Yang Liu, Yi Gong, Hang Ge, Mengyi Zhu, Hong Yu, Jiaxing Feng, Xinyu Hu, Hui He, Jingshu Gao, Xiaoke Wu
A higher baseline ZJU index was associated with poorer reproductive outcomes in women with PMOS undergoing fertility treatment. The ZJU index may serve as a metabolic marker associated with reproductive outcomes in women with PMOS. However, its ability to predict individual reproductive outcomes and any clinically applicable threshold require further evaluation in dedicated prediction studies with external validation.
PURPOSE: The Zhejiang University (ZJU) index is a novel composite metabolic score incorporating body mass index, fasting glucose, triglycerides, and the alanine aminotransferase/aspartate aminotransferase ratio. This study aimed to evaluate whether baseline ZJU index is associated with reproductive outcomes in women with polyendocrine metabolic ovarian syndrome (PMOS) undergoing fertility treatment.
METHODS: This post-hoc analysis is based on the Polycystic Ovary Syndrome Acupuncture and Clomiphene Trial (PCOSAct). Participants were stratified into tertiles based on baseline ZJU index levels. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for ovulation, conception, clinical pregnancy, and live birth, adjusting for potential confounders. Restricted cubic spline (RCS) analyses assessed nonlinear associations, and sensitivity analyses evaluated the robustness of the findings.
RESULTS: Women in the highest ZJU tertile had significantly lower rates of ovulation, conception, clinical pregnancy, and live birth compared with the lowest tertile (all P < 0.05). In the primary adjusted model (Model 2), each one-unit increase in ZJU was associated with reduced odds of ovulation (OR 0.94, 95% CI 0.91-0.97), conception (OR 0.96, 95% CI 0.93-0.99), clinical pregnancy (OR 0.95, 95% CI 0.92-0.98), and live birth (OR 0.95, 95% CI 0.92-0.99). No significant non-linearity was observed (all P for non-linearity > 0.05). For the continuous ZJU associations, point-estimate E-values ranged from 1.17 to 1.22, and the corresponding confidence-limit E-values ranged from 1.09 to 1.15, indicating limited robustness to unmeasured confounding. Associations between the ZJU index and reproductive outcomes remained consistent across sensitivity analyses.
CONCLUSION: A higher baseline ZJU index was associated with poorer reproductive outcomes in women with PMOS undergoing fertility treatment. The ZJU index may serve as a metabolic marker associated with reproductive outcomes in women with PMOS. However, its ability to predict individual reproductive outcomes and any clinically applicable threshold require further evaluation in dedicated prediction studies with external validation.