Infertile Polycystic Ovary Syndrome Research Articles

Mesenchymal stem cells-derived exosomes as a promising new approach for the treatment of infertility caused by polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a multifactorial metabolic and most common endocrine disorder that its prevalence, depending on different methods of evaluating PCOS traits, varies from 4% to 21%. Chronic low-grade inflammation and irregular apoptosis of granulosa cells play a crucial role in the pathogenesis of PCOS infertility. Mesenchymal stem cells (MSCs)-derived exosomes and extracellular vesicles (EVs) are lipid bilayer complexes that act as a means of intercellular transferring of proteins, lipids, DNA and different types of RNAs. It seems that this nanoparticles have therapeutic effects on the PCOS ovary such as regulating immunity response, anti-inflammatory (local and systemic) and suppress of granulosa cells (GCs) apoptosis. Although there are few studies demonstrating the effects of exosomes on PCOS and their exact mechanisms is still unknown, in the present study we reviewed the available studies of the functions of MSC-derived exosome, EVs and secretome on apoptosis of granulosa cells and inflammation in the ovary. Therefore, the novel cell-free therapeutic approaches for PCOS were suggested in this study.

The Application of Complementary and Alternative Medicine in Polycystic Ovary Syndrome Infertility.

Polycystic ovary syndrome (PCOS) is a lifelong reproductive endocrine disease, which is the most common cause of anovular infertility. Modern medicine mainly treats infertile patients with PCOS by improving living habits, ovulation induction therapy, and assisted reproductive technology (ART), but the effect is not satisfied. Complementary alternative medicine (CAM) has conspicuous advantages in the treatment of PCOS infertility due to its good clinical efficacy, wide mechanism of action, and no obvious adverse reactions, but its safety and effectiveness in the treatment of PCOS infertility have not been proved. Based on the existing clinical and experimental studies, this paper looks for the therapeutic effect and the mechanism behind it, and explores the safety and effectiveness of its treatment in PCOS infertility, in order to provide reference for future clinical treatment and experimental research.

REPRODUCTIVE AND METABOLIC EFFECTS OF A NUTRITIONAL INTERVENTION FOR KETOSIS INDUCTION ADDED TO IVF IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME

High-carbohydrate diets (glucotoxicity) and hyperinsulinemia contribute to PCOS disturbances and infertility; a ketogenic diet could mitigate the harmful effects of insulin resistance (IR) and improve PCOS women's fertility results when combined with IVF.

Effect of weight loss on pregnancy outcomes, neuronal-reproductive-metabolic hormones and gene expression profiles in granulosa cells in obese infertile PCOS patients undergoing IVF-ET.

ObjectiveTo investigate the effect of weight loss on pregnancy outcomes, PCOS related neuronal-reproductive-metabolic hormones and ovarian granulosa cell gene expression profiles in obese PCOS infertile patients undergoing in vitro fertilization-embryo transfer (IVF-ET).Methods75 patients undergoing IVF-ET due to tubal factors alone collected as the control group (group A), and 352 patients with obese PCOS infertility were divided into four groups according to the amount of weight loss before IVF: 0 kg (group B), 1-5 kg (group C), 5-10 kg (group D), and >10 kg (group E). Six cases of ovarian granulosa cells were collected randomly with the random number table method in each group for detecting mRNA profiling. Pathway networks and biological functions of the differentially expressed genes were analyzed. Validation by RT-PCR was performed.Results(1) The levels of luteinizing hormone(LH), testosterone(T) and homeostasis model assessment insulin resistance(HOMA-IR) in group E were significantly lower than those in groups B and C (P<0.05). (2) Compared with groups A and E, groups B and C showed increased total gonadotropin (Gn) and days of Gn stimulation (P<0.05), and the E2 level on trigger day and number of oocytes obtained in group B was significantly less than that in group E (P<0.05 or 0.01). Embryo implantation rate, clinical pregnancy rate and live birth rate were increased and miscarriage rate was decreased in groups A, D and E compared with group B (P<0.05 or 0.01). (3) There were significant differences among the control group and PCOS groups in some genes that are involved in neuronal-reproductive-metabolic endocrine, transcriptional regulation, cell proliferation and differentiation, etc (P<0.05). RNA-Seq results were validated by real time PCR analysis for the expression of follicle stimulating hormone receptor (FSHR), drosophila mothers against decapentaplegic protein 7(Smad7) and glutathione peroxidase 3(GPX3) genes that are known to have an important role in follicular development. Functional alterations were confirmed by the improvement in the ovarian responsiveness to Gn and embryo quality.ConclusionWeight loss more than 5kg may regulate the neuroreproductive endocrine hormone secretion, insulin resistance and gene expression profiles of ovarian granulosa cells, so as to improve the ovarian responsiveness to Gn, the embryo quality, embryo implantation rate, clinical pregnancy rate, live birth rate, and reduce the spontaneous abortion rate in obese infertile PCOS patients undergoing IVF-ET.Clinical trial registration www.chictr.org.cn, identifier ChiCTR1800018298.

The effect of metabolic syndrome on controlled ovarian stimulation outcome in infertile women with polycystic ovary syndrome undergoing assisted reproductive technology cycles.

To evaluate the effect of metabolic syndrome (MetS) diagnosis on oocyte quality and pregnancy outcomes in infertile women with polycystic ovary syndrome (PCOS) who undergoing antagonist-controlled ovarian stimulation (COS) and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. This prospective cohort study was conducted from November 2019 to November 2020 across two university-affiliated infertility centers in Iran. The PCOS diagnosis was defined according to the Rotterdam criteria. The patients prior to IVF/ICSI cycles were evaluated for MetS diagnosis. MetS was detected according to the National Cholesterol Education Program/Adult Treatment Panel III with the presence of at least three or more of the specific clinical criteria. The cycle outcomes were compared between MetS and non-MetS groups. Overall, 68 eligible infertile PCOS patients with MetS diagnosis and 126 without MetS participated. The MetS diagnosis was associated with the increased requirement of gonadotropins and the COS duration significantly (P = 0.001). Although the total numbers of retrieved and MII oocytes, obtained and topquality embryos as well as clinical pregnancy and live birth rates in the MetS group were lower than those of in the non-MetS group, the differences were not statistically significant (P > 0.05). In followup of the obstetrics complications, the rate of preeclampsia was significantly higher in patients with MetS (P = 0.02). MetS diagnosis in PCOS patients was associated with non-significant poor COS and pregnancy outcome. Further studies with larger sample sizes are recommended to clarify the risk of MetS in patients undergoing ART cycles.

Kisspeptin: a potential therapeutic target in patients with unexplained infertility?

Kisspeptin has recently emerged as a key regulator of the reproductive axis in women. Kisspeptin, acting centrally via the kisspeptin receptor, stimulates the secretion of the gonadotrophin-releasing hormone (GnRH). To investigate serum kisspeptin levels in infertility patients for its clinical utilisation in management and understanding of the pathophysiology of infertility in a wide array of patients. This prospective case-control study analysis involved 92 primary infertile women with PCOS, diminished ovarian reserve (DOR), unexplained infertility (UEI), and male factor infertility between 20 and 42years of age. Serum samples were collected between the second and fifth day of the menstrual cycle. The kisspeptin level was determined using a human kisspeptin ELISA kit according to the manufacturer's procedure. The median value of serum kisspeptin in the PCOS infertility group was significantly higher than that in the UEI group (p = 0.011). There was a statistically significant (p = 0.015, r = -0.182) negative weak correlation found between serum kisspeptin levels and age. The optimal cutoff value obtained to differentiate the UEI from others (PCOS infertility + DOR + male factor infertility) according to the serum kisspeptin level was 214.3ng/L with a sensitivity of 55% and specificity of 80.9%. Understanding the role of kisspeptin may lead to its use as a biomarker in infertility diagnosis in UEI patients and might guide the use of kisspeptin analogues in selected patients for infertility management.

The Effect of Age on IVF-ET Outcome in Infertile Patients with PCOS Based on Tiangui Theory in Chinese Medicine.

Objective Our aim was to investigate the effect of age on the outcome of IVF-ET and ICSI in infertile PCOS patients under the guidance of Tiangui theory in traditional Chinese medicine. Method This was a retrospective analysis of 532 infertile women with PCOS and 1,392 women with infertility due to tubal factors as the controls. All of the participants were divided into different age groups-aged 20–28 years, 29–35 years, and ≥36 years-according to the stages of female reproductive development in Tiangui theory as described in the Canon of Internal Medicine-Treatise of Ancient Natural Truth. We explored the effect of age on controlled ovarian hyperstimulation (including the initial dosage and duration of Gn and the estradiol level on the day of human chorionic gonadotropin administration); the numbers of retrieved oocytes, 2PN zygotes, and embryos; and the rates of fertilization, clinical pregnancy, abortion, live birth, and OHSS incidence. Results Compared to controls, the maximum follicular diameter and the numbers of follicles with d ≥ 20 mm, retrieved oocytes, and 2PN zygotes were greater in the PCOS group with age >28 years (p < 0.05). The abortion rate of PCOS patients with age ≤28 years was higher than that of the controls. All PCOS groups and the control group showed reduced numbers of retrieved oocytes and live births with age. The difference in age was not significant in the PCOS groups but was significant in the control group (p < 0.05), and the trend in the PCOS groups was more gradual. Conclusion The fertility of all subjects decreased with age, but PCOS patients decreased more slowly than in controls at the same age, which verified the applicability of the guiding principles of Tiangui theory in the clinic.

Induction of ovulation in women with PCOS using letrozole versus letrozole plus gonadotropin and its effect on spontaneous on going pregnancy rate through multicenter IVF in Beni-Suef city using randomized controlled study

Background: We developed a multicenter randomized observational trial to assess the effectiveness of letrozole monotherapy and the co-therapy of letrozole and gonadotropins on pregnancy outcomes including the ovulation induction, pregnancy rate, estradiol (E2) levels and endometrial thickness in infertile women with polycystic ovarian syndrome (PCOS).Methods:At three in vitro fertilization (IVF) centers in Egypt, we conducted our study since May 2019 until we have recruited the planned number of patients. Infertile PCOS patients were recruited after they met our criteria. We had two intervention groups based on the treatment regimen.Moreover, baseline parameters, outcomes, and hormonal assessment was conducted throughout the study period. Results: We included 90 patients in this study and were equally randomized into two groups; the letrozole monotherapy (Group A) and the letrozole with gonadotropins (Group B) groups. The mean age was significantly higher in group A [26 (±3.5)] than group B [24.2 (±3.1)] (P= 0.015). Both groups showed resulted in similar pregnancy rates (31.1%) (P= 0.079).Moreover, group B [2.4 (±0.8)] resulted in a significantly higher (P= 0.023) mean number of follicles than group A [2.0 (±0.7)]. On the other hand, no statistical significance was estimated in terms of estradiol levels and endometrial thickness (P= 0.209 and 0.485, respectively).

Polycystic Ovary Syndrome Develops the Complications of Assisted Reproductive Technologies.

Ovarian hyperstimulation syndrome (OHSS) is a serious complication that remains a threat to every patient experiencing stimulation of ovulation. Polycystic ovary syndrome (PCOS) appears to be the most important predisposing factor for OHSS. The severity of OHSS is associated with the degree of the follicular response to the ovulation inducing agents. The objective of this study was to investigate the relationship between PCOS with the risk of moderate-to-severe OHSS in intracytoplasmic sperm injection treatment patients. Sixty patients in the reproductive ages (20-38), including OHSS patients and age-matched normoresponders were included in this study. Patients who had larger follicle counts on the day of hCG injection were considered at risk for developing moderate-to-severe OHSS. In addition, oocyte quality was assessed about 20-30 min after oocyte pickup. The incidence of OHSS in PCOS patients increased significantly up to 13.9 times higher than in patients without PCOS (OR=13.900; P=0.007). Moreover, moderate-to-severe OHSS increased significantly (OR=3.860; P=0.043) in patients with primary infertility than those with secondary infertility. In addition, oocyte quality was not affected with the severity of OHSS. In conclusion, the risk of moderate-to-severe OHSS is correlated with PCOS and primary infertility without affecting oocyte quality.

TGFß Gene Members and Their Regulatory Factors in Granulosa Compared to Cumulus Cells in PCOS: A Case-Control Study.

Objective Transforming growth factor-beta (TGF-β) superfamily and its members that include bone morphogenetic protein 15 (BMP15), anti-Mullerian hormone (AMH), growth /differentiation factor-9 (GDF9), and their respective receptors: BMPR1A, BMPR1B, and BMPR2 have been implicated as key regulators in various aspects of ovarian function. The abnormal function of the ovaries is one of the main contributing factors to polycystic ovarian syndrome (PCOS), so this study aimed to investigate the mRNA expression profile of these factors in granulosa (GCs) and cumulus cells (CCs) of those patients. Materials and Methods The case-control research was conducted on 30 women (15 infertile PCOS and 15 normo-ovulatory patients, 22≤age ≤38 years old) who underwent ovarian stimulation for in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) cycle. GCs/CCs were obtained during ovarian puncture. The expression analysis of the aforementioned genes was quantified using real-time polymerase chain reaction (PCR). Results AMH and BMPR1A expression levels were significantly increased in GCs of PCOS compared to the control group. In contrast, GDF9, BMP15, BMPR1B, and BMPR2 expressions were decreased. PCOS' CC showed the same expression patterns. GDF9 and AMH were effectively expressed in normal CCs, and BMP15 and BMPR1B in normal GCs (P<0.05). ConclusionDifferential gene expression levels of AMH and its regulatory factors and their primary receptors were detected in granulosa and cumulus cells in PCOS women. Since the same antagonist protocol for ovarian stimulation was used in both PCOS and control groups, the results were independent of the protocols. This diversity in gene expression pattern may contribute to downstream pathways alteration of these genes, which are involved in oocyte competence and maturation.

AN OBSERVATIONAL ANALYSIS OF CLINICAL PROFILE ASSOCIATED WITH OVULATION INDUCTION USING LETROZOLE AMONG INFERTILE WOMEN WITH POLYCYSTIC OVARIAN SYNDROME

Background- Polycystic ovary syndrome (PCOS) is major endocrine and metabolic disease in reproductive women. As per latest procedures, letrozole should be taken as the rst-line pharmacological treatment for infertile women with PCOS. This study was planned to study the role of clinical prole in ovulation induction after letrozole therapy among infertile women with poly- cystic ovarian syndrome. This was a prospective analytical observational study carried out at the IVF centre, SMS Medical College,Methods- Jaipur. The present study enrolled 100 patients attending the IVF centre for fertility treatment who were diagnosed with PCOS as per Rotterdam criteria. Anthropometric measurements like Body mass index (BMI calculated as weight in kilograms divided by square of height in meters) and waist circumference (the smallest circumference at the level of umbilicus) was taken. A comprehensive physical examination of all patients was done to note signs of clinical hyperandrogenism like acne, alopecia, and hirsutism. Treatment response was dened as ovulation in response to letrozole in doses from 2.5 mg to 7.5 mg. In this study, women from 20 to 25 years of age with shorter duration of infertility, lower BMI,Results- lower waist circumference, absence of hirsutism, or mild hirsutism on clinical examination showed better response to Letrozole. Conclusion- Letrozole can be considered a suitable ovulation induction agent in infertile PCOS patients with lower BMI, lower waist circumference, and absence of hirsutism. A predictive ovulation score can be developed from basic clinical parameters. Identication of various factors affecting response to letrozole may help the clinician to individualize ovulation induction protocols in PCOS women.

The Essential Role of Body Weight in Adjusting Gn Dosage to Prevent High Ovarian Response for Women With PCOS During IVF: A Retrospective Study.

Polycystic ovarian syndrome (PCOS) is the major cause of anovulatory infertility. Since women with PCOS are often accompanied by increased body weight and hyper response to controlled ovarian stimulation, individualized gonadotropin (Gn) dose is required to achieve a therapeutic effect while minimizing the risk of ovarian hyperstimulation simultaneously. We aimed to investigate the essential role of body weight in optimizing initial Gn dosage for PCOS patients during in vitro fertilization (IVF). We retrospectively included 409 infertile PCOS patients who used gonadotropin-releasing hormone (GnRH)-antagonist fixed protocol and underwent their first cycle of IVF in West China Second University Hospital from January 2019 to June 2021. Baseline characteristics controlled ovarian stimulation parameters, and reproductive outcomes were compared between patients with different body weights and different ovarian responses. Multivariable linear regression analyses were adopted to investigate the relationship between body weight and initial Gn dosage. Receiver operating characteristic (ROC) curves were drawn to find the optimal cut-off value of body weight in predicting the starting Gn dosage so as to prevent high ovarian response (HOR). We found that luteinizing hormone (LH) level and Anti-Mullerian hormone (AMH) level were lowest in the group with body weight over 70 kg and was highest in the group with body weight less than 50 kg. Increased body weight was significantly correlated to the rise of initial Gn dosage (Beta = 0.399, t = 8.921, p < 0.001). Normal ovarian response (NOR) patients had significantly less fresh cycle cancel rate and ovarian hyperstimulation syndrome (OHSS) rate which outweighed the fewer embryos compared with HOR patients. Using ROC curves, 53.25 kg (sensitivity, 84.2%; specificity, 53.8%) and 70.5 kg (sensitivity, 58.8%; specificity, 93.0%) were identified as the optimal cut-off values to predict the initial Gn dosage of no more than 150 IU and 225 IU, respectively. In conclusion, adjusting the initial Gn dosage based on body weight is crucial to preventing ovarian hyperstimulation while not influencing reproductive outcomes for PCOS patients during IVF.

P-576 Spontaneous pregnancy rates after the weight loss program in infertile PCOS women with obesity

Abstract Study question What is the spontaneous pregnancy rate in infertile polycystic ovary syndrome (PCOS) women with obesity after the weight loss program in womoen who achieve ≥ 5% BMI reduction? Summary answer Spontaneous pregnancy rate in infertile PCOS women is 29.4 % after the end of the weight loss program and reduction of BMI for ≥ 5%. What is known already PCOS affects 6 to 15% of reproductive age women and is the most common cause of anovulatory infertility. Twenty-five to 75 % of women with PCOS are overweight (BMI &amp;gt;25 kg/m2) or obese (BMI &amp;gt;30 kg/m2). Obesity aggravates symptoms of PCOS. Women with obesity and women with PCOS have lower spontaneous and IVF pregnancy rates. Pregnant women with PCOS and obesity have higher incidence of pregnancy-associated complications. Weight reduction of even 5% improves metabolic and hormonal profile as well as reproductive functions and weight reduction through lifestyle modification is the treatment of choice for overweight and obese women with PCOS. Study design, size, duration Twenty-seven infertile PCOS women with BMI &amp;gt;30 kg/m2 were prospectively included to the study. They attended a weight loss program prior to inclusion to IVF procedures. The program lasted for 8-12 consecutive weeks. Participants/materials, setting, methods Twenty-seven infertile women, aged less than 38 years, with PCOS and obesity were prospectively included to the weight loss program. The program consisted of lifestyle modifications (diet with daily caloric deficit) and physical exercise. Group trainings were held twice a week and were designed as circuit interval trainings. Individual aerobic activity (walking, brisk walking, cycling, walking up the hill) were also performed twice a week. Main results and the role of chance All women completed the prescribed weight loss program. Mean body weight before the program (106.43 kg ± 15.09 kg) was significantly (p &amp;lt; 0.001) higher than after the program (100.63 kg ± 14.67 kg). Mean BMI prior to the start was 37.65 ± 5.1 kg/m2 and after the end of the program 35.68 ± 4.9 kg/m2. The difference was statistically significant (p &amp;lt; 0.001). Of 27 included women, 17 (62.9 %) achieved the desirable BMI reduction of ≥ 5%. Of women who reduced their BMI by ≥ 5%, 5 (29.4 %) conceived spontaneously in three months after the end of the weight loss program. All other were included to IVF procedures. Besides weight loss, significantly more women reported on having healthier eating habits, started to exercise regularly, and improved their sleep after the end of the weight loss program. Limitations, reasons for caution The limitation of the present study is a relatively small sample size. Wider implications of the findings Weight loss represents an important approach towards treatment of obese infertile PCOS women prior to inclusion to IVF procedures. Almost 30 % of women who achieved the desirable BMI reduction conceived spontaneously. They were therefore spared of IVF procedures which has a beneficial health, psychological as well as financial impact. Trial registration number NCT04989244

P-355 Association between high serum uric acid level and adverse reproductive outcomes in infertile women with polycystic ovary syndrome

Abstract Study question Does high serum uric acid (SUA) level affect the reproductive outcomes in women with polycystic ovary syndrome (PCOS) undergoing in-vitro fertilization (IVF)? Summary answer Elevated SUA is associated with decreased live birth rate, biochemical pregnancy rate and clinical pregnancy rate, and increased miscarriage rate in women with PCOS. What is known already SUA levelsand the prevalence of hyperuricemia (25.48%) are both significantly higher in women with PCOS than in women without PCOS (8.74%). SUA levels also can be used as a predictor of pregnancy complications (gestational diabetes mellitus and hypertensive disorders of pregnancy) and adverse foetal outcomes (preterm birth and low birth weight). Study design, size, duration This retrospective cohort study was conducted ininfertile women with PCOS between September 2012 and December 2019. Participants/materials, setting, methods A total of 1,032 infertile PCOS women undergoing their first IVF/ICSI cycle were observed. Data of reproductive outcomes including live birth rate, biochemical pregnancy rate, clinical pregnancy rate, and miscarriage rate were analyzed according to the quartile groups of SUA levels. Main results and the role of chance In quartiles of SUA levels, there was a significant decreasing trend in live birth rate from the lowest quartile (Q1: 34.5%) to the highest (Q4: 19.2%) (Pfor trend &amp;lt;0.001). Notably, the miscarriage rate in Q4 was significantly higher than that in the other 3 quartiles (all P values &amp;lt; 0.05). From Q1 to Q4, the incidence of miscarriage dramatically increased from 15.5% to 31.0% (Pfor trend &amp;lt;0.05). In addition, the biochemical pregnancy rate and clinical pregnancy rate decreased significantly from the lowest quartile to the highest (Pfor trend &amp;lt;0.05). With the first quartile of uric acid as the reference group, the logistic regression analysis showed that in both unadjusted and adjusted models, elevated SUA level was associated with significantly lower probabilities of live birth, biochemical pregnancy, and clinical pregnancy, and a higher risk of miscarriage in a linear fashion (all Pfor trend&amp;lt; 0.05). Limitations, reasons for caution This study is limited by its retrospective design. It was difficult to ensure consistency in clinical practice among the physicians. Wider implications of the findings Our study suggeststhat clinical physicians need to pay close attention to PCOS women with high SUA levelsbefore IVF treatment. Prospective studies to determine an appropriate range of lower-SUA levels prior to treatment is necessary to support our findings. Trial registration number not applicable

The Comparison of the Effect of Recombinant FSH in Antagonist Protocol on Serum and Follicular Fluid Kisspeptin between PCOS and non-PCOS Infertile Women during ICSI

Background: Reproduction is a highly delicate organized process accomplished by the controlled interaction of the higher centers in the brain, the gonads, and different body parts. Kisspeptin is a neuropeptide that acts as a key regulator controlling the hypothalamic-pituitary-gonadal axis and organizing the reproduction process. Gonadotropins treatment used in controlled ovarian hyperstimulation increases the follicular count in an attempt to improve the pregnancy rate. However, one of its drawbacks is the increase in ovarian hyperstimulation syndrome risk. Published data proved that kisspeptin has a fundamental role in regulating follicular growth and maturation at central and peripheral levels highlighting its possible role in diagnosing and treating infertility problems. Objective: To study the influence of gonadotropin (recombinant FSH medication) used in ovarian hyperstimulation program on the level serum and follicular fluid kisspeptin level in PCOS and non-PCOS patients. Subject, Materials, and Method: This is a cross-sectional study performed in the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Naharin University, from September 2020 to July 2021. The study includes a sample of (80) infertile Iraqi women aged (18–40 years) scheduled for an intracytoplasmic sperm injection program after being stimulated by GnRH antagonist protocol. On the day of oocytes retrieval, blood and follicular fluid samples were drawn from each participant to measure kisspeptin level using ELIZA technique. Results: In PCOS patients, significant positive correlations were found between recombinant FSH medication with serum and follicular fluid kisspeptin level (p is less than 0.05). Serum kisspeptin was insignificantly higher in the PCOS patient (p = 0.838) while follicular fluid kisspeptin was insignificantly lower in the PCOS women (p = 0.651). There were significant correlations between serum and follicular kisspeptin in the PCOS and the control groups (p = 0.000) and (p = 0.002), respectively. Conclusions: Serum and follicular fluid kisspeptin are positively correlated with the cumulative recombinant FSH medication used by infertile polycystic ovarian syndrome women undergoing ICSI, addressing the possible role of kisspeptin in improving the pregnancy rate in PCOS patients with a lower incidence of ovarian hyperstimulation syndrome.

In vitro fertilization cycle and embryo transfer outcomes in oligoanovulatory patients with hypothalamic hypogonadism vs. polycystic ovary syndrome and compared with normo-ovulatory patients

ObjectiveTo study the difference in the live birth rates between anovulatory women with hypothalamic hypogonadism (HH) and those with polycystic ovary syndrome (PCOS) and normo-ovulatory women undergoing fresh embryo transfer or frozen embryo transfer (FET).DesignRetrospective cohort study.SettingAcademic medical center.Patient(s)Patients with oligoanovulation (HH, n = 47; PCOS, n = 533) and normo-ovulation (tubal factor infertility, n = 399) undergoing in vitro fertilization and intracytoplasmic sperm injection cycles from January 1, 2012, to June 30, 2019.Intervention(s)None.Main Outcome Measure(s)Live birth rate.Result(s)Patients with HH had longer stimulation durations than both patients with PCOS and tubal factor infertility. Patients with HH had fewer oocytes retrieved than patients with PCOS, but their numbers of blastocysts were similar. Patients with HH and tubal factor infertility had similar numbers of oocytes retrieved and blastocysts. In fresh embryo transfer cycles, the live birth rates were similar among patients with HH, PCOS, and tubal factor infertility (37.5% vs. 37.1% vs. 29.3%, respectively). When evaluating FET cycles, patients with HH had lower live birth rates than patients with PCOS (26.5% vs. 46.7%) and tubal factor infertility (42.6%).Conclusion(s)Live birth rates are similar among patients with HH, PCOS, and normo-ovulation undergoing fresh embryo transfer but are significantly lower in women with HH undergoing FET.

Plasma Complement C1q/tumor necrosis factor-related protein 15 concentration is associated with polycystic ovary syndrome.

Polycystic ovarian syndrome (PCOS) is a common poignant endocrine disorder affecting women, posing a close association with metabolic syndrome and obesity. Existing literature characterizes PCOS with deranged levels of several adipokines and myokines. CTRP15 is a paralogue of adiponectin, mainly expressed by skeletal muscles, and plays a key role in insulin, glucose, and lipid metabolism. In the current study, we aim to determine the circulating levels of CTRP15 and evaluate its association with cardiometabolic and inflammatory parameters in PCOS women. This case-control study included 120 PCOS patients (60 Recurrent pregnancy loss (RPL) and 60 infertile (inf) PCOS) and 60 healthy non-PCOS controls. Serum levels of hs-CRP were measured by commercial kits, while serum levels of adiponectin and CTRP15 were determined using the ELISA technique. Serum levels of CTRP15 were significantly elevated in PCOS-RPL and PCOS-inf subgroups when compared to controls (94.80 ± 27.08 and 87.77 ± 25.48 vs. 54.78 ± 15.45, both P < 0.001). Moreover, serum adiponectin was considerably lower in the PCOS group and subgroups (P < 0.001), while serum hs-CRP, fasting insulin, HOMA-IR, and free testosterone were significantly higher when compared to the non-PCOS group (P < 0.05). Furthermore, CTRP15 closely associated with FSH, HOMA-IR, hs-CRP, and BMI. These results highlight a possible involvement of CTRP15 in the pathogenesis of PCOS. The elevated levels of CTRP15 might be a compensatory mechanism for the metabolic dysregulations (excess adiposity, insulin resistance, metaflammation) associated with the syndrome. Nevertheless, future studies are necessary to unravel the underlying mechanism.

Prevalence of Vitamin D deficiency in infertile women with Polycystic ovarian syndrome and its possible association with endocrine parameters

Polycystic ovarian syndrome (PCOS) is a most common endocrinopathy in women of reproductive age group characterised by various metabolic and reproductive disturbances. Vitamin D is a fat-soluble vitamin having major influence on reproductive health. The beneficial effects of vitamin D on reproduction may be attributed to ovulation stimulation as well as improved implantation. Since infertility is the frequent presentation in patients with PCOS, we aim to determine the circulating vitamin D levels in infertile patients with PCOS in comparison with normal fertile controls and to correlate it with other endocrine parameters. A cross sectional study was conducted in a tertiary care hospital including 111 infertile patients presenting with PCOS and 107 normal fertile controls in the age group 18-39yrs. Circulating FSH, LH, Total testosterone, SHBG (sex hormone binding globulin) and vitamin D levels were measured in both the groups by chemiluminescence immunoassay. Free androgen index (FAI) was calculated. Circulating vitamin D levels in PCOS patients was compared with normal fertile controls using unpaired ‘t’ test and correlated with other endocrine parameters like FSH, LH, Testosterone, SHBG and FAI using Pearson correlation analysis. Mean circulating vitamin D levels in cases were significantly lower compared to controls (17.08 Vs 26.95, p&lt;0.001). Vitamin D showed a significant negative correlation with testosterone (r -0.66, p&lt;0.001), FAI (r -0.41, p&lt;0.001) and significant positive correlation with SHBG (r 0.18, p&lt; 0.001). No significant correlation was observed between circulating vitamin D levels with other endocrine parameters like FSH, LH and LH:FSH ratio. Low circulating vitamin D levels in infertile PCOS patients and its correlation with endocrine parameters found in our study suggest the possible role of this fat-soluble vitamin in pathogenesis and complications of PCOS.

Does alpha-1-acid glycoprotein determine for infertility in polycystic ovary syndrome?

ObjectivesThe underlying cause of metabolic abnormalities and ovarian dysfunction in PCOS is thought to be chronic low-grade inflammation. This study aimed to show whether alpha-1-acid glycoprotein (AGP), an inflammatory marker, predicts the risk of infertility in fertile and infertile women with PCOS. Our study had a cros-sectional case-control design. Study designA total of 20 fertile and 50 infertile patients with PCOS who wanted a child were in the early follicular phase were included in our study. Among the study groups (fertil (n = 20) and infertile (n = 50), AGP, CRP, NLR, BMI, FAI, VAI, triglyceride, HDL-cholesterol, fasting blood sugar, HOMA-IR, SHBG, testosterone values and waist circumference were measured. ResultsAmong the inflammatory markers compared in the fertile and infertile groups included in the study, only the difference between the AGP variable was statistically significant (p = 0.011). The mean AGP was found to be higher at a statistically significant level in the infertile group (p < 0.05). Age, BMI, waist circumference and AGP were weakly positive and CRP was moderately positive in the infertile group (p < 0.05). ConclusionAGP can be a good indicator of inflammation in PCOS, especially in infertility.Revealing the risk of infertility in PCOS with AGP measurement may contribute to the correct management of the reproductive process.

Parameters for Calcium Metabolism in Women with Polycystic Ovary Syndrome Who Undergo Stimulation with Letrozole: A Prospective Cohort Study.

For women with polycystic ovarian syndrome (PCOS) and infertility, stimulation with the aromatase-inhibitor letrozole has been recommended as a first-line for ovulation induction. Calcium-associated signaling has also been a component for other ovulation induction and superovulation medications. This study’s aim was to evaluate parameters of calcium metabolism in PCOS women. In a prospective cohort study, 61 anovulatory, infertile PCOS patients who underwent letrozole stimulation were included. Outcome measures were: follicular maturation after letrozole stimulation; parathyroid hormone (PTH); 25-hydroxyvitamin D3 (25OHD3); serum levels of calcium, phosphorus, magnesium, albumin, and total protein. Successful recruitment of a dominant follicle was achieved in 35 patients (57.4%). Women with and without successful follicular development did not differ in serum levels of PTH (38.4 ± 19.7 vs. 39.6 ± 16.2 pg/mL), 25OHD3 (62.5 ± 32.1 vs. 65.4 ± 30.9 nmol/L), calcium (2.36 ± 0.08 vs. 2.37 ± 0.12 mmol/L), or protein (70.2 ± 13.3 vs. 74.0 ± 3.7 g/L), respectively (p > 0.05). However, women who were not responsive to letrozole for ovulation induction demonstrated higher anti-Müllerian hormone (AMH) levels (9.7 ± 4.7 vs. 5.0 ± 3.2 ng/mL, p = 0.005). In conclusion, the success of letrozole stimulation in women with PCOS is independent from calcium metabolism parameters. However, AMH levels seem predictive of medication resistance.