of BMI,the incidence of PCOS in patients with OHSS was increased.The obese group(BMI≥28kg/m2)in patients with PCOS compared with the control group with clinical pregnancy rate higher(p<0.05).(3)with the increase of age,the control group the number of oocytes and live birth rates were decreased(p<0.05),but no significant difference in PCOS group,but the decrease is less than the control group(the number of oocytes:PCOS vs control=-0.028vs-0.25 slope;slope:PCOS vs live birth control=-0.0144vs.-0.0235).(4)aged 28 years old,PCOS pregnancy loss rate was higher than the control group;older than 35 years old,the occurrence of OHSS in patients with PCOS was higher than the control group,the adjustment factors still have significant difference(p<0.05)Conclusion:(1)PCOS patients were high responsible to Gn stimulation.(2)with the increase of BMI,the incidence of PCOS in patients with OHSS was increased.BMI≥28kg/m2,PCOS patients compared with control group with clinical pregnancy rate higher(p<0.05).(3)PCOS may be compared with normal ovarian function in patients with age compared to the better,when older than 28 years of age,PCOS pregnancy loss rate is high,when over 35 year old OHSS has high incidence rate(p<0.05).Part Ⅱ.Evaluation of Early Embryo Dynamics Study in PCOS Patients With Phlegm-dampness type By Time-lapse.Objective:To evaluate the characteristics of early embryonic kinetics parameters and the influence on pregnancy outcome in patients with PCOS by time-lapse technique.Method:PCOS patients in Center of Dalian Maternal and Child Health Hospita accept conventional long protocol down regulation in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)were divided into three groups prospectively.phlegm-dampness type of PCOS,non-phlegm-dampness type of PCOS,and the healthy people.Baseline characteristics:Age,infertility years,BMI,basic LH,FSH and T,the dynamic parameters of embryo quality:including T2,T3,T4,T5,T7,T8,CC2(t3-t2),CC3(t5-t3)and S2(T4-T3),the number of retrieved oocytes,the number of oocytes MII,fertilization rates,lmplantation rates,Pregnancy rate,miscarriage rates were compared between the three groups.Result:(1)Compared with the control group,T2,T3,T7,T8 were prolonged in the phlegm-dampness type and non phlegm-dampness PCOS group(p<0.05);Compared with non phlegm-dampness type PCOS and control group,T4 and T7 of patients with phlegm dampness type PCOS were prolonged(p<0.05).But there was no statistical difference in CC2(t3-t2),CC3(t5-t3)and S2(T4-T3)between the three groups(p>0.05).(2)Compared with the control group,the number of retrieved oocytes in the PCOS group was higher than that in the phlegm dampness type and non phlegm dampness type group,there was statistical difference(p<0.05).The rate of implantation and pregnancy rate was low,and the rate of miscarry was high in PCOS group,there was no statistical difference between the non phlegm-dampness PCOS group and the control group(p>0.05)。Conclusion:(1)the dynamics parameters of PCOS early embryos were different from those of the normal population,mainly reflected in T2,T3,T7,T8 time extension.(2)the abnormal dynamics parameters of early embryos in patients with phlegm dampness type PCOS,mainly reflected in the T4,T7 time extension(p>0.05)。Part Ⅲ.Study On the Relationship Between Serum SHBG and PCOS Metabolism and Pregnancy outcome.Objective:This topic is the analysis of baseline data and outcomes of the subjects in the project of PCOSAct 1000 cases,SHBG and PCOS to investigate infertility patients with metabolic characteristics and ovulation,pregnancy,pregnancy,miscarry and live birth correlation.Methods:In 1000 subjects,subjects with missing SHBG data were excluded,and the remaining 954 cases were excluded,divided into three groups according to the different levels of HCY detection of three:High SHBG group;SHBG≥46.6 nmol/L,Middle SHBG group:24.8<SHBG<46.6 nmol/L and Low SHBG group:SHBG≤24.8 nmol/L.Observation indexes include:Age,BMI,waist to hip ratio,hirsutism score score,acne score;previous infertility time,whether CC treatment,whether acupuncture treatment;serum indicators HCY,SHBG,E2,T,P,LH,FSH,LH/FSH,free testosterone,glucose,insulin,HOMA index;Pregnancy outcome:ovulation rate,conception rate,pregnancy rate,single and double pregnancy number,pregnancy loss,early pregnancy loss,biochemical pregnancy,ectopic pregnancy,live birth rate,single twin live birth rate,pregnancy weeks,neonatal birth weight,neonatal sex ratio.The baseline levels of the three groups were compared with those of the subjects,such as ovulation,pregnancy,conception and live birth,and to explore the correlation between SHBG level and pregnancy outcome.And the risk factors of MS were predicted.Results:(1)With the decrease of SHBG,metabolic parameters such as BMI,WHR,fasting blood glucose,insulin,HOMA-IR and MS increased,free testosterone and hairy scores increased,and E2 decreased,After the adjustment is still statistically significant(p<0.05)。(2)Reproductive outcome after CC and acupuncture treatment,with the reduction of SHBG,live birth rate,conception rate,pregnancy rate and ovulation rate also decreased(p<0.01).After adjustment,ovulation rate and conception rate were statistically significant(p<0.05),There was no statistical difference in live birth rate and pregnancy rate(p>0.05)。(3)SHBG is a predictive risk factor for MS.There was no significant difference between WHR and HOMA-IR in predicting the risk factors for MS(AUC:SHBG vs WHR:0.7505 vs.0.7609,p=0.62;SHBG vs HOMA:0.7505 vs.0.7536,p=0.88)。Conclusion:(1)Low levels of SHBG were predictors of MS risk factors.The predictive ability of SHBG to to MS risk factors was not different from that of WHR and HOMA-IR.(2)Low levels of SHBG are associated with decreased rates of ovulation and conception in PCOS patients.Part Ⅳ.Study on Serum HCY and PCOS Metabolism and Pregnancy Outcome.Objective:In this study,1000 subjects of PCOSAct project were selected to analyze the data of baseline and outcome of HCY.Objective to investigate the relationship between PCOS and MS,ovulation,pregnancy,pregnancy,abortion and live birth in patients with HCY and infertility.Methods:1000 subjects were excluded from the HCY data after the remaining 936 cases,according to the different levels of HCY were divided into three groups of different levels,High HCY group:HCY≥9.34umol/L,Middle HCY group:6.09umol/L<HCY<9.34umol/L and Low HCY group:HCY≤6.09umol/L,The remaining 1000 cases(excluding the missing data)in the remaining 908 cases were divided into 3 groups according to whether HHCY,MS,HHCY group,MS group and control group.The observation indexes include:age,BMI,waist hip ratio,hirsutism score,acne score;previous infertility time,CC treatment,acupuncture treatment;serum HCY,SHBG,E2,T,P,LH,FSH,LH/FSH,free testosterone,glucose,insulin,HOMA index.Pregnancy outcome:ovulation rate,conception rate,pregnancy rate,single and double pregnancy number,pregnancy loss,early pregnancy loss,biochemical pregnancy,ectopic pregnancy,live birth rate,single twin live birth rate,pregnancy weeks,neonatal birth weight,neonatal sex ratio.To compare the levels of baseline,ovulation,conception,pregnancy and live birth between different groups,and to explore the correlation between HCY level and pregnancy outcome.Result:(1)With the decrease of HCY,BMI and free T in patients with PCOS decreased,and the levels of FSH,SHBG and glucose increased(p<0.05).(2)Compared with MS group,HHCY group and control group BMI,glucose,insulin,HOMA-IR and hirsutism score is reduced;LH,FSH,LH/FSH and SHBG increased(P<0.05);compared with the control group,HHCY group and MS group of WHR,E2,free testosterone was significantly elevated(p<0.05).(3)Comparison between high HCY group and middle and low HCY group,the ovulation rate(according to the patient count)decreased significantly(p=0.003),adjust the treatment factors,there are still significant differences(p=0.004);The loss rate of middle and late pregnancy of high HCY group was higher than middle HCY group(p=0.05),but no difference in treatment adjustment factors(P=0.5032).(4)MS group(according to the ovulation rate,pregnancy rate,cycle count)pregnancy rate and live birth rate decreased,and the ratio of HHCY group and control group(P<0.05),while HHCY is no difference with the control group,after the adjustment was statistically significant(p<0.05);HHCY group and MS group,the ovulation rate(according to the patient’s count)decreased,compared with the control group,while HHCY and MS were no difference,after the adjustment was statistically significant(p<0.05);group HHCY total pregnancy loss is higher than that of MS group and control group,after the adjustment was statistically significant(p<0.05).Conclusion:(1)Correlation between HCY and PCOS carrier hormones.(2)The metabolic characteristics of HHCY group were lower than that of MS.(3)In PCOS infertility patients,the HHCY group had a relatively normal fertilization rate,while in the MS group,the fertilization rate was impaired.(4)HHCY is asosilation with the loss of pregnancy,while MS affects conception,pregnancy,and live birth,that the two effects on PCOS reproductive outcome is to occur in different stages.