Abstract
Objectives: The purpose of this review is to provide an overview of existing studies on the specificities of gene expression in the endometrium in PCOS and possible molecular mechanisms linking those specificities with reproductive and obstetric consequences of PCOS. Mechanism: Polycystic ovary syndrome (PCOS) is a complex disorder combining features of reproductive, metabolic, and psychological disturbances. The effect of metabolic, inflammatory, and endocrine abnormalities on ovulatory function and oocyte quality has been seen as the main reproductive issue in PCOS women. However, even after the restoration of ovulation, this group exhibits lower than expected reproductive outcomes. Functionally relevant sequence alterations in genes involved in regulating endometrial receptivity could also be relevant in PCOS as a property independent of extra-endometrial influences. Findings: Hyperandrogenism, ovulatory dysfunction, and insulin resistance are associated with the alterations in endometrial gene expressions leading to suboptimal endometrial receptivity in PCOS. Endometrial steroid receptor malfunction seems to be a contibuting factor to the intrinsic suboptimal endometrial receptivity in PCOS. Conclusion: epigenetic or epigenomics mechanisms altering gene expressions on the endometrial level in PCOS should not be ruled out. Future studies should focus on investigating specificities of each PCOS phenotype and developing individual treatment strategies to meet the specific needs of every PCOS patient.
Highlights
Polycystic ovary syndrome (PCOS) is a complex disorder combining features of reproductive, metabolic, and psychological disturbances
Anovulation is the primary event associated with infertility in PCOS patients with an obvious impact on the molecular behavior in the endometrium in PCOS
The uterine fluid analysis seems to be a promising diagnostic tool for the identification of PCOS patients with alteration in the secretion of cytokines associated with endometrial receptivity
Summary
Polycystic ovary syndrome (PCOS) is a complex disorder combining features of reproductive, metabolic, and psychological disturbances. It is well established that infertility, early pregnancy loss, gestational hypertension, and preeclampsia-eclampsia are more prevalent in women with PCOS [4,5,6]. Endometrial receptivity is a state of an endometrium defined by its readiness for embryo implantation [10]. Endometrial receptivity failure can be defined as a state of suboptimal endometrial preparedness for implantation leading to a complete or partial rejection of the implantable embryo. Even a modest receptivity failure can lead to partially abnormal embryo implantation could result in different obstetric complications such as gestational hypertension and preeclampsia-eclampsia [10]. In PCOS women, dysregulated expression of gene clusters due to aberrant ovarian hormonal and metabolic settings could lead to decreased endometrial receptivity.
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