| Polycystic ovary syndrome(PCOS)is an ovarian dysfunctional disease with a complex pathogenesis.The incidence of polycystic ovary syndrome is up to 5%-10% in women at puberty and childbearing age.The clinical practice guide of the European Institute of endocrinology has defined PCOS(according to the Rotterdam standard)as a clinical syndrome with two or more than two symptoms as follows: hyperandrogenemia,ovulatory disorders and ovarian polycystic changes.The diagnosis of PCOS should exclude the endocrine diseases such as hyperprolactinemia,thyroid disease(hypothyroidism and hyperthyroidism)and congenital adrenal hyperplasia.Because of the high incidence and heterogeneity of clinical manifestations,the diagnosis and treatment of PCOS has been a hot and difficult topic in obstetrics and gynecology.The current treatment measures include improving life style,reducing weight,lowering androgens,improving insulin resistance and promoting ovulation.These treatments are effective for 70% of PCOS patients,of which 30%-40% gets pregnancy.However,there are still some refractory PCOS patients who need assisted reproductive technology to get pregnancy.Compared with tubal infertility patients,PCOS patients often merge with overweight / obesity,and there are endocrine and metabolic abnormalities such as Hyperandrogenism or insulin resistance,which may affect oocyte quality,early embryonic development and endometrial receptivity,and then affect the outcome of in vitro fertilization / Intracytoplasmic sperm injection.Ovarian reserve is an important indicator for evaluating female fertility.After 35 years of age,ovarian reserve in females decreased,manifested as decreased number of follicle antral count,increased basic follicle stimulating hormone and serum anti-Mullerian hormone and reduced responsiveness to controlled ovarian hyperstimulation,decreased oocyte retrieval.PCOS is a disorder of follicular maturation.Compared with non-PCOS patients,the decline of ovarian reserve function in PCOS patients is slowed down,and the physiological age of ovarian is delayed.ART can obtain more oocytes and available embryos,more transplant cycles,theoretically should have a higher cumulative live birth rate.This study used a retrospective cohort study of IVF/ICSI outcomes in patients with PCOS and the same age non-PCOS patients,who were defined as junior(younger than 35 years)group and senior(older than 35 years)group.To investigate the cumulative live birth rate and relevant influencing factors of IVF/ICSI assisted pregnancy therapy in young and elderly PCOS patients.At present,CLBR is attracting more and more attention.It is a well-recognized evaluation index of clinical outcome of IVF/ICSI.There are many ways to calculate CLBR.This study uses the definition of: the ratio of the number of patients who received a live birth in the first stimulation cycle and subsequent fresh and resuscitation transplant cycles to the total number of patients undertook their first stimulation cycle.A case-control study was used to compare the baseline data of the PCOS live birth group and non-live birth group with the clinical and laboratory data on ovulation induction and to investigate the key factors affecting the pregnancy outcomes and the cumulative live birth rate of the first stimulation cycle.Factors that provide a reliable basis for follow-up clinical work.ObjectiveTo compare the cumulative live birth rate of the first stimulation cycle between PCOS patients and tubal infertility patients at the same period.Investigate the factors affecting the cumulative live birth rate.Controlled studies compared baseline data and clinical and laboratory data on ovulation induction between live birth PCOS group and non-live birth PCOS group and investigated the effect of body mass index on the outcome of IVF/ICSI in PCOS patients.Materials and Methods1.Objective: Select 1362 cases of PCOS patients who had transplanted all embryos obtained from the first stimulation from July 2014 to November 2017 in the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University,matched by age,and randomly selected by a ratio of 1:2,2724 tubal infertility patients at the same time as control group.2.Methods: Part I: A retrospective cohort study was used to compare baseline such as duration of infertility,BMI,and basal endocrine levels in junior(<35)and senior(≥35 years old)PCOS patients and tubal infertility patients of the same period.Clinical data and laboratory data,differences in pregnancy outcomes and cumulative live birth rates of the first stimulation cycle are also included.Part II: According to whether got a live birth in the first stimulation cycle,the PCOS patients are divided into live birth group and non-live birth group,and the baseline data,clinical data of ovulation and laboratory data are compared between the two groups.The difference in BMI between the two groups was found to be significant.According to BMI,PCOS patients were divided into low body reorganization,normal body reorganization,super recombination,and obesity groups.The differences in pregnancy outcomes of fresh cycle and CLBR were compared between the four groups.To further explore the impact of different BMI on the outcomes of the IVF/ICSI fresh cycle and the cumulative live birth rate of the first stimulation cycle in PCOS patients.3.Statistical approch: SPSS21.0 statistical software was used for statistical analysis.Measured data were expressed as mean±standard deviation,The data of the numerical variables were analyzed by student t-test or Wilcoxon rank sum test.The comparison of rates was X2 test.Logistic regression was used to analyze the risk factors affecting cumulative live birth rate;The Cox regression survival curve was used to analyze the effect of the number of transplant cycles on the cumulative live birth rate of the first stimulation cycle;95% confidence interval was used and α=0.05 was used as the test level.Results1.Retrospective cohort study:1.1.Junior group(younger than 35 years):1.1.1.Baseline data comparison: Duration of infertility,BMI,LH,LH/FSH ratio,T,AMH,and AFC were all higher in the PCOS group than in the tubal infertility control group.FSH was lower than the control group.The difference was statistically significant(P<0.05).There was no significant difference in age,primary/secondary ratio of infertility and fasting blood glucose between the two groups(P≥0.05).1.1.2.Comparison of clinical and laboratory data of COH: The total dose of Gnadotropin and the top quality of embryos were lower in the PCOS group than in the tubal infertility control group.Duration of COH,the number of oocytes retrieved and the number of transferable embryos were significantly higher in the PCOS group than in the control group(P<0.05);There was no statistical difference in 2PN fertilization rate between the two groups(P≥0.05).1.1.3.Comparison of outcomes of fresh cycle and CLBR of first stimulation cycle:In the PCOS group,the proportion of D5 blastocysts in the fresh cycle was higher than that in the control group,and the proportion of D3 embryos was lower in the PCOS group than in the control group;the cumulative live birth rate and the average number of transplant cycles of first stimulation cycle in the PCOS group were higher than those in the control group(P<0.05).There was no significant difference in the average number for transplanted embryos per fresh cycle,the implantation rate,the clinical pregnancy rate,the miscarriage rate and the live birth rate of the fresh cycle between two groups(P≥0.05).1.1.4.Logistic regression analysis showed: Duration of infertility and T were risk factors affecting cumulative live birth rate in the first stimulation cycle of junior patients(younger than 35 years).The number of retrieved oocytes was a protective factor.1.1.5 Cox regression showed:With the increase of the number of transplantation cycles,the cumulative live birth rate of younger patients(<35 years old)gradually increased.The cumulative live birth rate of PCOS patients during each transplantation cycle was higher than that of tubal infertility control group,and the differences was statistically significant(P<0.05).1.2.senior group(older than 35 years):1.2.1.Baseline data comparison: There was a statistically significant difference in the ratio of primary/secondary infertility among the two groups;in the PCOS group,duration of infertility,BMI,LH,LH/FSH ratio,T,AMH,AFC,and fasting blood glucose were all higher than those of tubal infertility control group;FSH was lower than the control group,and the difference was statistically significant(P<0.05).1.2.2.Comparison of clinical and laboratory data of COH: The number of oocytes retrieved and transferable embryos were higher in the PCOS group than in the control group.The total dose of Gn and 2PN fertilization rates were lower in the PCOS group than in the control group(P<0.05).The duration of COH and top quality embryo rate between two groups were not statistical differences(P≥0.05).1.2.3.Comparison of outcomes of fresh cycle and CLBR of first stimulation cycle: In the PCOS group,the proportion of D5 blastocysts in the fresh cycle was higher than that in the control group,and the proportion of D3 embryos was lower in the PCOS group than in the control group;The average number for transplant cycles per first stimulation cycle in the PCOS group was higher than that in the tubal infertility control group;The average number of transplanted embryos per fresh cycle was lower than in the control group,with a statistically significant difference(P<0.05);There was no significant difference between the two groups in fresh cycle implantation rate,clinical pregnancy rate,miscarriage rate,live birth rate,and cumulative live birth rate of the first stimulation cycle(P≥0.05).1.2.4.Logistic regression analysis showed: Age,duration of infertility,BMI,FSH,E2 and infertility factors PCOS were risk factors that affected the cumulative live birth rate of the first stimulation cycle in patients who were older than 35 years.1.2.5.Cox regression showed:With the increase of the number of transplant cycles,the cumulative live birth rate of elderly patients(older than 35 years)gradually increased,and the cumulative live birth rate of tubal infertility group was higher than that of PCOS group,but the differences was not statistically significant(P<0.05).2.Case-control study:2.1.Baseline and COH clinical and laboratory data of the PCOS patients in the live birth group and the non-live birth group: The proportion of primary infertility in the live birth group was higher than that in the non-live birth group,and the proportion of secondary infertility was lower than that of the non-live birth group;Age,duration of infertility,BMI,LH,T,HOMA-IR and duration of COH were all lower than those in the non-live birth group;The top quality embyros rate,the number of oocytes retrieved and the numbers of transplantable embryos were higher than those in the non-live birth group.Those differences were statistical significance(P<0.05);There was no statistical difference in FSH,E2,AMH,AFC,and total dose of Gn(P≥0.05).2.2.Comparing the ART outcome of IVF/ICSI fresh cycle and the cumulative live birth rate of the first stimulation cycle in PCOS patients with different BMI intervals: According to BMI,PCOS patients were divided into two groups(normal weight group: 18.5kg/m≤BMI<24kg/m2;Overweight/Obesity group: BMI≥24kg/m2).With age adjustment,we found that FSH,number of oocytes retrieved and transplantable embryos of normal weight group were higher than those of the overweight/obesity group,and the HOMA-IR was lower than that in the overweight/obesity group(P<0.05).There was no statistical difference in top quality embyros rate,the clinical pregnancy rate,abortion rate and live birth rate of fresh cycle and cumulative live birth rate of the first stimulation cycle in the two groups(P≥0.05).2.3.Logistic regression analysis showed: Age,BMI and the number of retrived oocytes were the risk factors affecting the cumulative live birth rate of the first stimulation cycle of PCOS patients.Conclusions(1)Young PCOS patients can get more embyros than those tubal infertility peers.Its CLBR of their first stimulation cycle is more promising.(2)Elderly PCOS patients can get more embyros than those tubal infertility peers.However,the oocyte quality of older patients decreased,and its CLBR of the first stimulation cycle is lower than tubal infertility patients of same age.(3)Patients with PCOS who are younger,have a shorter duration of infertility,and have a lower BMI have a higher live birth rates. |
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