Ovary Syndrome Patients Research Articles

The impact of type 2 diabetes on polycystic ovary syndrome in patients undergoing sleeve gastrectomy.

Does the concurrent type 2 diabetes mellitus (T2DM) aggravate the features and prognosis of PCOS in patients undergoing sleeve gastrectomy (SG)? For patients undergoing SG with obesity, concurrent T2DM is associated with aggravated metabolic but milder reproductive features of PCOS and did not attenuate the resumption of regular menstruation for up to 1 year after surgery. Women with T2DM have an increased risk of PCOS. However, whether concurrent T2DM further increases the disease burden and treatment difficulty of PCOS in patients with obesity requires further investigation. This was a single-center, two-arm, prospective, cohort study enrolling a total of 329 women with PCOS and scheduled for SG because of obesity at an university-affiliated hospital between January 2020 and August 2023, with a 1-year follow-up after surgery. Comparisons were made between patients with T2DM (PCOS+T2DM) and without (PCOS) to examine the impact of T2DM on the metabolic, reproductive, and psychological features of PCOS. The follow-up data of weight loss and menstruation were analyzed to determine the impact of T2DM on PCOS prognosis for up to 1 year after SG. After controlling for confounders, patients in the PCOS+T2DM group (n = 98) showed more severe insulin resistance, glucose intolerance, dyslipidemia, and non-alcoholic fatty liver disease (NAFLD) (NAFLD activity score 4.31 ± 1.15 versus 3.52 ± 1.42, P < 0.001) than those in the PCOS group (n = 149). In addition, the PCOS+T2DM group had a lower level of total testosterone (1.63 ± 0.69 versus 1.82 ± 0.76, P = 0.045), a lower ratio between luteinizing hormone and follicle-stimulating hormone (median 1.48 versus 1.68, P = 0.030), and a lower proportion of patients with polycystic ovarian morphology (88% versus 96%, P = 0.022) than the PCOS group. As a result, the two groups differed significantly in terms of the Rotterdam classification of PCOS (P = 0.009). No significant difference was detected by group in the psychological features of PCOS except a lower degree of emotional eating in the PCOS+T2DM group (P = 0.001). Although the PCOS+T2DM group took longer to resume regular menstruation after SG (P = 0.037), the two groups had similar proportions of patients with regular menstruation (85% versus 87%, P = 0.758) 1 year after SG, which was further confirmed by subgroup analyses by body mass index. The prognosis of PCOS after SG mainly focused on the results of menstruation rather than a complete evaluation of the remission of the disease. Our study showed that, for patients with obesity, concurrent T2DM is associated with aggravated metabolic but milder reproductive features of PCOS and did not attenuate the resumption of regular menstruation for up to 1 year after surgery. Our study also highlights the need for high-quality studies with a more comprehensive evaluation of the impact of T2DM on the prognosis of patients with PCOS after SG. This study was funded by the National Natural Science Foundation of China Grants (82100853), the Natural Science Foundation of Shandong Province of China (ZR2021QH028), and the Clinical Research Project of Shandong University (2020SDUCRCC024). The authors have no conflicts of interest. Chinese Clinical Trial Registry with No. ChiCTR1900026845.

Prevalence of polycystic ovary syndrome in patients with type 2 diabetes: A systematic review and meta-analysis.

PurposeWith type 2 diabetes mellitus (T2DM) occurring at a younger age, a greater number of women with T2DM experience reproductive health problems. The prevalence of polycystic ovary syndrome (PCOS), a common reproductive disease associated with T2DM, remains unknown in women with T2DM. This systematic review and meta-analysis aimed to determine the prevalence of PCOS in women with T2DM.MethodsStata 15.1 was used to perform a meta-analysis on the prevalence of PCOS in patients with T2DM included in this study. Additionally, a narrative review of the effects of different diagnostic methods, obesity, state, and other factors on the prevalence of PCOS was conducted.ResultsMeta-analysis showed that the overall prevalence of PCOS in women with T2DM was approximately 21%. Subgroup analysis showed that the incidence of PCOS in female patients aged 25-45 years was higher than that in female patients aged < 25 years. The prevalence of PCOS in obese women was 14%, which was lower than that in normal weight women and normal weight or overweight or obese women. Women with T2DM in Oceania had the highest incidence of PCOS, followed by those in Europe and Asia; women with T2DM in North America had the lowest incidence. In terms of PCOS diagnostic standards, the prevalence of PCOS diagnosed by the National Institutes of Health was the lowest. The prevalence of PCOS diagnosed on the basis of clinical symptoms and biochemical characteristics was the highest, and the prevalence of PCOS diagnosed on the basis of medical records was 20%.ConclusionsPCOS is a common disease in female patients with T2DM. The prevalence of PCOS in women with T2DM at childbearing age was higher than that in adolescent females. Women with T2DM at childbearing age should pay attention to the screening and prevention of PCOS to avoid the hazards of PCOS to reproductive health.Systematic review registrationPROSPERO, identifier CRD42022318657.

Polycystic Ovary Syndrome in Girls With Type 2 Diabetes

Source: Cioana M, Deng J, Nadarajah A, et al. Prevalence of polycystic ovary syndrome in patients with pediatric type 2 diabetes a systematic review and meta-analysis. JAMA Netw Open. 2022;5(2):e2147454. doi:10.1001/jamanetworkopen.2021.47454Investigators from multiple institutions conducted a meta-analysis to estimate the prevalence of polycystic ovary syndrome (PCOS) in girls with type 2 diabetes (T2D). For the meta-analysis, systematic search procedures were used to identify studies in which the prevalence of PCOS in girls diagnosed with T2D when they were ≤18 years old was estimated. Studies included could have cross-sectional, retrospective, or prospective cohort designs, if they had a minimum sample of 10 patients. No specific criteria for the diagnosis of PCOS were required. The prevalence of PCOS in each included study was determined, and a pooled prevalence was calculated. A secondary analysis that included studies in which specific criteria were required for the diagnosis of PCOS also was conducted. For studies with the available data, the prevalence of PCOS among girls with T2D from different racial groups was calculated.The authors screened 722 articles to identify 6 studies that met the inclusion criteria; 5 of these were retrospective cohort studies. Data on 470 girls were included in the meta-analysis. The mean age at diagnosis of T2D among participants in the included studies ranged from 12.9 years to 16.1 years. Overall, the pooled prevalence of PCOS among adolescent females with T2D was 19.58% (95% CI, 12.02%, 27.14%). Three studies required a history of persistent oligomenorrhea and clinical and/or biochemical hyperandrogenism for a diagnosis of PCOS. Among 87 girls with T2D included in these studies, the pooled prevalence of PCOS was 24.04% (95% CI, 15.07%, 33.01%). There were 2 studies in which the prevalence of PCOS by race was reported; reported prevalence was 17% among 36 white females, 23.10% in Indian adolescent females (N = 195), and 2.0% in indigenous females in Canada (N = 64).The authors conclude that approximately 1 in 5 girls with T2D had PCOS.Dr. Fechner has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.It is not surprising that 1 in 5 girls with T2D have PCOS, as insulin resistance with hyperinsulinemia increases androgen production by the ovary, leading to PCOS.1 While the diagnosis of PCOS in adult women requires 2 of 3 criteria: androgen excess, oligo/anovulation or polycystic ovaries,2 the presence of polycystic ovaries on ultrasound and anovulatory symptoms may be normal in the early post-menarchal years. Thus, a history of anovulation and an ultrasound with polycystic ovaries may be normal during the period after menarche. A consensus statement on the pathophysiology, diagnosis, and treatment of PCOS in adolescence in 2017 suggested the diagnostic criteria of clinical and/or biochemical hyperandrogenism with irregular menses/oligomenorrhea at least 2 years post-menarche.3As in adults, it is important to exclude other etiologies such as non-classic congenital adrenal hyperplasia, hyperprolactinemia, and thyroid disease. PCOS has many of the same co-morbidities as T2D. In addition, there is increased infertility and increased risk of endometrial cancer as well as possible increased androgen exposure to the female fetus leading to ambiguous genitalia in the fetus.2 Treatment of PCOS overlaps T2D treatment, with lifestyle management to lose weight as a primary intervention. Adolescents with PCOS may also benefit from the use of an oral contraceptive to decrease androgens and improve acne, hirsutism, anovulatory symptoms, and to prevent pregnancy. Metformin for those unsuccessful with lifestyle management may also benefit both PCOS and T2D management.3It is important to gather menstrual history and look for signs of hyperandrogenism in females with T2D as PCOS appears to be a relatively common morbidity in girls with T2D.

1301-P: The Effect of Insulin on α-Aminoadipic Acid Metabolism in Polycystic Ovary Syndrome (PCOS) Patients with Insulin Resistance

Population studies have shown that the α-Aminoadipic Acid (AAA) , a lysine metabolite, predicts future type 2 diabetes and AAA concentrations decrease following administration of insulin sensitizers. To determine whether women with PCOS and insulin resistance have altered lysine and AAA kinetics we compared age-matched 18 women with PCOS to 12 women without PCOS using stable isotopes labeled [α-15N1]-lysine and [13C1]-AAA to measure lysine and AAA kinetics. Baseline levels of AAA flux and lysine concentrations were higher in PCOS compared to women without PCOS. Insulin decreased the concentrations and flux values of lysine and AAA. The conversion of lysine to AAA and AAA-metabolic clearance rates were increased on insulin infusion in both groups (Table) . Insulin sensitivity was negatively correlated with lysine concentration (r = - 0.547, p &amp;lt; 0.05) and AAA flux (r= - 0.587, p &amp;lt; 0.05) . In conclusion, our results indicate that insulin sensitivity is a determinant of AAA metabolism and insulin administration modulate the kinetics thus reducing AAA concentration indicating that altered AAA and lysine metabolism may result from insulin resistance. Disclosure A.Y.Chang: None. A.K.Asokan: None. D.Sakrikar: Employee; The Binding Site. A.Lalia: None. M.Petterson: None. K.Nair: None. Funding National Institutes of Health (RAG62859)

Effect on the cardiovascular independent risk factor lipoprotein(a) in overweight or obese PCOS patients with ethinyl-estradiol/drospirenone alone or plus orlistat

Objective This study aimed to assess the effect on the cardiovascular independent risk factor Lipoprotein(a) [Lp(a)] in overweight or obese polycystic ovary syndrome (PCOS) patients with ethinyl-estradiol/drospirenone (EE/DRSP) alone or plus orlistat. Methods In this randomized controlled prospective study, 66 PCOS patients with overweight or obesity were matched according to age and BMI. All participants were randomly divided into two groups to receive EE/DRSP plus Orlistat (n = 33) or EE/DRSP alone (n = 33) for 3 months. Changes in cardiovascular risk factors including Lp(a), CRP, LDL-C, anthropometric assessments, variations in sex hormones related parameters, and in glucolipid metabolic index were evaluated after the intervention. Results Lp(a) and CRP were significantly decreased at 3 months only in the EE/DRSP plus Orlistat group. There were significant reductions in LDL-C, weight, BMI, waist circumference (WC), body fat percentage (BFP), FT in both groups compared to baseline. However, these reductions were significantly greater in EE/DRSP plus Orlistat group. The levels of HDL-C, TG, and SHBG significantly increased, while TT and LH significantly decreased in both groups over time. TC, FINS, FPG were not significantly changed in both groups after the intervention. Conclusions This is the first study found that EE/DRSP plus Orlistat could significantly decrease Lp(a) in overweight or obese PCOS patients. This result can be assessed as particularly important, because Lp(a) is well-known as an independent risk factor predicting an increased risk of cardiovascular diseases (CVDs).

Prevalence of Polycystic Ovary Syndrome in Patients With Pediatric Type 2 Diabetes

The prevalence of pediatric type 2 diabetes (T2D) is increasing globally. Girls with T2D are at risk of developing polycystic ovary syndrome (PCOS), but the prevalence of PCOS among girls with T2D is unknown. To determine the prevalence of PCOS in girls with T2D and to assess the association of obesity and race with this prevalence. In this systematic review and meta-analysis, MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science: Conference Proceedings Citation Index-Science, and the gray literature were searched from inception to April 4, 2021. Two reviewers independently screened for studies with observational study design that recruited 10 or more participants and reported the prevalence of PCOS in girls with T2D. Risk of bias was evaluated using a validated tool, and level of evidence was assessed using the Oxford Centre for Evidence-Based Medicine criteria. A random-effects meta-analysis was performed. This study follows the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline. The main outcome of this systematic review was the prevalence of PCOS in girls with T2D. Secondary outcomes included assessing the associations of obesity and race with PCOS prevalence. Of 722 screened studies, 6 studies involving 470 girls with T2D (mean age at diagnosis, 12.9-16.1 years) met the inclusion criteria. The prevalence (weighted percentage) of PCOS was 19.58% (95% CI, 12.02%-27.14%; I2 = 74%; P = .002). Heterogeneity was moderate to high; however, it was significantly reduced after excluding studies that did not report PCOS diagnostic criteria, leading to a calculated prevalence (weighted percentage) of 24.04% (95% CI, 15.07%-33.01%; I2 = 0%; P = .92). Associations with obesity and race could not be determined because of data paucity. In this meta-analysis, approximately 1 in 5 girls with T2D had PCOS, but the results of this meta-analysis should be considered with caution because studies including the larger numbers of girls did not report the criteria used to diagnose PCOS, which is a challenge during adolescence. The associations of obesity and race with PCOS prevalence among girls with T2D need further evaluation to help define at-risk subgroups and implement early assessment and treatment strategies to improve management of this T2D-related comorbidity.

Prevalence of Polycystic Ovary Syndrome in Patients With McCune Albright Syndrome.

To identify polycystic ovarian syndrome (PCOS) in a population of female patients with McCune-Albright syndrome (MAS) by retrospective chart review. Retrospective study. Academic setting. All female patients with a prior diagnosis of MAS who were more than 12 years of age at the time of chart review. Only complete medical records from January 2009 to January 2020 were included in the analysis. None. Diagnosis of PCOS based on the Rotterdam 2003 criteria. Seventeen female patients with MAS were included in the analysis. PCOS appeared to be more prevalent in MAS patients than expected based on population estimates (exact binomial test=0.353; CI=0.142-0.617, P=.01). The average body mass index was not significantly different between MAS patients with and without PCOS (23.38 kg/m2 vs 23.44 kg/m2, 2-sample Wilcoxon rank-sum test with continuity correction, W=29, P=0.733). The majority of patients (71%) were treated with an aromatase inhibitor and/or a gonadotropin-releasing hormone (GnRH) agonist. The results of this study suggest that female individuals with MAS have a statistically higher prevalence of PCOS. These findings warrant further studies to determine whether the increased risk of PCOS may be associated with precocious puberty, treatment of precocious puberty, or other factors.

Elevated SAA1 promotes the development of insulin resistance in ovarian granulosa cells in polycystic ovary syndrome

BackgroundInsulin resistance (IR) contributes to ovarian dysfunctions in polycystic ovarian syndrome (PCOS) patients. Serum amyloid A1 (SAA1) is an acute phase protein produced primarily by the liver in response to inflammation. In addition to its role in inflammation, SAA1 may participate in IR development in peripheral tissues. Yet, expressional regulation of SAA1 in the ovary and its role in the pathogenesis of ovarian IR in PCOS remain elusive.MethodsFollicular fluid, granulosa cells and peripheral venous blood were collected from PCOS and non-PCOS patients with and without IR to measure SAA1 abundance for analysis of its correlation with IR status. The effects of SAA1 on its own expression and insulin signaling pathway were investigated in cultured primary granulosa cells.ResultsOvarian granulosa cells were capable of producing SAA1, which could be induced by SAA1 per se. Moreover, the abundance of SAA1 significantly increased in granulosa cells and follicular fluid in PCOS patients with IR. SAA1 treatment significantly attenuated insulin-stimulated membrane translocation of glucose transporter 4 and glucose uptake in granulosa cells through induction of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expression with subsequent inhibition of Akt phosphorylation. These effects of SAA1 could be blocked by inhibitors for toll-like receptors 2/4 (TLR 2/4) and nuclear factor kappa light chain enhancer of activated B (NF-κB).ConclusionsHuman granulosa cells are capable of feedforward production of SAA1, which significantly increased in PCOS patients with IR. Excessive SAA1 reduces insulin sensitivity in granulosa cells via induction of PTEN and subsequent inhibition of Akt phosphorylation upon activation of TLR2/4 and NF-κB pathway. These findings highlight that elevation of SAA1 in the ovary promotes the development of IR in granulosa cells of PCOS patients.

Effectiveness of herb-partitioned moxibustion combined with electroacupuncture on polycystic ovary syndrome in patients with symptom pattern of kidney deficiency and phlegm-dampne.

To observe the effect of herb-partitioned moxibustion combined with electroacupuncture on polycystic ovary syndrome (PCOS) in patients with symptom pattern of kidney deficiency and phlegm-dampness. Totally 62 PCOS patients who met the inclusion criteria were randomly divided into intervention group and control group. In the intervention group, acupoints were subjected to (43 ± 1) ℃ herb-partitioned moxibustion and electroacupuncture treatment. In the control group, acupoints were subjected to (37 ± 1) ℃ herb-partitioned moxibustion and sham electroacupuncture treatment. Treatment was provided 3 times per week for 12 weeks, and the treatment was stopped during menstruation. After the treatment, the clinical efficacy, the Traditional Chinese Medicine (TCM) symptom pattern score, basal body temperature (BBT) levels, menstrual cycle, and related sex hormone levels of the two groups were evaluated. Sixty patients were eventually included in the study (30 in the intervention group and 30 in the control group). There were not obvious between-group differences in the baseline efficacy parameters (all P > 0.05). (a) After treatment, the two groups have improved in terms of clinical efficacy, TCM symptom pattern score, menstrual cycle and, BBT (P < 0.01, < 0.05), and the intervention group was better than the control group (P < 0.01, < 0.05). (b) In the intervention group, the estradiol (E2) and P450 aromatase (P450arom) levels were increased (all P < 0.05), the testosterone (T) level was decreased (P < 0.05), and the luteotropic hormone (LH) and anti-Müllerian hormone (AMH) levels were significantly decreased (P < 0.01). In the control group, E2 level was increased (P < 0.05), and LH level was decreased (P < 0.05). After treatment, the T, LH, and AMH levels of the intervention group were decreased compared with those of the control group (all P < 0.05), and the P450arom level was increased (P < 0.05). Herb-partitioned moxibustion combined with electroacupuncture can effectively improve the related clinical symptoms of PCOS patients with kidney deficiency and phlegm-dampness. Herb-partitioned moxibustion combined with electroacupuncture may inhibit the overexpression of AMH to increase the expression level of P450arom in ovarian granulosa cells, thereby reconstructing the dependence of follicular development on FSH, and finally improving abnormal follicular development and hyperandrogenism in PCOS patients with kidney deficiency and phlegmdampness. ChiCTR1900024182.

P–710 The possible relation between kisspeptin and apoptosis on granulosa cells of PCOS patients

Abstract Study question Does kisspeptin administration affect the apoptotic factors of granulosa cells of Polycystic Ovary Syndrome (PCOS) patients? Summary answer Kisspeptin administration significantly increased apoptosis related factors. What is known already Kisspeptin plays a critical role in central gonadotropin secretion by acting on GnRH neurons in the hypothalamus. Kisspeptin receptors are also expressed on the ovaries. Kisspeptin–54 has recently been known as a prominent agent in oocyte maturation. Although there are many studies on the possible roles of kisspeptin administration in vivo on hypothalamic gonadotropin secretion and ovarian function and the possible roles of these effects in the pathogenesis of PCOS, there is not enough information about the effect of in vitro application of kisspeptin on ovarian function and conditions that lead to the development of PCOS. Study design, size, duration This basic research study was an in vitro experimental approach involving the use of granulosa cell from a PCOS and normal cases between July to December in 2020. 32 women were included in both control and PCOS groups. Participants/materials, setting, methods Women with (n = 16) and without (n = 16) PCOS were included in the study. Granulosa cells, follicular fluids and blood samples were collected on oocyte pick-up day. Cells were isolated from follicular fluids. Kisspeptin–54 levels were determined by ELISA in serum and follicle fluids. Also, FSH and LH levels were determined in serum. Kisspeptin–54 administrated in vitro to the half of the samples. Fluorescence spectrophotometer and laser scanning confocal microscope were used to evaluate calcium concentrations Main results and the role of chance The serum kisspeptin level was found significantly higher in PCOS patients compared to the control group (p &amp;lt; 0.05). Also, the level of kisspeptin in follicular fluid was statistically significantly higher in PCOS patients compared to the control group (p &amp;lt; 0.05). The mean serum FSH level of PCOS patients was found to be significantly lower than the control group (p &amp;lt; 0.05). Furthermore, the mean serum LH level of PCOS patients was significantly higher than control groups (p &amp;lt; 0.05). The intracellular calcium concentration in granulosa cells obtained from PCOS patients was significantly lower than the control group (p &amp;lt; 0.05). Limitations, reasons for caution The KISS1, KISS1R, BCL–2, CASPASE–3, FSHR, LHCGR, STAR, ESR1, ESR2, INHBA gene expression levels of apoptotic process is still under analyses. The protein expression analyses of these genes may strength the results. Wider implications of the findings: Using kisspeptin antagonists may be supposed as an additional treatment for patients with PCOS. Trial registration number OMU KAEK 2019 /724

Analysis of LncRNA-mRNA Co-Expression Profiles in Patients With Polycystic Ovary Syndrome: A Pilot Study.

PurposeThis study aimed to investigate the profiles of messenger RNAs (mRNAs) and long noncoding RNAs (lncRNAs) in peripheral blood samples collected from polycystic ovary syndrome (PCOS) patients. In addition, an in-depth bioinformatics analysis regarding the lncRNA-mRNA co-expression network was performed.MethodsHigh-throughput sequencing was used to measure the profiles of mRNAs and lncRNAs expressed in the peripheral blood samples isolated from six patients (three patients with PCOS and three normal women). In addition, five differentially expressed lncRNAs were chosen to validate the results of high-throughput sequencing by quantitative RT-PCR (qRT-PCR). Furthermore, a lncRNA-mRNA co-expression network was constructed using the Cytoscape software.ResultsA total of 14,276 differentially expressed mRNAs and 4,048 differentially expressed lncRNAs were obtained from the RNA-seq analysis of PCOS patients and healthy controls (adjusted q-value < 0.05, Fold change >2.0).The qRT-PCR results were consistent with the data obtained through high-throughput sequencing. Gene ontology (GO) and KEGG pathway analyses showed that the differentially expressed mRNAs were enriched in the chemokine signaling pathway. In addition, the analysis of the lncRNA-mRNA co-expression network of the chemokine signaling pathway showed the involvement of 6 mRNAs and 42 lncRNAs.ConclusionClusters of mRNAs and lncRNAs were aberrantly expressed in the peripheral blood of PCOS patients compared with the controls. In addition, several pairs of lncRNA-mRNAs in the chemokine signaling pathway may be related to PCOS genetically.

English

English

Effects of oral contraceptives on the quality of life of women with polycystic ovary syndrome: a crossover randomized controlled trial

Background and objectiveA limited number of studies have evaluated the effects of oral contraceptives (OCs) on the quality of life (QOL) of polycystic ovary syndrome (PCOS) patients. This study aimed to compare the effects of using OCs containing levonorgestrel (LNG) and those containing desogestrel (DSG), cyproterone acetate (CPA) or drospirenone (DRSP) for 6 months on the QOL with PCOS.MethodsIn this crossover randomized controlled 6-arm trial, 200 eligible patients with PCOS scheduled for OC therapy were randomly assigned to one of the 6 study arms. All 6 arms include two 6-month treatment periods, one period with OCs containing LNG, and the other with each of the 3 OCs containing DSG, CPA, or DRSP. Outcomes of interest were the total score of QOL and its domains, which were assessed using a specific and valid health-related quality of life questionnaire for PCOS, which is consisted of six domains, including psychosocial–emotional, self-image, fertility, sexual function, hirsutism, and obesity– menstrual disorders.ResultsFinally, a total of 88 patients were analyzed for this study. The results showed that use of OCs containing DSG, CPA, and DRSP for 3 months was not associated with significant differences in the total scores of QOL compared to those OCs containing LNG, whereas, after 6 months of treatment, patients treated with OCs containing CPA had more improvements in their total scores of QOL, in comparison to OCs containing LNG (P < 0.042). We found no significant differences in QoL domains, including psychosocial–emotional, self-image, fertility, sexual function, hirsutism, and obesity-menstrual disorders after 3–6 months of treatment with DSG, CPA, or DRSP, compared to LNG. The sequence and period effects were not significant in any of the analyses at 3 and 6 months of treatment. The carry-over effect was not significant for most outcomes assessed.ConclusionsThis crossover study demonstrated non-inferiority of OCs with newer generation progestins on different domains of QOL, in comparison with older compounds, although usage of products containing CPA was significantly associated with more improvement in total QOL of PCOS patients, compared to those containing LNG after 6-month of treatment.Trial registrationIRCT201702071281N2.

Relation of serum vitamin D level in polycystic ovarian syndrome (PCOS) patients to ICSI outcome

BackgroundRecently, vitamin D was discovered to have an important role in female reproduction and IVF. However, there were no studies specifically addressed its role in polycystic ovarian syndrome (PCOS) patients undergoing ICSI cycles. Therefore, this cross-sectional study in a university hospital was conducted to evaluate the effect of serum level of vitamin D (VD) on the number of retrieved and fertilized oocytes, and chemical and clinical pregnancy rate in PCOS females undergoing ICSI cycles. The study included 80 PCOS cases undergoing ICSI cycles in the age from 20 to 39 years using antagonist protocol. Cases with severe male or tubal factors were excluded. Serum 25 (OH) D vitamin level was assessed by the ELIZA method on the day of oocyte retrieval. Correlation and regression analyses were used in the analysis.ResultsVD was positively correlated to both numbers of retrieved and fertilized oocytes (r = 0.35, 95% CI 0.15, 0.53, P = 0.001; r = 0.33; 95% CI 0.03, 0.57, P = 0.03, respectively). It was still significantly correlated to the number of oocytes (coefficient 0.47; 95% CI 0.1, 0.9; P = 0.018) and to the number of fertilized eggs (coefficient 0.3; 95% CI 0.02, 0.58; P = 0.03) after adjusting for age, BMI, and type of ovulation-triggering agent. This means with each 2 ng/mL increase in serum VD level, around one more egg will be retrieved. In addition, there will be one more fertilized oocyte with each 3 ng/mL increase in the vitamin level. However, no significant correlation was found between the vitamin level and the occurrence of chemical or clinical pregnancy.ConclusionsSerum vitamin D level is positively correlated with the number of retrieved and fertilized oocytes in PCOS patients undergoing ICSI cycles.

Polycystic ovary syndrome in patients with hair thinning

To the Editor: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age, involving pathways that produce metabolic, reproductive, cardiovascular, and dermatologic effects. Diagnosis is based on the Endocrine Society Clinical Practice Guideline and the 2003 Rotterdam criteria, which requires 2 of the following to establish a definitive diagnosis1,2: (1) oligo- or anovulation, (2) hyperandrogenism (clinical or biochemical), and (3) polycystic ovary morphology on transvaginal ultrasonography.

Abstract P6-09-01: RAD51B loss-of-function variants confer susceptibility to hereditary breast and ovarian cancers and result in tumors with genomic features of homologous recombination repair defects

Abstract Introduction: Germline pathogenic variants in genes in the homologous recombination (HR) pathway such as BRCA1, BRCA2, ATM, PALB2, RAD51C and RAD51D confer an increased risk of breast and ovarian cancers. Screening for germline variants in these cancer susceptibility genes is critical as prophylactic measures and monitoring can be performed in these individuals to minimize their risk of developing breast and/or ovarian cancers. More recently, it has been recognized that cancers arising in carriers of germline pathogenic (P)/ likely pathogenic (LP) variants in HR genes often show a homologous recombination (HR) deficient (HRD) phenotype and can be targeted with platinum agents or PARP inhibitors. RAD51B is a RAD51 paralog that binds to RAD51C and functions as a heterodimer in the HR pathway. Whilst RAD51B germline variants have been reported in isolated cases of breast and ovarian cancers, it is unclear as to whether RAD51B P/LP germline variants would confer predisposition to these cancer types. Materials and Methods: We screened 9,287 consecutive unselected cancer patients who consented for both tumor and germline testing using the MSK-IMPACT platform for the presence of RAD51B germline truncating variants. Selected RAD51B germline mutant breast cancers identified by MSK-IMPACT were subjected to whole-exome sequencing (WES) analysis to determine the dominant mutational signatures using DeconstructSigs. Functional assays were performed to ascertain the impact of RAD51B loss on HR DNA repair and PARP inhibitor sensitivity using genome editing methods in non-malignant breast epithelial cell lines. Results: Out of the 9,287 cancer patients, we detected likely pathogenic loss of function RAD51B germline variants in 11 patients (0.12%), which was similar to the frequency detected in the gnomAD database (0.09%). All female carriers of RAD51B loss of function variants (n=8) had breast or ovarian cancers (8/1,619 breast or ovarian cancers, 0.5%). The observed carrier frequencies of germline truncating variants in RAD51B was statistically enriched in breast and ovarian cancer patients compared to individuals in the gnomAD database (0.5% vs 0.09% P=0.0003; odds ratio = 5.06 (95% CI: 2.1-10.3)). Although segregation studies were not available, 9/11 of the RAD51B germline loss of function variant carriers had a personal or family history of breast or ovarian cancers. All five breast and ovarian cancers from RAD51B mutation carriers investigated by WES were found to harbor RAD51B bi-allelic inactivation through loss of heterozygosity of the RAD51B wild-type allele. In addition, these five cases were found to display genomic features of HRD including high large-scale state transition scores and a dominant mutational signature 3. CRISPR/Cas9 genome editing of RAD51B in a non-malignant breast epithelial cell model revealed that RAD51B deficient cells display PARP inhibitor sensitivity similar to that reported in BRCA1 and BRCA2 deficient cell lines. Conclusion: RAD51B loss-of-function germline variants confer susceptibility to breast and ovarian cancer development. Breast and ovarian cancers occurring in the context of RAD51B germline mutations harbor bi-allelic inactivation of RAD51B through loss-of-heterozygosity of the wild-type allele, genomic features of HRD and are likely sensitive to PARP inhibition. Albeit rarely germline mutated, RAD51B should be considered as an addition to clinical germline testing panels for hereditary breast and ovarian cancer syndrome patients. &amp;lt;!–EndFragment→ Citation Format: Diana SReis-FilhoReis-Filho Mandelker, Semanti Mukherjee, Jeremy Setton, Pier Selenica, Yelena Kemel, Ozge Ceyhan-Birsoy, Margaret Sheehan, Kaitlyn Tkachuk, David N Brown, Simon Powell, Britta Weigelt, Mark E Robson, Nadeem Riaz, Kenneth Offit, Jorge S Reis-Filho. RAD51B loss-of-function variants confer susceptibility to hereditary breast and ovarian cancers and result in tumors with genomic features of homologous recombination repair defects [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-09-01.

Significant reduction of T3 hormone and increase in the occurrence of non-thyroid illness syndrome in ovarian cyst and polycystic ovary syndrome patients

Significant reduction of T3 hormone and increase in the occurrence of non-thyroid illness syndrome in ovarian cyst and polycystic ovary syndrome patients

Relation of Vitamin D Deficiency in Women with Polycystic Ovarian Syndrome in Kirkuk

Polycystic ovary syndrome is one of the most chronic diseases affecting women. Some studies indicate that the level of vitamin D is related to the development of polycystic ovary syndrome. This vitamin-like hormone has a certain effect on insulin sensitivity and restoring reproductive capacity in women with polycystic ovary syndrome. Therefore, it was planned to study the relationship between vitamin D deficiency and PCOS. This study planned to show the relationship between vitamin D deficiency, total cholesterol level, and the appearance of polycystic ovary syndrome in patients attending Kirkuk General Hospital.

A Meta-Analysis of Oocyte Quality and Clinical Outcome of Intracytoplasmic Sperm Injection Cycles in Patients with Polycystic Ovary Syndrome

Whether treatment outcomes in intracytoplasmic sperm injection (ICSI) cycles differ between polycystic ovary syndrome (PCOS) and non-PCOS patients remains inconclusive. The aim of this meta-analysis is to compare oocyte quality and clinical outcomes in PCOS patients and non-PCOS patients undergoing ICSI procedure. Methods: Databases including Medline, Embase and the Cochrane Library were searched for studies published up to 18 January 2018. All articles searched were independently reviewed and selected by two evaluators according to predetermined inclusion and exclusion criteria. Results: Eight studies were selected for inclusion, and a total of 474 PCOS patients (627 cycles) were compared to age-matched controls (962 patients, 992 cycles). The total gonadotropin usage was significant less in PCOS group, and the MD was –481.72 IU [95% CI:– 603.76–359.68, P &lt; 0.00001]. A significantly higher mean number of oocytes, metaphase II (MII) oocytes and 2-pronucleated (2PN) oocytes per cycle were observed in the PCOS group than in the non-PCOS group (P &lt; 0.005), the total MDs were 4.20 [95% CI: 2.50–5.90], 1.52 [95% CI: 0.84–2.20] and 1.71 [95% CI: 0.73–2.69], respectively. The fertilization rate was comparable. The clinical pregnancy rate per transfer cycle was higher in the PCOS group, the odd ratio (OR) was 1.59 [95% CI: 1.23–2.05, P &lt; 0.005] and the live birth rate was comparable. A higher miscarriage rate was observed in the PCOS group, but this did not reach statistical significance. The risk of ovarian hyperstimulation syndrome (OHSS) was significantly higher in the PCOS group [OR: 3.01, 95% CI: 1.16–7.82, P &lt; 0.05]. Conclusions: This meta-analysis demonstrated that PCOS patients may have more favourable ICSI outcomes than non-PCOS patients. Our findings should be evaluated in further prospective cohort studies.

The effect of artificial cycle scheme after long-acting GnRH agonist down regulation in endometrium preparation in frozen embryo transfer cycle in patient with polycystic ovarian syndrome

Objective To assess the effects of artificial cycle after long-acting gonadotropin-releasing hormone (GnRH) agonist down regulation scheme and artificial cycle only scheme in preparation of endometrium before frozen embryo transfer in polycystic ovary syndrome (PCOS) patients on pregnancy outcome. Methods A retrospective analysis was made on the frozen embryo transfer of 132 PCOS patients in the reproductive center of Hunan Maternal and Child Health Hospital from November 2016 to October 2017. The patients were divided into GnRH-a down regulation + artificial cycle group (n=66) and simple artificial cycle group (n=66) according to the different endometrial preparation schemes before frozen embryo transplantation. The transplantation cycle and pregnancy outcome of the two groups were compared. Results ⑴ There was no statistically significant difference in age, primary infertility rate, infertility years and body mass index (BMI) between the two groups (P>0.05). ⑵ In the artificial cycle group, 4 cases in which the transplantation was cancelled, including 2 cases who were cancelled due to breakthrough bleeding and 2 cases due to endometrial thickness that were less than 7 mm. There was a statistically significant difference in the cancellation rate between the two groups (χ2=4.13, P=0.04). There were no statistically significant difference in embryo frozen storage time, retrieved oocytes in fresh embryo cycle, frozen thawed embryos in the survival rate, graftage embryonic number, high-quality embryonic rate, endometrium thickness in conversion day (P>0.05). Estrogen level, luteinizing hormone (LH) levels on endometrium conversion day in GnRH-a down regulation plus artificial cycle group and artificial cycle group were respectively as [(1 439.38±357.43)nmol/ml vs (1 580.54±479.69)nmol/ml and (2.32±0.94)mIU/ml vs (9.46±1.52)mIU/ml], with statistically significant difference (χ2=53.64, P<0.001; χ2=14.32, P<0.001). ⑶ The biochemical pregnancy rates of the patients in the GnRH-a down regulation plus artificial cycle group and artificial cycle group were 72.73% and 53.23% respectively, with statistically significant difference (χ2=5. 23, P=0.036). The clinical pregnancy rate (65.15%) in GnRH-a down regulation plus artificial cycle group was higher than that of the artificial cycle group (46.77%), with statistically significant difference (χ2=4.39, P=0.022). There was no statistically significant difference in early abortion rate and ectopic pregnancy rate between the two groups. Conclusions In frozen embryo transplantation cycle, long-term GnRH-a down regulation after artificial cycle scheme is superior to simple artificial cycle scheme with significantly reduced cycle cancellation rate, low estrogen and LH levels in endometrium transformation day and higher biochemical pregnancy rate and clinical pregnancy rate. Key words: Gonadotropin-releasing hormone; Polycystic ovary syndrome; Embryo transfer; Endometrium