Is elevated baseline SHBG associated with increased ovulation?

Abstract

Sexual hormone binding globulin (SHBG) is associated with the endocrine and reproductive systems. We aimed to investigate the role of SHBG in the reproductive process. Therefore, we conducted a secondary analysis of the PCOSAct (Polycystic Ovary Syndrome and Acupuncture Clinical Trial) study, which involved 21 sites in China and a total of 1000 women with PCOS. Out of these, 954 women with SHBG were included in the analysis. Through multivariate analysis of ovulation predictors, we found that age, BMI, estradiol, testosterone, and SHBG all showed a positive predictive value for ovulation (p = 0.0211, 0.0011, 0.0211, 0.0029, 0.0434, respectively). However, the LH to FSH ratio had a negative predictive value (p = 0.0539). Higher quartiles of SHBG were associated with a higher rate of ovulation, and per quartile increased was statistically significant (HR = 1.138, 95%CI [1.054,1.229]). The association remained significant even after adjusting for testosterone (HR = 1.263, 95%CI [1.059, 1.507]). On the other hand, quartiles of testosterone and estradiol did not exhibit any significant tendency toward ovulation. SHBG demonstrated predictive ability for ovulation, conception, pregnancy, and live birth (p < 0.05), and this correlation remained significant after adjusting intervention. Kaplan-Meier curves illustrated that increased levels of SHBG were a factor in high rates of ovulation, conception, and pregnancy. In comparison to other sexual hormones, a higher baseline level of SHBG was related to increased ovulation.

Keywords:

• PCOS
• SHBG
• ovulation
• reproductive outcomes
• prediction

Acknowledgements

We gratefully acknowledge the 21 collaborating sites and the following members of the PCOSAct study group: LH Hou, Zhen-Xing Hu, Xiao-Guang Shao, Jun Ge, Jin-Feng Zhang, Hui-Ying Xue, Xiao-Feng Xu, Rui-Ning Liang, Hong-Xia Ma, Hong-Wei Yang, WeiLi Li, Dong-Mei Huang, Yun Sun, Cui-Fang Hao, Shao-Min Du, Zheng-Wang Yang, Xin Wang, Ying Yan, Xiu-Hua Chen, Ping Fu, Cai-Fei Ding, Ya-Qin Gao, ZhongMing Zhou, Chi Chiu Wang, Tai-Xiang Wu, Jian-Ping Liu, Ernest HY Ng, Richard S Legro, and Heping Zhang. Dr. Xiaoke Wu had full access to all data in the study (including statistical reports and tables) and thus takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Dr Xiaoke Wu, Elisabeth Stener Victorin, Ernest HY Ng and Chi Chi-u-Wang. Drafting of the manuscript: Hui Chang and Hang Ge. Data collection and data interpretation: Hui Chang, Yanli Zhang, Mengyi Zhu, Xi Luo and Yanhua Han. Statistical analysis: Qi Wu, Jian Li, Dr Yong Wang and Dr Chi Chiu Wang. Supervision: Dr Xiaoke Wu. All authors critically reviewed the article and approved it for submission.

Disclosure statement

No potential conflict of interest was reported by the authors.

Compliance with ethics guidelines

All authors (Hui Chang, Hang Ge, Qi Wu, Yanli Zhang, Jian Li, Mengyi Zhu, Xi Luo, Yanhua Han, Yong Wang, Chi Chiu Wang, Xiaoke Wu) declare that they have no conflict of interest or financial conflicts to disclose.

Preprint

A preprint has previously been published [36].

Data availability statement

The datasets generated analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

Additional information

Funding

This work was financially supported by the National Key Research and Development Program of China (No.2019YFC1709500), the Project of Heilongjiang Province ‘TouYan’ Innovation Team, Youth Program of National Natural Science Foundation of China (No.82004404) and Outstanding Youth Project of Heilongjiang Provincial Natural Science Foundation (No.YQ2020H031).