OBJECTIVE

目的

Current evidence on the potential association of age at menarche with ovarian reserve is inconclusive, and studies are limited. We aimed to investigate the association, if any, between age at menarche and markers of ovarian reserve [day-3 follicular stimulating hormone (D3-FSH) and anti-Mullerian hormone (AMH)] among women seeking IUI+OI treatments.

目前关于月经初潮年龄与卵巢储备之间潜在关联的证据尚不确定，研究也很有限。我们旨在研究接受诱导排卵宫腔内人工授精助孕（IUI+OI）的女性，其月经初潮年龄与卵巢储备标志物月经第三天的血清卵泡刺激素值（D3-FSH）、抗苗勒氏管值（AMH）之间的关系。

MATERIALS AND METHODS

材料与方法

Design: Retrospective cohort.

Setting: Academic fertility center.

Patients: 3,974 women seeking IUI+OI treatments.

Intervention: Age at menarche (years).

Outcomes: D3-FSH (IU/L) and AMH (ng/ml) as assessed at the time of fertility evaluation.

Statistics: Beta coefficients (β) and their respective 95% confidence intervals (95%CI) were calculated using linear regression, adjusted for potential confounders [age at fertility evaluation, body mass index, race, and polycystic ovarian syndrome (PCOS) diagnosis]. Age at menarche was analyzed as a linear variable and in quartiles (Q1-Q4). A sub-analysis was performed stratified by PCOS diagnosis.

设计：回顾性队列研究。

中心：学术生育中心。

患者：3974名接受IUI+OI助孕女性。

干预：初潮年龄（岁）。

结果：在助孕评估时采用D3-FSH（IU/L）和AMH（ng/ml）。

统计：使用线性回归计算β系数（β）及各自的95%置信区间（95%CI），并根据潜在的混杂因素[助孕时年龄、体重指数、种族和多囊卵巢综合征（PCOS）诊断]进行调整。月经初潮年龄作为线性变量和四分位数进行分析（Q1-Q4）。根据多囊卵巢综合征的诊断进行亚分析。

RESULTS

结果

Mean±SD age at menarche, D3-FSH, and AMH were 12.8±1.6 years, 7.7±4.5 IU/L, and 4.2±4.7 ng/ml, respectively. Quartiles of age at menarche were as follows: Q1(<12), Q2(12-13), Q3(13-14), and Q4(≥14 years).

Overall, neither D3-FSH (Q1:7.6±4.4, Q2: 7.7±4.9, Q3: 7.6±4.0, and Q4: 7.6±4.6 IU/L, p=0.988) nor AMH levels (Q1: 4.1±4.9, Q2: 4.3±4.4, Q3: 4.2±4.6, and Q4: 4.3±4.8 ng/ml, p=0.754) differed between menarche age quartiles.

Similarly, after adjustment, we noted no significant associations of either D3-FSH or AMH with age at menarche [adjβ(95%CI): D3-FSH: -0.04(-0.13, 0.06); AMH: -0.01(-0.13, 0.11); age at menarche as linear; and D3-FSH: -0.02(-0.46, 0.42), -0.19(-0.63, 0.25), -0.19(-0.64, 0.26); AMH: 0.01(-0.52, 0.55), -0.09(-0.63, 0.44), -0.17(-0.72, 0.38); for Q2, Q3, and Q4 vs. Q1, respectively].

No significant associations of age at menarche with markers of ovarian reserve were noted among the non-PCOS strata [adjβ(95%CI): D3-FSH: -0.06(-0.16, 0.05); AMH: 0.02(-0.09, 0.13); age at menarche as linear; D3-FSH: -0.01(-0.50, 0.49), -0.31(-0.80, 0.19), -0.23(-0.74, 0.27); AMH: 0.46(-0.03, 0.94), 0.06(-0.43, 0.55), 0.12(-0.38, 0.63); for Q2-4 vs. Q1, respectively].

Within the PCOS strata, there were no significant associations of age at menarche with D3-FSH and AMH, except for lower AMH in Q2 compared to Q1 [adjβ(95%CI) D3-FSH: 0.05(-0.05, 0.16); AMH: -0.20(-0.69, 0.28), age at menarche as linear; D3-FSH: -0.11(-0.66, 0.43), 0.43(-0.12, 0.98), 0.03(-0.53, 0.58); AMH: -2.49(-4.84, -0.14), -1.03(-3.38, 1.32), -2.00(-4.45, 0.45); for Q2-4 vs. Q1, respectively].

初潮年龄、D3-FSH和AMH三者均数±标准差分别为：12.8±1.6岁、7.7±4.5IU/L、4.2±4.7ng/ml。月经初潮年龄的四分位数如下：Q1（＜12）、Q2（12-13）、Q3（13-14）和Q4（≥14岁）。

总而言之，月经初潮年龄时四分位数之间的D3-FSH（Q1：7.6±4.4，Q2：7.7±4.9，Q3：7.6±4.0，Q4：7.6±4.6IU/L，P=0.988）、AMH水平（Q1：4.1±4.9，Q2：4.3±4.4，Q3：4.2±4.6，Q4：4.3±4.8ng/mL，P=0.754）均不存在差异。

同样，在调整后，我们注意到D3-FSH或AMH与初潮年龄都没有显著相关性[adjβ（95%CI）：D3-FSH：-0.04（-0.13，0.06）；AMH：-0.01（-0.13，0.11）；月经初潮年龄为线性变量时；Q2、Q3、Q4的D3-FSH分别为：-0.02（-0.46，0.42），-0.19（-0.63，0.25），-0.119（-0.64，0.26）；AMH分别为：0.01（-0.52，0.55），-0.09（-0.63，0.44），-0.17（-0.72，0.38）；Q2、Q3和Q4分别与Q1相比]。

在非多囊卵巢综合征患者中，月经初潮年龄与卵巢储备标志物也没有显著相关性[adjβ（95%CI）：D3-FSH：-0.06（-0.16，0.05）；AMH：0.02（-0.09，0.13）；月经初潮年龄为线性变量时；Q2、Q3、Q4的D3-FSH分别为：-0.01（-0.50，0.49），-0.31（-0.80，0.19），-0.23（-0.74，0.27）；AMH分别为：0.46（-0.03，0.94），0.06（-0.43，0.55），0.12（-0.38，0.63）；Q2-4分别与Q1相比]。

在PCOS患者中，初潮年龄与D3-FSH和AMH没有显著关联，除了Q2的AMH比Q1低[adjβ（95%CI）D3-FSH：0.05（-0.05，0.16）；AMH：-0.20（-0.69，0.28），月经初潮年龄为线性线性变量时；Q2、Q3、Q4的D3-FSH分别为：-0.11（-0.66，0.43），0.43（-0.12，0.98），0.03（-0.53，0.58）；AMH分别为：-2.49（-4.84，-0.14），-1.03（-3.38，1.32），-2.00（-4.45，0.45）；Q2-4分别与Q1相比]。

CONCLUSIONS

结论

We found no major associations between age at menarche and markers of ovarian reserve (D3-FSH and AMH) among patients undergoing ΙUI treatments, regardless of PCOS diagnosis.

我们发现，在接受IUI治疗的患者中，无论是否被诊断为多囊卵巢综合征，初潮年龄与卵巢储备标志物（D3-FSH和AMH）之间没有明显的关联。

IMPACT STATEMENT

影响声明

Compared to prior smaller conflicting studies, our findings do not suggest a significant association of age at menarche with ovarian reserve later in a woman’s life. This information can be a valuable counseling tool for patients seeking fertility treatments and/or planning to achieve their family building goals.

与之前较小规模的矛盾研究相比，我们的研究结果并未显示初潮年龄与女性后期卵巢储备之间存在显著关联。这一信息对于寻求生育治疗或计划实现家庭建设目标的患者来说，可以作为有价值的咨询工具。

文章来源：

AGE AT MENARCHE IS NOT ASSOCIATED WITH OVARIAN RESERVE MARKERS AS ASSESSED AT THE TIME OF EVALUATION FOR FERTILITY TREATMENTS Cherouveim, Panagiotis et al.Fertility and Sterility, Volume 120, Issue 4, e318