Abstract

Polycystic ovary syndrome (PCOS) is a frequent disorder affecting women of reproductive age characterized by infertility. Affected endometrial receptivity seems to contribute to decreased fertility of these patients as suggested by several studies. Understanding the mechanism behind this reduced endometrial receptivity could contribute to discovery of new therapeutic targets for infertility of PCOS. The aim of the paper is to review the current data regarding endometrial receptivity in PCOS patients, the potential mechanisms involved with particular focus on recent findings as the impact of gut microbiota on endometrium, the relationship between vitamin D and endometrial receptivity and the different impact of letrozole and clomiphene citrate on endometrial receptivity in infertile PCOS women.

Highlights

  • Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, having a prevalence of 8 to 13% and of 21% in high-risk groups [1]

  • It seems that the criteria used for diagnosis can impact the prevalence of infertility which is higher in women with polycystic ovary morphology in patients diagnosed according to Androgen Excess Society criteria (21,7%), while in patients diagnosed according to Rotterdam criteria infertility is present in only 6% of them [5]

  • Another randomized controlled study which included 160 patients diagnosed with PCOS found that indices of endometrial receptivity like the volume, vascularization index, flow index and vascularization flow index of endometrium on the day of hCG administration and 7–9 days after ovulation were significantly increased in letrozole group compared with clomiphene citrate (CC) [95]

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Summary

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, having a prevalence of 8 to 13% and of 21% in high-risk groups [1]. The latest guidelines [7] recommend the use of Rotterdam Consensus criteria for PCOS diagnosis, which assumes that two out of the following three features are present: oligo- or anovulation, hyperandrogenism (clinical or biochemical) and polycystic ovaries [8]. The use of these criteria generates several clinical phenotypes with variate impact on reproductive potential and metabolic profile, with some of them diagnosed with difficulty due to a scarce clinical picture. Bioavailability of androgens is increased due to insulin effect to reduce the hepatic production of sex-hormone binding globulin

Fertility in patients with polycystic ovary syndrome
Endometrial receptivity in women with polycystic ovary syndrome
Estrogen receptors (ER) expression and function
Progesterone receptor (PR) expression and function
Androgen receptor
Hyperandrogenism
Hyperinsulinemia and insulin resistance
Vitamin D
Ovulation induction agents
Antiandrogens
Freeze all strategy
Gut microbiota and endometrial receptivity
Assessment of endometrial receptivity and therapeutical implications
Findings
Conclusion
Full Text
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