目的:PCOS和肥胖女性在6个月的生活方式干预后排卵恢复与内分泌和代谢参数的差异变化相关(体重,胰岛素抵抗,抗苗勒管激素(AMH),和雄激素)与保持无排卵状态的PCOS女性相比?
结论:对PCOS和肥胖女性进行6个月的生活方式干预后,排卵恢复与血清11β-羟基雄烯二酮(11OHA4)浓度的变化有关。
背景:生活方式干预已被证明可降低PCOS女性的临床和生化高雄激素血症。体重减轻5-10%可能会逆转无排卵状态,从而提高自然受胎率。然而,目前尚不清楚某些PCOS患者在减重后仍保持无排卵状态而另一些患者恢复排卵的潜在机制.基线时的生殖特征以及通过生活方式干预的内分泌和代谢特征的更大程度的变化可能对排卵反应至关重要。
方法:我们使用来自早期随机对照试验(RCT)的数据和样本,该研究研究了不孕症治疗前6个月的生活方式干预对肥胖女性活产率的影响。在2009年至2012年之间,共有577名肥胖女性(BMI>29kg/m2)被随机分配。被分配到原始RCT干预组的无排卵性PCOS妇女(n=95)被纳入当前分析。
方法:我们根据以下标准将女性定义为已恢复排卵(RO):自然妊娠;或分配给期待管理;或在自然周期中的IUI作为生活方式干预后的治疗策略。使用液相色谱串联质谱法测量类固醇激素。使用调整基线测量值以及组和时间之间相互作用的广义估计方程来检查RO(n=34)和持续无排卵女性之间内分泌和代谢参数变化的差异(RO-,n=61)在干预后3和6个月。
结果:在基线时,RO+组平均±SD年龄为27.5±3.6岁,RO-组平均27.9±4.1岁(P=0.65),平均±SD重量为101.2±9.5kg和105.0±14.6kg,分别为(P=0.13)。基线AMH浓度显示RO+和RO-女性之间存在显着差异(中位数和四分位距[IQR]4.7[3.2;8.3]与7.2[5.3;10.8]ng/ml,分别)。两组的基线雄激素浓度没有差异。在生活方式干预期间和之后,两组均显示体重减轻;RO+和RO组之间11OHA4的变化有显着差异(交互作用的P值=0.03).SHBG也有类似的趋势(相互作用P值=0.07),和DHEA-S(相互作用P值=0.06),在前3个月观察到最明显的差异。其他参数,如AMH和FAI,随着时间的推移而下降,但两组之间没有差异。
结论:在生活方式计划结束时,没有使用高分辨率经阴道超声检查来确认排卵状态。小样本大小可能限制结果的鲁棒性。
结论:生活方式干预期间和之后,雄激素浓度降低与排卵周期的恢复有关。如果我们的结果在其他研究中得到证实,可以在生活方式干预期间监测雄激素浓度,从而为患有PCOS和肥胖的无排卵女性的复排卵时间提供个性化建议.
背景:这项研究得到了ZonMw的资助,荷兰卫生研究与发展组织(50-50110-96-518)。UMCG妇产科获得了FerringPharmaceuticalsBV的无限制教育补助金,荷兰。A.H.报告了由Ferring制药公司开发的生活方式AppMyFertiCoach的开发和实施咨询。所有其他作者都没有冲突要声明。
背景:LIFEstyleRCT在荷兰的审判登记处(NTR1530)注册。
OBJECTIVE: Is resumption of ovulation after a 6-month lifestyle intervention in women with PCOS and obesity associated with differential changes in endocrine and metabolic parameters (weight, insulin resistance, anti-Müllerian hormone (AMH), and androgens) compared to women with PCOS who remained anovulatory?
CONCLUSIONS: Resumption of ovulation after a 6-month lifestyle intervention in women with PCOS and obesity is associated with changes in serum 11β-hydroxyandrostenedione (11OHA4) concentrations.
BACKGROUND: Lifestyle interventions have been shown to reduce clinical and biochemical hyperandrogenism in women with PCOS. Weight loss of 5-10% may reverse anovulatory status, thereby increasing natural conception rates. However, the mechanisms underlying why some women with PCOS remain anovulatory and others resume ovulation after weight loss are unclear. Reproductive characteristics at baseline and a greater degree of change in endocrine and metabolic features with lifestyle intervention may be crucial for ovulatory response.
METHODS: We used data and samples originating from an earlier randomized controlled trial (RCT), which examined the efficacy of a 6-month lifestyle intervention prior to infertility treatment compared to prompt infertility treatment on live birth rate in women with obesity. A total of 577 women with obesity (BMI > 29 kg/m2) were randomized between 2009 and 2012. Anovulatory women with PCOS who were allocated to the intervention arm of the original RCT (n = 95) were included in the current analysis.
METHODS: We defined women as having resumed ovulation (RO+) based on the following criteria: spontaneous pregnancy; or assignment to expectant management; or IUI in natural cycles as the treatment strategy after lifestyle intervention. Steroid hormones were measured using liquid chromatography tandem mass spectrometry. Generalized estimating equations with adjustment for baseline measures and interaction between group and time was used to examine differences in changes of endocrine and metabolic parameters between RO+ (n = 34) and persistently anovulatory women (RO-, n = 61) at 3 and 6 months after intervention.
RESULTS: At baseline, the mean ± SD age was 27.5 ± 3.6 years in the RO+ group and 27.9 ± 4.1 years in the RO- group (P = 0.65), and the mean ± SD weights were 101.2 ± 9.5 kg and 105.0 ± 14.6 kg, respectively (P = 0.13). Baseline AMH concentrations showed significant differences between RO+ and RO- women (median and interquartile range [IQR] 4.7 [3.2; 8.3] versus 7.2 [5.3; 10.8] ng/ml, respectively). Baseline androgen concentrations did not differ between the two groups. During and after lifestyle intervention, both groups showed weight loss; changes in 11OHA4 were significantly different between the RO+ and RO groups (P-value for interaction = 0.03). There was a similar trend for SHBG (interaction P-value = 0.07), and DHEA-S (interaction P-value = 0.06), with the most pronounced differences observed in the first 3 months. Other parameters, such as AMH and FAI, decreased over time but with no difference between the groups.
CONCLUSIONS: No high-resolution transvaginal ultrasonography was used to confirm ovulatory status at the end of the lifestyle program. The small sample size may limit the robustness of the results.
CONCLUSIONS: Reduction of androgen concentrations during and after lifestyle intervention is associated with recovery of ovulatory cycles. If our results are confirmed in other studies, androgen concentrations could be monitored during lifestyle intervention to provide individualized recommendations on the timing of resumption of ovulation in anovulatory women with PCOS and obesity.
BACKGROUND: The study was supported by a grant from ZonMw, the Dutch Organization for Health Research and Development (50-50110-96-518). The Department of Obstetrics and Gynecology of the UMCG received an unrestricted educational grant from Ferring Pharmaceuticals BV, The Netherlands. A.H. reports consultancy for the development and implementation of a lifestyle App MyFertiCoach developed by Ferring Pharmaceutical Company. All other authors have no conflicts to declare.
BACKGROUND: The LIFEstyle RCT was registered at the Dutch trial registry (NTR 1530).