Objective: To exlplore the association between the baseline luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio of polycystic ovary syndrome (PCOS) and in vitro fertilisation-embryo transfer outcomes. Methods: This was a retrospective cohort study. A total of 2 868 PCOS patients were enrolled, all of the participants were patients in The First Affiliated Hospital of Anhui Medical University Hospital from October 2015 to October 2021. Propensity score matching (1∶2.5) was conducted to regulate the non-random allocation of patients. Data were extracted from the hospital's medical records. Patients with baseline LH/FSH ratio>2 were deemed as study group, patients with baseline LH/FSH ratio≤2 were deemed as control group. Single factor analysis was applied to compare the differences of pregnancy outcomes between two groups. Results: After propensity score matching (1∶2.5), there were no statistically significant differences in baseline data between the two groups (all P>0.05), indicating that the data were comparable. In the study group, the total dose of gonadotropin (Gn) and duration of Gn were lower than those of the control group (t=4.989, P<0.001; t=3.267, P=0.001), the rate of in vitro maturation was higher than that of the control group (χ2=4.938, P=0.026), the number of retrieved oocytes and cleavage were higher than those of the control group (t=-2.305, P=0.021; t=-2.816, P=0.005), but there were no differences in the number and rate of high-quality embryos between the two groups (t=-1.636, P=0.102; t=-0.123, P=0.902). The incidence of moderate to severe ovarian hyperstimulation syndrome in the study group was significantly higher than that in the control group (χ2=17.277, P<0.001). Regardless of fresh embryo transfer or frozen-thawed embryo transfer cycles, the incidences of gestational diabetes mellitus in the study group were higher than those in the control group (χ2=9.174, P=0.002; χ2=4.204, P=0.040) of singleton pregnancy. In the fresh embryo transfer cycle, the clinical pregnancy rate [30.30% (20/66) vs 47.75% (53/111)] and delivery rate [30.30% (20/66) vs 46.85% (52/111)] in the study group were lower than those in the control group (χ2=5.198, P=0.023; χ2=4.695, P=0.030). In the frozen-thawed embryo transfer cycle, the delivery rate in the study group was higer than that in the control group [59.41% (423/712) vs 55.04% (1 053/1 913); χ2=7.526, P=0.023]. The clinical pregnancy rate and delivery rate of fresh embryo transfer cycle in the study group were significantly lower than those of frozen-thawed embryo transfer cycle (χ2=21.308, P<0.001; χ2=20.871, P<0.001), but there were no significant differences in the control group (all P>0.05). Conclusions: PCOS patients with a higher basal LH/FSH ratio are more likely to develop moderate to severe ovarian hyperstimulation syndrome after controlled ovarian stimulation and have a higher incidence of gestational diabetes mellitus. Better pregnancy outcome could be obtained by frozen-thawed embryo transfer.
目的： 探讨体外受精-胚胎移植治疗中，多囊卵巢综合征（PCOS）患者的基础黄体生成素/卵泡刺激素（LH/FSH）比值与治疗结局之间的关系。 方法： 采用回顾性队列研究方法，根据纳入排除标准，共纳入2 868例2015年10月至2021年10月间在安徽医科大学附属第一医院生殖医学中心行体外受精-胚胎移植的PCOS患者，其中基础LH/FSH比值>2者为观察组（818例），比值≤2者作为对照组（2 050例）。采用倾向性评分匹配（1∶2.5）来调节患者的非随机分配。通过单因素分析验证基础LH/FSH比值是否与治疗结局相关。 结果： 经倾向性评分匹配（1∶2.5）后，观察组（778例）与对照组（2 024例）患者的基线数据均无显著差异（P均>0.05），具有可比性。观察组患者使用促性腺激素总量及持续时间均少于对照组（t=4.989，P<0.001；t=3.267，P=0.001），卵母细胞体外成熟率高于对照组（χ2=4.938，P=0.026），获卵数和卵裂数均高于对照组（t=-2.305，P=0.021；t=-2.816，P=0.005），但两组优质胚胎数和优质胚胎率比较均无显著差异（P均>0.05）。观察组患者的中重度卵巢过度刺激综合征发生率高于对照组（χ2=17.277，P<0.001）。无论新鲜胚胎移植还是冻融胚胎移植周期中，剔除多胎妊娠数据后，观察组患者的妊娠期糖尿病发生率仍显著高于对照组（χ2=9.174，P=0.002；χ2=4.204，P=0.040）。在新鲜胚胎移植周期中，观察组患者的临床妊娠率［分别为30.30%（20/66）、47.75%（53/111）］和分娩率［分别为30.30%（20/66）、46.85%（52/111）］均显著低于对照组（χ2=5.198，P=0.023；χ2=4.695，P=0.030）；而在冻融胚胎移植周期中，观察组的分娩率显著高于对照组［分别为59.41%（423/712）、55.04%（1 053/1 913）；χ2=7.526，P=0.023］。观察组新鲜胚胎移植周期的临床妊娠率及分娩率均显著低于冻融胚胎移植周期（χ2=21.308，P<0.001；χ2=20.871，P<0.001），对照组则均无显著差异（P均>0.05）。 结论： PCOS患者中基础LH/FSH比值较高者，促排卵后更易发生中重度卵巢过度刺激综合征，妊娠期糖尿病的发生率更高。全胚胎冷冻后行冻融胚胎移植可获得更好的妊娠结局。.