青春期服用高劑量雌激素易導致日後懷孕率下降

青春期服用高劑量雌激素易導致日後懷孕率下降

http://jcem.endojournals.org/content/96/4/1098.full

Fertility and Ovarian Function in High-Dose Estrogen-Treated Tall Women

1. A. E. J. Hendriks, 
2. J. S. E. Laven, 
3. O. Valkenburg, 
4. S. Lie Fong, 
5. B. C. J. M. Fauser,
6. M. A. J. de Ridder, 
7. F. H. de Jong, 
8. J. A. Visser, 
9. A. M. van Ginneken, 
10. A. M. Boot and
11. S. L. S. Drop

-Author Affiliations

1. Department of Pediatrics (A.E.J.H., S.L.S.D.), Division of Endocrinology, Erasmus Medical Center-Sophia, 3015 GJ Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., O.V., S.L.F.), Division of Reproductive Medicine and Departments of Biostatistics (M.A.J.d.R.), Internal Medicine (F.H.d.J., J.A.V.), and Information Technology (A.M.v.G.), Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Reproductive Medicine and Gynecology (B.C.J.M.F.), University Medical Center, 3584 CX Utrecht, The Netherlands; and Department of Pediatric Endocrinology (A.M.B.), University Medical Center Groningen, 9713 GZ Groningen, The Netherlands

1. Address all correspondence and requests for reprints to: A. E. J. Hendriks, M.D., Department of Pediatrics, Division of Endocrinology, Erasmus Medical Center-Sophia, Room Sp3435, Dr. Molenwaterplein 60, 3015 GJ Rotterdam, The Netherlands. E-mail: a.e.j.hendriks@erasmusmc.nl.

 

Next Section

Abstract

Background/Objective:High-dose estrogen treatment to reduce final height of tall girls has been shown to interfere with fertility. Ovarian function has not been studied. We therefore evaluated fertility and ovarian function in tall women who did or did not receive such treatment in adolescence.

Methods:This was a retrospective cohort study of 413 tall women aged 23–48 yr, of whom 239 women had been treated. A separate group of 126 fertile, normoovulatory volunteers aged 22–47 yr served as controls.

Results:Fertility was assessed in 285 tall women (157 treated, 128 untreated) who had attempted to conceive. After adjustment for age, treated women were at increased risk of experiencing subfertility [odds ratio (OR) 2.29, 95% confidence interval (CI) 1.38–3.81] and receiving infertility treatments (OR 3.44, 95% CI 1.76–6.73). Moreover, fecundity was notably affected because treated women had significantly reduced odds of achieving at least one live birth (OR 0.26, 95% CI 0.13–0.52). Remarkably, duration of treatment was correlated with time to pregnancy (r = 0.23, P= 0.008). Ovarian function was assessed in 174 tall women (119 treated, 55 untreated). Thirty-nine women (23%) exhibited a hypergonadotropic profile. After adjusting for age category, treated women had significantly higher odds of being diagnosed with imminent ovarian failure (OR 2.83, 95% CI 1.04–7.68). Serum FSH levels in these women were significantly increased, whereas antral follicle counts and serum anti-Müllerian hormone levels were decreased.

Conclusion:High-dose estrogen-treated tall women are at risk of subfertility in later life. Their fecundity is significantly reduced. Treated women exhibit signs of accelerated ovarian aging with concomitant follicle pool depletion, which may be the basis of the observed subfertility.

Table 2.

Fertility outcome in treated and untreated women

Fertility	Treated	Untreated	OR (95% CI)a
n	239	174
Attempt to conceive	157 (65.7%)	128 (73.6%)	0.71 (0.43–1.16)
Conceive a pregnancy	129 (82.2%)b	122 (95.3%)b	0.22 (0.09–0.55)c
Doctor's visit for fertility	68 (43.3%)b	32 (25.0%)b	2.29 (1.38–3.81)c
Infertility treatments	44 (28.0%)b	13 (10.2%)b	3.44 (1.76–6.73)c
Achieve live birth	110 (70.5%)b	113 (89.7%)b	0.26 (0.13–0.52)c