The Role Of Different LH/FSH Ratios On The Characteristics And Reproductive Outcomes In Chinese PCOS Women

Objective:To determine the characteristics of biometric features,circulating sex steroids and gonadotropins,metabolism profiles,PCOS phenotypes,clinical classifications of traditional Chinese and western medicine and reproductive outcomes by different ratios of baseline LH/FSH,so as to explore the role of different baseline LH/FSH ratios on the baseline characteristics and reproductive outcomes in Chinese PCOS women.Method:According to the diagnostic criteria concluded by the Japanese Society of Obstetrics and Gynecology(JSOG)and the Group of Endocrinology,Obstetrical and Gynecological Society,Chinese Medical Association,956 participants who satisfied the inclusion criteria and had complete data were divided into four groups:LH/FSH<1,1≤LH/FSH<2,2≤LH/FSH<3 and LH/FSH≥3.Analysis of variance(ANOVA)tests and Chi-square/Fisher’exact test were used,as appropriate,to determine differences across these groups.Pearson’s correlation was used for baseline characteristic and LH,FSH and LH/FSH.A linear regression model was performed to explore the factor of LH/FSH by backwards method.Logistic regression models were used to explore the association between baseline LH/FSH and clinical reproductive outcomes.The associations of baseline LH/FSH and the cumulative incidence of clinical reproductive outcomes were analyzed by Cox proportional hazard regression model.Meanwhile,AUC was used for assessing the performance of model of LH/FSH,HA and PCO on predicting reproductive outcomes.Analyses were performed in SAS version9.4.Result:1.In our analytic sample,the breakdown into four groups for the 956participants was as follows:222 participants with LH/FSH<1.0(23.2%),408participants with 1≤LH/FSH<2(42.7%),231 participants with 2≤LH/FSH<3(24.2%),95 participants with LH/FSH≥3(9.9%).There were significant differences in BMI,weight,WHR,waist,hip,E2,P,TT,SHBG,FAI,AMH,HDL-C,FINS,HOMA-IR,TG and the prevalence of metabolic syndrome among four levels of baseline LH/FSH.2.Among PCOS women with LH/FSH<1.0,the number of women belonging to the PCO+OA classification was the highest(P=34.3%).While,for PCOS women with 1≤LH/FSH<2,2≤LH/FSH<3 and LH/FSH≥3,the number of women belonging to the HA+PCO+OA classification were the highest,accounting for 55.7%,65.8%and 72.8%.There were significant differences in menstrual cycle,the number of menstrual cycles per year and the prevalence of amenorrhea and PCO among four levels of baseline LH/FSH.Among PCOS women with LH/FSH<1,1≤LH/FSH<2 and LH/FSH≥3,the number of women belonging to the kidney deficiency and liver stagnation classification were the highest,accounting for 45.0%,44.9%and 36.9%.While,for PCOS women with 2≤LH/FSH<3,the number of women belonging to the spleen deficiency and phlegm dampness classification were the highest(36.8%).3.Baseline LH/FSH level were negatively correlated with age,BMI and actively correlated with TT,E2 and AMH.Pearson’s correlation was indicated that baseline LH/FSH level were actively correlated with FT,while linear regression model got the contradictory result.4.Women with elevated LH/FSH ratio were associated with lower ovulation(LH/FSH≥1 OR=0.42,95%CI,0.26-0.68;LH/FSH≥2 OR=0.32,95%CI,0.20-0.54;LH/FSH≥3 OR=0.40,95%CI 0.21-0.74)when compared with LH/FSH<1.The association was held after adjustment for treatment with or without the confounding factors.Women with LH/FSH ratio≥1 likely needed longer duration(χ~2=16.10,P<0.001)to achieve first ovulation than women with LH/FSH ratio<1.Although no association between LH/FSH ratio and biochemical pregnancy,women with 1≤LH/FSH<2 were associated with higher clinical pregnancy(OR=1.71;95%CI,1.09-2.67)and live birth(OR=1.73;95%CI,1.09-2.75)compared to women with LH/FSH<1.Women with 2≤LH/FSH<3 were also associated with lower miscarriage rate(OR=0.38;95%CI,0.16-0.93).5.After ovulation induction,unovulatory PCOS women had significantly higher LH/FSH than ovulatory PCOS women in PCO+OA classification(T=3.04,P=0.003).While no significant difference was observed in other western medicine classifications.Unovulatory PCOS women had significantly higher LH/FSH than ovulatory PCOS women in kidney deficiency and liver stagnation classification.While no significant difference was observed in other traditional Chinese medicine classifications.6.For predictive models of ovulation(AUC:0.596 vs 0.559和0.504)and miscarriage(AUC:0.550 vs 0.501和0.509),the AUC of LH/FSH were larger than HA and PCO.Conclusion:1.Baseline LH/FSH were negatively correlated with age,BMI and FT,and actively correlated with TT,E2 and AMH.2.Baseline LH/FSH was significantly associated with ovulation among PCOS women with PCO+OA classification and spleen deficiency and phlegm dampness classification.3.Elevated baseline LH/FSH in women with PCOS was associated with poor ovulatory response,but women were more likely to achieve clinical pregnancy and live birth than women with normal LH/FSH.Compare to HA and PCO,LH/FSH have better performance on predicting ovulation and miscarriage.