患有多囊卵巢综合症的女性可以减轻生育压力

诸平

据澳大利亚昆士兰大学（University of Queensland简称UQ, Brisbane, Queensland, Australia）2023年12月13日提供的消息，昆士兰大学的研究人员发现，患有多囊卵巢综合症 (polycystic ovary syndrome简称PCOS) 的女性对生育治疗反应良好，并且出生率与未患有PCOS的女性相同。相关研究结果于2023年12月12日已经在《生育与不育》（Fertility and Sterility）杂志网站发表——Katrina M. Moss, Jenny Doust, Tessa Copp, Hayden Homer, Gita D. Mishra. Fertility treatment pathways and births for women with and without polycystic ovary syndrome—a retrospective population linked data study. Fertility and Sterility, 2023. DOI: 10.1016/j.fertnstert.2023.11.008. Available online 12 December 2023. https://www.sciencedirect.com/science/article/abs/pii/S0015028223019970?via%3Dihub

参与此项研究的除了来自昆士兰大学的研究人员之外，还有来自澳大利亚悉尼大学（The University of Sydney, Sydney, New South Wales, Australia）、澳大利亚昆士兰生育小组（Queensland Fertility Group, Brisbane, Queensland, Australia）的研究人员。

上述研究论文的第一作者也是通讯作者昆士兰大学公共卫生学院（ UQ’s School of Public Health ）的卡特里娜·莫斯博士（Dr Katrina Moss ）表示，这一发现应该可以让那些担心自己生育能力的PCOS女性感到安心。

卡特里娜·莫斯博士说：“我们研究了1109名正在接受生育治疗的女性，发现患有和不患有PCOS的女性以及接受不同治疗途径的女性之间的生育情况没有差异。更多患有PCOS的女性接受了生育治疗，这一比例为38%，而未患有PCOS的女性为13%，但出生率相当，因此患有PCOS的女性并没有处于不利地位。”

大约十分之一的澳大利亚女性患PCOS，会导致排卵不规律或不排卵，从而难以怀孕。临床实践指南建议对PCOS相关不孕症采取阶梯式治疗——诱导排卵 (ovulation induction简称OI)，然后是宫内人工授精 ( intrauterine insemination简称IUI)，最后是试管受精（in-vitro fertilization简称IVF）。

卡特里娜·莫斯博士说：“根据我们的分析，大多数患有PCOS的女性都遵循推荐的治疗途径。71%的PCOS女性开始出现OI，而未患PCOS的女性中这一比例只有36%，而且患有PCOS的女性很少进行IVF。像OI这样的非侵入性治疗非常有效，这是积极的，从这种治疗开始，如果需要的话，再进行其他治疗并没有什么不利之处，这表明临床实践指南对大多数女性都很有效。”

昆士兰大学公共卫生学院的珍妮·杜斯特教授（Professor Jenny Doust）表示，这些发现意味着全科医生可以让患有PCOS的女性放心，她们生孩子的机会与其他人没有什么差别。

“然而，这可能是因为患有PCOS的女性更有可能更早开始生育治疗，即31岁左右，而没有 PCOS的女性则在34岁左右开始生育治疗，而年龄是成功的关键因素，”珍妮·杜斯特教授说。

“我们还发现，需要接受宫内人工授精（intra-uterine insemination简称IUI）和体外受精（in vitro fertilization简称IVF）等更具侵入性治疗的女性更有可能出现其他生殖缺陷，如子宫内膜异位症、肥胖或年龄较高。临床医生和患者在选择治疗途径时应考虑这些因素，因为让女性尽早接受最有效的治疗非常重要。”

该研究是澳大利亚妇女健康纵向研究（Australian Longitudinal Study on Women’s Health）的一部分，该研究由昆士兰大学和纽卡斯尔大学（University of Newcastle）管理。研究人员感谢澳大利亚政府卫生和老年护理部（Australian Government Department of Health and Aged Care）的资助以及提供调查数据的女性。

上述介绍，仅供参考。欲了解更多信息，敬请注意浏览原文或者相关报道。

Abstract

Objective

To study the fertility treatment pathways used by women with and without polycystic ovary syndrome (PCOS) and which pathways were more likely to result in a birth.

Design

This retrospective national community-based cohort study used longitudinal self-report survey data (collected 1996–2022; aged 18–49 years) from women born in 1973–1978 who are participants in the Australian Longitudinal Study on Women’s Health. The study also used linked administrative data on fertility treatments (1996–2021).

Patients

Of the 8,463 eligible women, 1,109 accessed fertility treatment and were included.

Exposure

Polycystic ovary syndrome diagnosis was self-reported. Main outcome measure: use of ovulation induction (OI), intrauterine insemination, and/or in vitro fertilization (IVF) was established through linked administrative data. Births were self-reported.

Results

One in 10 of the eligible participants had PCOS (783/7,987, 10%) and 1 in 4 of the women who used fertility treatment had PCOS (274/1,109, 25%). Women with PCOS were 3 years younger on average at first fertility treatment (M = 31.4 years, SD = 4.18) than women without PCOS (M = 34.2 years, SD = 4.56). Seven treatment pathways were identified and use differed by PCOS status. Women with PCOS were more likely to start with OI (71%; odds ratio [OR] 4.20, 95% confidence interval [CI]: 2.91, 6.07) than women without PCOS (36%). Of the women with PCOS who started with OI, 46% required additional types of treatment. More women without PCOS ended up in IVF (72% vs. 51%). Overall, 63% (701/1,109) had an attributed birth, and in adjusted regressions births did not vary by last type of treatment (IVF: 67%, reference; intrauterine insemination: 67%, OR 0.94 95% CI: 0.56, 1.58; OI: 61%, OR 0.71, 95% CI: 0.52, 0.98), or by PCOS status (OR 1.27, 95% CI: 0.91, 1.77). By age, 74% of women under 35 years (471/639) and 49% of women 35 years or older had a birth.

Conclusion

More women with PCOS used fertility treatment but births were equivalent to women without PCOS. Most women followed clinical recommendations. Births did not differ between pathways, so there was no disadvantage in starting with less invasive treatments (although there may be financial or emotional disadvantages).