Age related endocrine patterns observed in polycystic ovary syndrome patients vs. ovulatory controls: descriptive data from a university based infertility center

ABSTRACT Objective To compare serum anti-Müllerian hormone (AMH) and other endocrine parameters between patients diagnosed with polycystic ovary syndrome (PCOS) and age-matched ovulatory women. Materials and methods AMH, DHEAS, FSH, LH, PRL, TSH and total testosterone (TT) were prospectively measured in oligo-ovulatory PCOS patients (n = 595) and in ovulatory non-PCOS women (n = 157) referred to a tertiary infertility center. Mean BMI was similar across the two study populations and there were no smokers in the sample. Patients in both groups were further classified into three categories by age: < 25 yrs, 25-34 yrs, and ≥ 35 yrs. Selected clinical and demographic characteristics were tabulated for each group. Results Serum AMH was significantly higher among PCOS patients compared to non-PCOS controls in the non-stratified sample (7.54 ± 5.8 vs. 2.49 ± 2.0 ng/mL, respectively; p < 0.0001), while serum FSH, DHEAS, TSH and prolactin were similar for both groups (p > 0.05). As expected, mean (total) testosterone levels were notably different between PCOS vs. non-PCOS controls (0.84 ± 0.76 vs. 0.43 ± 0.38 ng/mL, respectively; p < 0.001), and mean AMH level was significantly lower in the oldest age category (> 35 yrs) compared to both younger control groups (p < 0.0001). Both DHEAS and total testosterone decreased with age among PCOS patients, although mean serum DHEAS for women age > 35 yrs was significantly lower than DHEAS measured in younger women with PCOS (p < 0.02). For PCOS patients, AMH remained relatively stable irrespective of age. Conclusion Although AMH can serve as a satisfactory marker of ovarian reserve, for PCOS patients the expected decline in AMH associated with reproductive aging appears attenuated despite ovarian senescence. In contrast, mean DHEAS levels were markedly lower among older PCOS women (> 35 yrs) compared to younger PCOS patients.

摘要
研究目的：对比多囊卵巢综合征（polycystic ovary syndrome, PCOS）患者与年龄匹配的排卵女性的血清抗缪勒管激素（anti-Müllerian hormone, AMH）及其他内分泌参数。
材料与方法：前瞻性检测了就诊于三级不孕中心的595例少排卵型PCOS患者与157例排卵型非PCOS女性的AMH、脱氢表雄酮硫酸盐（DHEAS）、卵泡刺激素（FSH）、黄体生成素（LH）、催乳素（PRL）、促甲状腺激素（TSH）及总睾酮（total testosterone, TT）水平。两组研究人群的平均体质量指数（BMI）无显著差异，且所有受试者均无吸烟史。随后按年龄将两组受试者进一步分为3个亚组：<25岁、25~34岁及≥35岁，对各组的临床及人口统计学特征进行制表汇总。
结果：在未分层的整体样本中，PCOS患者的血清AMH水平显著高于非PCOS对照组（7.54±5.8 ng/mL vs 2.49±2.0 ng/mL，P<0.0001）；两组的血清FSH、DHEAS、TSH及催乳素水平均无显著差异（P>0.05）。如预期所示，PCOS组与非PCOS对照组的平均总睾酮水平存在显著差异（0.84±0.76 ng/mL vs 0.43±0.38 ng/mL，P<0.001）；且≥35岁年龄亚组的平均AMH水平显著低于两个较年轻的对照组亚组（P<0.0001）。在PCOS患者中，DHEAS及总睾酮水平均随年龄增长而降低，其中≥35岁PCOS女性的血清DHEAS水平显著低于较年轻的PCOS患者（P<0.02）。而PCOS患者的AMH水平在各年龄亚组中均保持相对稳定。
结论：尽管AMH可作为卵巢储备的可靠标志物，但PCOS患者中，尽管存在卵巢衰老，与生殖衰老相关的AMH水平预期下降现象却被显著减弱。与之相反，≥35岁的老年PCOS女性的平均DHEAS水平显著低于较年轻的PCOS患者。