Objective To investigate the relationship and potential pathways between metal(loid)exposure and the risk of polycystic ovary syndrome(PCOS)in women of childbearing age. Methods This case-control study included 200 patients with PCOS(cases)and 896 non-PCOS controls with the age of 25-37 years.The concentrations of 29 metal(loid)s in the follicular fluid(FF)and clinical indicators in the serum were measured in all participants.Logistic regression analysis and mediation analysis were conducted to evaluate the associations between metal(loid)exposure and PCOS risk and investigate the possible roles of clinical indicators,respectively. Results Logistic regression analysis revealed an association between high copper levels in FF and increased PCOS risk(highest vs.lowest quartile:adjusted odds ratio=2.94,95%confidence interval:1.83-4.72).A high luteinizing hormone/follicle-stimulating hormone ratio and elevated levels of testosterone and anti-Müllerian hormone(AMH)were strongly associated with increased PCOS risk induced by high copper exposure.The mediation analysis indicated a mediating effect of AMH in the association between copper exposure and PCOS risk. Conclusion Copper may affect PCOS risk through the hypothalamic-pituitary-ovarian axis,mediated by AMH.Copper exposure and internal AMH levels are important indicators for early warning of PCOS development.

Objective:To investigate the effect of follicular phase long-acting gonadotropin-releasing hormone (GnRH) agonist long protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes of patients with endometriosis (EMS). Methods:This retrospective cohort study was carried out from July 1st 2015 to June 30th 2019 and enrolled 383 young patients with EMS who underwent the first IVF/ICSI. According to the controlled ovarian hyperstimulation protocols, patients were classified into three groups: follicular phase long-acting GnRH agonist long protocol group (group A), short-acting GnRH agonist long protocol group (group B) and GnRH antagonist protocol group (group C). The clinical outcomes of IVF/ICSI were compared among the groups by using univariate and multivariate logistic regression analyses.Results:The patients with EMS in group A had significantly higher duration of stimulation and total dosage of gonadotrophin (Gn) used [11 (9,13) d, 2700 (2250, 3200) IU] than those in group B and group C [9 (8,10) d, 1875 (1575, 2250) IU; 8 (8,9) d, 1800 (1425, 2250) IU] (all P<0.001). Serum levels of luteinizing hormone (LH) [0.64 (0.35, 0.99) IU/L vs. 1.78 (1.42, 2.05) IU/L vs. 5.00 (3.63, 6.46) IU/L; 0.89 (0.37, 1.33) IU/L vs. 2.48 (1.76, 3.25) IU/L vs. 2.46 (1.66, 3.67) IU/L] and estradiol [6.70 (5.00,16.90) μg/L vs. 7.93 (6.50, 7.93) μg/L vs. 34.05 (22.99, 45.58) μg/L; 1.82 (1.11, 2.75) μg/L vs. 2.97 (2.16,4.24) μg/L vs. 2.03 (1.49, 2.96) μg/L) on Gn initiation day and human chorionic gonadotropin (hCG) injection day were significantly lower in group A (all P<0.001). Group A had significantly higher clinical pregnancy rate [76.53% (75/98)], implantation rate [54.10% (99/183)] and live birth rate [66.33% (65/98)] compared with those in group B and group C [61.39% (62/101) and 54.39% (31/57), P=0.010; 42.63% (81/190), and 40.19% (43/107), P=0.029; 53.47% (54/101), and 47.37% (27/57), P=0.046]. Conclusion:Follicular phase long-acting GnRH agonist protocol could improve IVF/ICSI outcomes of patients with EMS compared with short-acting GnRH agonist long protocol and GnRH antagonist protocol.

Objective:To investigate the effect of follicular phase long-acting gonadotropin-releasing hormone (GnRH) agonist long protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes of patients with endometriosis (EMS). Methods:This retrospective cohort study was carried out from July 1st 2015 to June 30th 2019 and enrolled 383 young patients with EMS who underwent the first IVF/ICSI. According to the controlled ovarian hyperstimulation protocols, patients were classified into three groups: follicular phase long-acting GnRH agonist long protocol group (group A), short-acting GnRH agonist long protocol group (group B) and GnRH antagonist protocol group (group C). The clinical outcomes of IVF/ICSI were compared among the groups by using univariate and multivariate logistic regression analyses.Results:The patients with EMS in group A had significantly higher duration of stimulation and total dosage of gonadotrophin (Gn) used [11 (9,13) d, 2700 (2250, 3200) IU] than those in group B and group C [9 (8,10) d, 1875 (1575, 2250) IU; 8 (8,9) d, 1800 (1425, 2250) IU] (all P<0.001). Serum levels of luteinizing hormone (LH) [0.64 (0.35, 0.99) IU/L vs. 1.78 (1.42, 2.05) IU/L vs. 5.00 (3.63, 6.46) IU/L; 0.89 (0.37, 1.33) IU/L vs. 2.48 (1.76, 3.25) IU/L vs. 2.46 (1.66, 3.67) IU/L] and estradiol [6.70 (5.00,16.90) μg/L vs. 7.93 (6.50, 7.93) μg/L vs. 34.05 (22.99, 45.58) μg/L; 1.82 (1.11, 2.75) μg/L vs. 2.97 (2.16,4.24) μg/L vs. 2.03 (1.49, 2.96) μg/L) on Gn initiation day and human chorionic gonadotropin (hCG) injection day were significantly lower in group A (all P<0.001). Group A had significantly higher clinical pregnancy rate [76.53% (75/98)], implantation rate [54.10% (99/183)] and live birth rate [66.33% (65/98)] compared with those in group B and group C [61.39% (62/101) and 54.39% (31/57), P=0.010; 42.63% (81/190), and 40.19% (43/107), P=0.029; 53.47% (54/101), and 47.37% (27/57), P=0.046]. Conclusion:Follicular phase long-acting GnRH agonist protocol could improve IVF/ICSI outcomes of patients with EMS compared with short-acting GnRH agonist long protocol and GnRH antagonist protocol.