PCOS Patients Research Articles

The effects of portfolio moderate-carbohydrate and ketogenic diets on anthropometric indices, metabolic status, and hormonal levels in overweight or obese women with polycystic ovary syndrome: a randomized controlled trial

BackgroundPolycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders in reproductive-age women caused by hyperinsulinemia. The portfolio Moderate-carbohydrate diet (PMCD) is a plant-based diet with a carbohydrate content of 40% and incorporates five cholesterol-lowering foods. While, the ketogenic diet is a high-fat diet with 70% fat, promoting a ketosis state. To the best of our knowledge, no study compared the therapeutic effects of these two diets in PCOS patients. Thus, this study aimed to compare the impact of PLCD and KD on anthropometric indices, metabolic status, and hormonal levels in overweight or obese women with PCOS.MethodsThis open-label, randomized clinical trial was conducted on forty-six PCOS women. 21 women in PMCD and 19 in the KD group completed the study. The anthropometric indices including body mass index (BMI) and fat body mass (FBM), metabolic markers (fasting blood glucose (FBG)) and plasma lipid profiles including low-density lipoprotein (LDL), triglycerides, and high-density lipoproteins (HDL) were measured. Reproductive hormones such as luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEA-s) and free testosterone were assessed at the baseline and after the intervention.ResultsHowever, after 8 weeks both diets demonstrated enhancement in anthropometric indices (BMI, FBM, lean body mass), metabolic status (FBG, insulin serum levels), and reproductive hormones such as LH, free testosterone, and DHEA-s. The mean difference in the KD improved more than the PMCD in the field of BMI reduction (MD (SD) 2.73 (0.351) vs. MD (SD) 1.71 (0.775)) and LH (MD 4.13 (1.375) vs.MD 2.46 (1.105)). Nevertheless, the lipid profile including LDL-C and triglycerides improved more in the PMCD compared to the KD (MD 33.95 (7.345) vs. MD 23.34 (14.136)) and (MD 38.20 (10.757) vs. MD 57.62 (21.688)) respectively. There were no significant changes in the Ferriman-Gallwey score within or between the two groups.ConclusionThe findings revealed that both diets were effective in improving PCOS manifestations. However, the KD exhibited greater effectiveness in enhancing body measurements, metabolic factors, and reproductive hormone levels compared to the PMCD in obese PCOS women. Furthermore, PMCD could be more beneficial for PCOS women with lipide disorders.Registration number of clinical trialIRCT20200912048693N3, Trial registered 2022–12–14. https://www.irct.ir/trial/67548

The identification of key genes and pathways in polycystic ovary syndrome by bioinformatics analysis of next-generation sequencing data

BackgroundPolycystic ovary syndrome (PCOS) is a reproductive endocrine disorder. The specific molecular mechanism of PCOS remains unclear. The aim of this study was to apply a bioinformatics approach to reveal related pathways or genes involved in the development of PCOS.MethodsThe next-generation sequencing (NGS) dataset GSE199225 was downloaded from the gene expression omnibus (GEO) database and NGS dataset analyzed is obtained from in vitro culture of PCOS patients’ muscle cells and muscle cells of healthy lean control women. Differentially expressed gene (DEG) analysis was performed using DESeq2. The g:Profiler was utilized to analyze the gene ontology (GO) and REACTOME pathways of the differentially expressed genes. A protein–protein interaction (PPI) network was constructed and module analysis was performed using HiPPIE and cytoscape. The miRNA-hub gene regulatory network and TF-hub gene regulatory network were constructed. The hub genes were validated by using receiver operating characteristic (ROC) curve analysis.ResultsWe have identified 957 DEG in total, including 478 upregulated genes and 479 downregulated gene. GO terms and REACTOME pathways illustrated that DEG were significantly enriched in regulation of molecular function, developmental process, interferon signaling and platelet activation, signaling, and aggregation. The top 5 upregulated hub genes including HSPA5, PLK1, RIN3, DBN1, and CCDC85B and top 5 downregulated hub genes including DISC1, AR, MTUS2, LYN, and TCF4 might be associated with PCOS. The hub gens of HSPA5 and KMT2A, together with corresponding predicted miRNAs (e.g., hsa-mir-34b-5p and hsa-mir-378a-5p), and HSPA5 and TCF4 together with corresponding predicted TF (e.g., RCOR3 and TEAD4) were found to be significantly correlated with PCOS.ConclusionsThese study uses of bioinformatics analysis of NGS data to obtain hub genes and key signaling pathways related to PCOS and its associated complications. Also provides novel ideas for finding biomarkers and treatment methods for PCOS and its associated complications.

Obesity is associated with SHBG levels rather than blood lipid profiles in PCOS patients with insulin resistance

ObjectivePolycystic ovary syndrome (PCOS) is a prevalent endocrine disorder characterized by hormonal imbalances and insulin resistance (IR). Among the metabolic abnormalities associated with PCOS, obesity is often present concurrently. Nevertheless, the correlation between obesity, sex hormone levels, and blood lipid profiles in PCOS patients with IR remains uncertain.MethodsThis is a cross-sectional study including a total of 206 Chinese women diagnosed with PCOS, enrolled between March 2016 and December 2021. The participants’ anthropometric measurements, such as weight, height, waist circumference, and hip circumference, were recorded. Additionally, fasting blood samples were collected to measure various parameters, including fasting glucose, insulin levels, lipid profiles, and sex hormone levels.ResultsOur findings highlight that obesity exhibited a significant correlation with lower levels of sex hormone binding globulin (SHBG) and elevated levels of free androgen index (FAI), fasting insulin, and HOMA-IR in PCOS patients diagnosed with IR. However, no significant association between obesity and blood lipid profiles was observed within this particular group of women.ConclusionThis study suggests that among PCOS patients with IR, lower levels of SHBG and higher levels of FAI are associated with obesity. These findings indicate that SHBG and FAI may have the potential to serve as a biomarker for the initial identification and prognosis of IR in PCOS patients.Trial registrationRetrospectively registered on 25/04/2020 at ClinicalTrials.gov Identifer: NCT04264832.

ICSI and PGT-A in PCOS phenotype-D patients: a matched case-control study versus idiopathic infertile women.

To assess oocyte competence and embryo chromosomal constitution in phenotype-D PCOS women undergoing ICSI for PGT-A at the blastocyst stage. Retrospective study at a private IVF center. In the period 2013-2021, 58 naïve phenotype-D PCOS women (i.e., oligomenorrhea, ovarian PCO-morphology, and absence of hyperandrogenism) underwent ICSI with ejaculated sperm for PGT-A. These cases were matched to 58 controls selected from 2211 naïve women with idiopathic infertility planned for the same treatment in the same period. The matching variables were age (≈ 36years), BMI (≈ 22), cumulus oocyte complexes (COCs) retrieved (≈ 21-23), and sperm quality (≈ 43-45% men with all sperm parameters > 5th percentile). The primary outcome was euploid blastocyst rate (EBR) per cohort of inseminated oocytes. Maturation rates per COCs and euploidy per biopsied blastocysts were similar. PCOS patients with phenotype-D showed higher fertilization per inseminated oocytes and higher blastulation per zygotes. This resulted into a higher EBR per inseminated oocytes and more euploid blastocysts available for transfer, although these differences adjusted for confounders were not significant. The live birth rate per first euploid transfers was comparable, so were all other outcomes considered. Oocyte competence was not compromised in phenotype-D PCOS women, while good prognosis idiopathic infertile women might have unknown oocyte issues. In case of repeated failures after intrauterine insemination, a timely referral to IVF might represent an efficient strategy, in line with the "one-and-done" approach fulfilling a family planning perspective. Indeed, 22% of the phenotype-D PCOS women had 2 singleton LBs and 76% had surplus oocytes/euploid blastocysts after achieving ≥ 1 live birth.

Gaps in knowledge regarding the diagnostic criteria and management of PCOS in Germany: An anonymous web-based survey

IntroductionPolycystic Ovary Syndrome (PCOS) is a multifactorial condition that can include a myriad of symptom complexes. A study in North America demonstrated that a significant percentage of physicians were unaware of crucial aspects of PCOS. This study aimed to examine the level of knowledge about PCOS among physicians in Germany. MethodsAn anonymous cross-sectional online questionnaire was distributed to all gynecological clinics and fertility centers in Germany. The responsible gynecologists in service were contacted and they were asked to distribute the questionnaire among the employed physicians in their clinic. Results and discussionThe questionnaire was completed 206 times. 92 (65.7 %) of all respondents were board-certified gynecologists without specialty training in reproductive medicine and gynecologic endocrinology (Non-RMGE), 48 (34.3 %) had completed this training (RMGE). RMGE were more likely to know the correct criteria for the diagnosis of PCOS (97.9 % vs. 51.3 %; p < 0.001) and were able to name a higher number of correct symptoms that may be associated with PCOS (20.8 vs. 14.0; p < 0.001) than Non-RMGE (B = 4.530, CI 1.379–7.680; p = 0.006). The preferred general treatments and fertility treatments for PCOS patients also differed significantly between the two groups (p = 0.002, p < 0.001). The participants were asked how doctors and healthcare professionals could be best supported to improve the care of PCOS patients. Over 58.3 % of participants considered the creation of a PCOS website dedicated to healthcare professionals to be valuable. ConclusionThis study is the first to identify knowledge gaps about PCOS among physicians in Germany. The findings also highlight the potential disparities in PCOS knowledge between hospital and fertility center settings, emphasizing the need for improved training to ensure consistent and high-quality care for PCOS patients. The participants preferred a dedicated website for health professionals, indicating a demand for easily accessible information and training resources.

Association between QTc and Poincare plot in polycystic ovary syndrome in young adolescents: A cross-sectional study

ABSTRACT Context: PCOS is one of the most neglected noncommunicable diseases, and early detection would be of great value to primary care physicians. Sympathovagal imbalance detected using heart rate variability (HRV) can be used to detect early autonomic changes if any. Aim: The present study aimed to evaluate QTc and Poincare plot (nonlinear analysis of HRV) in young adolescent PCOS patients. Materials and Methods: It was a cross-sectional study involving 25 PCOS and 25 healthy individuals of age group 12–18 years. HRV was evaluated using the lead II ECG for 10 min from which QTc was calculated manually using the Bazett formula. Student’s t-test was used to assess differences between means. A P value &lt; 0.05 was taken for statistical significance. The association between QTc and Poincare plot descriptors was assessed by Pearson’s correlation analysis. Results: HRV linear analysis domain represented as the LF/HF ratio was reported to significantly increased among the PCOS group (P = 0.04). Similarly, the nonlinear analysis of HRV by Poincare plot reported a significant decrease in SD1 (P = 0.04) and SD2 (P = 0.02). The heart rate was significantly increased among the PCOS group (P &lt; 0.001). QTc did not show any significant increase among the PCOS group (P = 0.09). QTc was reported to be positively correlated with SD1 (r = 0.37, P &lt; 0.01), SD2 (r-0.33, P = 0.02), LF HF ratio (r = 0.52, P &lt; 0.001), and BMI (r = 0.92, P &lt; 0.001), respectively. Conclusion: The study suggests that HRV nonlinear analysis can be used as a simple noninvasive tool to evaluate cardiovascular autonomic changes.

The effects of fresh embryo transfer and frozen-thawed embryo transfer on the perinatal outcomes of single fetuses from mothers with PCOS.

To investigate the effects of fresh embryo transfer and frozen-thawed embryo transfer on perinatal outcomes among patients with PCOS. Patients who underwent in vitro fertilization and embryo transfer at the reproductive medicine center of the Affiliated Hospital of Guangdong Medical University from February 2013 to March 2021 were retrospectively analyzed. Patients were divided into the fresh embryo transfer group and frozen-thawed embryo transfer group according to whether fresh embryo transfer was performed. According to their conditions, patients were further classified into the ET-PCOS group (group A, n = 104), ET-non-PCOS group (group B, n = 212), FET-PCOS group (group C, n = 102), or FET-non-PCOS group (group D, n = 148); the general data, laboratory indicators and pregnancy outcomes of the patients were statistically analyzed, and the perinatal outcomes and related factors between the groups were compared and analyzed. The level of E2 on the HCG test day in the ET group was lower than that in the FET group. The natural birth rate of group D was lower than that of group A and group B, and the cesarean section rate was higher than that of group A and group B; the clinical pregnancy rate of group A was higher than that of group B and group D, and the difference was statistically significant (P < 0.05). There was no significant difference in the total abortion rate, early abortion rate or late abortion rate between the groups (P > 0.05). There was no significant difference in gestational age, neonatal sex or neonatal weight between the groups (P > 0.05). The incidence of placenta previa in Group B was significantly lower than that in Group D, and the difference was significant (P < 0.05). The incidence of fetal distress in Group B was significantly lower than that in Groups C and D, and the incidence of neonatal jaundice in Group D was significantly higher than that in Groups A and B (P < 0.05). In the multivariate analysis, the number of high-quality embryos was independent factors affecting clinical pregnancy, and the embryo transfer method was an independent factor affecting fetal distress and neonatal jaundice. Young PCOS patients without risk of OHSS have a high clinical pregnancy rate with fresh transplant cycles. PCOS disease itself has no significant effect on the perinatal outcomes of the mother or singleton infant. Frozen-thawed embryo transfer may increase the incidence of low placenta, fetal distress and neonatal jaundice.

Correlation and predictive value of systemic immune-inflammation index for dyslipidemia in patients with polycystic ovary syndrome

BackgroundPolycystic ovary syndrome(PCOS) is one of the main factors leading to infertility in women of reproductive age, which is often accompanied by metabolic changes such as obesity and chronic low-grade inflammation. Chronic inflammation may play an important role in the occurrence and development of metabolic diseases. Therefore, it is of great significance to explore the relationship between abnormal lipid metabolism and inflammation in PCOS patients. This study aims to analyze the correlation between systemic immune-inflammatory(SII) markers and dyslipidemia in patients with PCOS and their value in early diagnosis.MethodsA total of 617 PCOS patients aged 20–35 years (according to the Rotterdam diagnostic criteria) who visited the Reproductive Center of the First Hospital of Lanzhou University from January 2020 to December 2022 were included. According to the presence or absence of dyslipidemia, the patients were divided into normal lipid metabolism group and abnormal lipid metabolism group. The clinical data of the patients were collected and analyzed by SPSS software.ResultsThere were 454 patients with normal lipid metabolism and 163 patients with abnormal lipid metabolism. The SII level of the abnormal lipid metabolism group was higher than that of the normal group. As the SII quartile increased, TC, TG and LDL increased, while HDL decreased accordingly. The SII level was positively correlated with TC, TG and LDL, and negatively correlated with HDL (all P < 0.05). Among them, SII had the best predictive efficiency for dyslipidemia of polycyctic ovary syndrome at 489.375 (AUC: 0.718, 95%CI: 0.672–0.764), and SII was still associated with the increased occurrence of PCOS dyslipidemia after excluding confounding factors (P < 0.05). ConclusionThe high level of SII has a correlation with the occurrence of dyslipidemia in PCOS patients, and it has a value in the early diagnosis of PCOS.

Pre-Conception Androgen Levels and Obstetric Outcomes in Polycystic Ovary Syndrome: A Single-Center Retrospective Study

Hyperandrogenism is a determining diagnostic factor for PCOS. If pregnancy is conceived, it is considered high-risk due to several potential complications, but the correlation between pre-pregnancy androgen levels and obstetric outcomes is poorly characterized. Objective: To determine if pre-pregnancy serum androgen concentrations and androgen indexes differed when certain obstetric and neonatal outcomes appeared in PCOS. Methods: A single-center, retrospective study was carried out. All patients were treated between 2012 and 2019. A total of 73 patients had all the endocrine and obstetric data available. Pre-pregnancy hormone levels (total testosterone-T, androstenedione-AD, DHEAS (dehydroepiandrosterone sulfate), SHBG (sex-hormone-binding globulin), and TSH (thyroid-stimulating hormone) were collected, and T/SHBG, AD/SHBG, DHEAS/SHBG, T/AD indexes were calculated and compared. Results: When miscarriage was present in the history, significantly elevated pre-pregnancy AD levels were observed. Higher pre-pregnancy AD level was noted in PCOS patients delivering female newborns as compared to males. Additionally, a higher T/AD ratio was associated with subsequent preterm delivery, but significance was lost after age adjustment. Maternal age at delivery had a significant negative correlation with pre-pregnancy DHEAS levels and DHEAS/SHBG ratio. Pre-pregnancy SHBG displayed a significant negative correlation, while pre-pregnancy androgen/SHBG ratios exhibited positive correlations with both birth weight and birth weight percentile. Conclusions: Based on our data, AD and the T/AD ratio emerge as distinctive factors in certain outcomes, implying a potential specific role of altered 17-β-HSD (17β-hydroxysteroid dehydrogenase) enzyme activity, possibly influencing offspring outcomes. The pre-pregnancy T/SHBG ratio exhibits a potentially stronger correlation with fetal growth potential compared to SHBG alone. DHEAS and maternal age at delivery are strongly correlated in PCOS patients.

High androgen level during controlled ovarian stimulation cycle impairs endometrial receptivity in PCOS patients

PCOS is one of the most common endocrine disorders among women of reproductive age. While the mechanism involved is not yet fully characterized. Our study aims to examine the pregnancy outcomes of embryo transfers in women with PCOS after pretreatment, and to explore the possible effect of high androgen levels on endometrial receptivity. Retrospective cohort study was conducted to analyze pregnancy outcomes among 2714 infertile women with tubal factor and 452 PCOS women. Endometrium samples were collected from 6 controls and 6 PCOS patients to detect the expression of endometrial receptivity marks. The implantation rate, clinical and ongoing pregnancy rates and live birth rate in women with PCOS followed fresh embryo transfers were obviously decreased even after the pretreatment. Similar pregnancy outcomes were found in frozen-thawed embryo transfer cycles between women with or without PCOS. Strikingly, serum total testosterone (TT) levels on trigger day were significantly higher in PCOS women. Women with high TT levels presented significantly lower clinical and ongoing pregnancy rates, and the expression of insulin-like growth factor binding protein 1 (IGFBP-1), and leukemia inhibitory factor (LIF) in the endometria decreased significantly as well. High doses of testosterone significantly down-regulated the expression of IGFBP-1 and LIF in Ishikawa cells. Although endocrine abnormalities had been improved before the controlled ovarian stimulation (COS) cycle started, higher serum TT levels were detected on the trigger day of the COS cycle in PCOS patients, which may contribute to the decreased fresh embryo implantation by impairing endometrial receptivity.

Polycystic Ovary Syndrome Accompanied by Hyperandrogenemia or Metabolic Syndrome Triggers Glomerular Podocyte Injury.

Objective: To determine whether the urinary excretion of podocyte degradation products varies according to PCOS phenotype and metabolic syndrome (MetS). Methods: The concentrations of podocalyxin (PDX) and nephrin, chronic markers of podocyte damage, and neutrophil gelatinase-associated lipocalin (NGAL), a marker of acute glomerular damage, were analyzed in the morning urine samples of 50 PCOS patients and 50 healthy controls matched by age and BMI. Albuminuria was assessed by calculating the urine albumin-creatinine ratio (uACR). Results: The PDX, nephrin and NGAL concentrations of PCOS participants were significantly higher than those of the control group. While PDX, nephrin and NGAL levels of classic phenotypes were similar, they were higher than ovulatory and non-hyperandrogenic phenotypes. Significant increases in urinary levels of each podocyte protein were detected in PCOS patients with MetS compared to patients without MetS. A positive significant correlation between podocyte proteins and BMI, systolic blood pressure, testosterone, glucose, HOMA-IR and uACR. After adjusting for age and BMI, podocyte proteins were an independent risk factor for microalbuminuria. The incidence of microalbuminuria in PCOS increased 6-fold compared to controls. The frequency of microalbuminuria was higher in classical phenotypes than in ovulatory phenotype. The frequency of microalbuminuria in PCOS patients with MetS was 6.5 times higher than in PCOS patients without MetS. Conclusions: In PCOS accompanied by hyperandrogenemia or metabolic syndrome, leakage of acute and chronic podocyte breakdown products into the urine becomes more pronounced.

Impact of Letrozole on Prevention of Early Onset Ovarian Hyperstimulation Syndrome in GnRH Antagonist Protocol: A Randomized Controlled Trial

Abstract Background Ovarian hyperstimulation syndrome (OHSS) is a risk associated with assisted reproductive technology. There is a link between higher incidences of OHSS and higher blood estrogen levels. With its strong, targeted, and reversible inhibition of aromatase and E synthetase, the nonsteroidal aromatase inhibitor letrozole can prevent the conversion of androgens into estrogens. Methods Study populations were divided into two equal groups: Group I: Consisted of 85 women who received controlled ovarian stimulation with a conventional antagonist protocol and letrozole. Group II: Consisted of 85 women who received controlled ovarian stimulation with a conventional GnRH antagonist protocol and a placebo. Results There were statistically significant differences among the groups in terms of Estradiol level on Trigger Day (p = 0.037), Number of oocytes retrieved (p = 0.018). The total days of stimulation and cumulative Gonadotropin dose were significantly lower in the Letrozole group (p = 0.045). There were no significant differences between the groups as regard endometrial thickness at trigger day, number of fertilized oocytes, fertilization rate, embryos transferred per cycle, and fresh embryos transferred, mild and critical early onset OHSS, Cycle cancels, Biochemical pregnancy, and Clinical pregnancy between the two groups (P &amp;gt; 0.05). There was a significant difference as regard moderate and severe early onset OHSS between the two groups (P &amp;lt; 0.05). Conclusion We've concluded that for PCOS patients facing a high risk of OHSS, supplementing the GnRH-ant protocol with LE offers a safer, more effective, cost-efficient, and patient-friendly approach compared to the traditional GnRH-ant protocol. The use of LE alongside conventional protocols might alleviate severe forms of OHSS, even among those at extreme risk, without compromising the potential for implantation, pregnancy, and delivery

DIA proteomic and PRM validation through human granulose cells profiles screen suitable biomarkers for polycystic ovary syndrome patients

The aim of this study is to identify differentially expressed proteins (DEPs) in granulose cells (GCs) from women with or withoutpolycystic ovary syndrome (PCOS) via data independent acquisition (DIA) proteomic analysis.A total of 63 women were recruited for this study, 34 PCOS patients as experimental group (P), and 29 women without PCOS as Normal group (NP). DIA-based proteomic analysis was performed to identify DEPs in GCs between the P and NP samples. Certain typical DEPs were further validated by Parallel reaction monitoring (PRM), and correlation analysis was performed between these DEPs and the clinical characteristics.Cell vitality was measured by CCK-8 assay. DIA analysis revealed 174 significantly DEPs, of which 7 were upregulated and 167 downregulated. Bioinformatics analysis was performed to analysis the significantly DEPs. The PRM experiment confirmed TOP2A and SPHKAP were upregulated significantly in P by comparing to NP, while GM2A, MRPS16, APOA2 and FGF2 were downregulated significantly. Most notably, Correlation analysis revealed that TOP2A, SPHKAP, MRPS16 and FGF2were positively correlated with TG, AMH and Age, but negatively correlated with Menarche age, DBIL, FT3, Basal serum FSH and LH.Meanwhile, CCK-8 assay has shown that downregulation of FGF2 could weaken cell viability. Finally, a panel of DEPs were identified in the GCs of patients with PCOS, of which certain significant DEPs might play essential roles in the pathogenesis of PCOS, could be regarded as candidate biomarkers for PCOS.

Letrozole Low Dose versus High Dose for Ovulation Induction with Timed versus Spontanous Intercourse in PCO

Abstract Objective to compare the effect of low dose and high dose of letrozole in ovulation induction in PCOS. Effect of (HCG) administration in ovulation rate and pregnancy rate. Effect of timed Versus spontaneous intercourse in pregnancy rate. Study Setting This study was carried out at. Ain Shams Maternity Hospital Infertility Clinic and Qena General Hospital Infertility Clinic. Study Design Four arm clinical randomized trial. Study Time Start from 4-October 2021 ended 10- Jan. 2023. Results The objective of this study was to investigate the effect of low dose and high dose of letrozole on ovulation induction and effect of spontaneous &amp; timed intercourse with (HCG) on pregnancy rate in one treatment cycle. This four arm clinical randomized trial study was carried out at Ain Shams Maternity Hospital Infertility Clinic and Qena General Hospital Infertility Clinic. The current study was conducted on 136 women. They were divided into 4 equal groups: A = letrozole 2.5 mg (Femra 2.5 mg NOVARTIS) (one tablet) without HCG. B = letrozole 2.5 mg+ HCG 10.000 IU. C = letrozole 10 mg (Femra 2.5 mg NOVARTIS) (four tablets) without HCG. D = lertozole 10 mg + HCG 10.000 IU. The study started 4-October 2021.ended 10-Jan 2023. Conclusion Conclusion, the present study revealed that, applying low dose or high dose of letrozole on ovulation induction and effect of spontaneous &amp; timed intercourse with (HCG) had similar follicular response and pregnancy rates. Recommendations Good selection of PCO patients acording to Rotirdam critaria. Start mangement of PCO patients by wieght reduction for obes patients. Start induction ovulation by letrozole as first choice. Start by smallest dose of letrozole 2.5mg &amp; can be titrated dose for not responding patient to high dose.

Correlation of Recombinant FSH Doses with Follicular and Serum Level Resolvin E1 in Polycystic Ovarian Syndrome Women Undergoing ICSI

Background: Reproduction is a intricately structured process achieved by interaction of the higher centers in the brain, the gonads, and different body parts; Whereas infertility is a multifactorial pathological condition affecting approximately 10–15% of couples, especially in industrialized region.RESOLVIN E1 is a member of specialized pro resolving mediator family of bio active lipids. It has anti-inflammatory effects in various inflammatory diseases. A promising researches in their way to prove its positive role in reproduction through direct effect on folliculogenesis. It 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. High level of RESOLVIN E1 which might play critical role in poly cystic ovarian syndrome due to its anti-inflammatory effects. Objectives: To investigate the correlation of serum and follicular RESOLVIN E1 to gonadotropin (recombinant FSH doses) in PCOS patient undergoing ICSI. Subject, Patients, Materials, and Method: A prospective cross-sectional study conducted in the high institute for infertility diagnosis and assisted reproductive technology /Al Nahrain University /Baghdad /Iraq, from November 2023 till March 2024. Twenty-nine infertile PCOS women who were undergoing intracytoplasmic sperm injection were enrolled in the study. Serum and follicular RESOLVIN E1 at day of oocyte pickup were measured using ELISA technique. Results: The current study shows significantly lower gonadotropins stimulation dose needed for PCOS females (p &lt;0.001). It also revealed no significant correlations between total gonadotropins dose with both serum and follicular fluids resolvin E1, while there were insignificant negative correlations between serum and follicular fluids resolvin E1 with patients’ ages and body mass indices among PCOS females. Conclusions: There is no correlation between the serum and follicular RvE1 levels in PCOS infertile females.

Voice analysis in women with polycystic ovary syndrome

BackgroundPolycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting one in five women of reproductive age. Polycystic appearance of the ovaries in ultrasonography is associated with oligomenorrhea, and clinical and or biochemical hyperandrogenism. PCOS has been associated with voice alterations for many years. However, there is insufficient research on voice analysis in PCOS patients.ObjectivesThis research aimed to examine the voice characteristics among women with PCOS.Patients and methodsOur study included 25 women confirmed with PCOS and 25 control. A complete voice assessment was performed for all participants using primary demographic data, vocal symptoms, auditory perceptual evaluation of the voice, Arabic version of the Voice Handicap Index, acoustic analysis, and video laryngoscopic examination of the larynx.ResultsOur study revealed statistically significant differences between PCOS and control groups in phonasthenic symptoms, auditory perceptual assessment of the voice, acoustic parameters, and laryngoscopic examination.ConclusionPCOS women with hirsutism are complaining of vocal symptoms, changes in vocal characters, and deterioration of the acoustic parameters of the voice. High serum levels of androgen can cause the deepening of the voice, which is essential for the early detection of vocal symptoms in PCOS patients to prevent virilization of their voice.Trial registrationNCT06085170. Registered 20 August 2023—retrospectively registered, https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://classic.clinicaltrials.gov/ct2/show/NCT06085170&ved=2ahUKEwjEyLqUq6KGAxWxRPEDHb57DIQQFnoECBQQAQ&usg=AOvVaw1xTurnA6mJEZ9PK0vQS8VL.

The effect of Clusterin level as a potential marker in women with polycystic ovary syndrome

An organ with high metabolic activity, adipose tissue secretes a variety of adipocytokines that control the metabolism of fats and carbohydrates and advance insulin resistance (IR). It is currently unclear what pathophysiological mechanism underlies PCOS. In most cases, IR and metabolic abnormalities coexist with PCOS, a chronic endocrine and metabolic illness. Prompt identification and intervention aid in enhancing patients' quality of life while delaying the development of associated issues. Adipokine clusterin (encoded by CLU) is new. Diabetes and obesity-related populations have higher serum clusterin levels. In order to establish a foundation for early PCOS screening, diagnosis, and therapy, the current study examined variations in serum CLU levels in PCOS patients along with their relationships to sex hormones and metabolic markers. A case-control study design consisting of ninety newly diagnosed PCOS patients of ages ranging between (18-42) years have been recruited according to the Rotterdam criteria of PCOS diagnosis. To compare the results, 90 apparently healthy women of age were matched with the patients' group as a control group. Serum clusterin, fasting insulin (FIN), and fertile hormones have been measured in sera using the enzyme-linked immune sorbent assay (ELISA) technique. An independent t-test analysis was performed on the data. Pearson correlation was utilized to evaluate the relationship between the variables. It was found that the PCOS patients had considerably greater serum CLU (41.672± 3.85 vs. 28.5845± 3.01 μg/ml, P &lt; 0.001) than healthy women. A multiple stepwise linear regression analysis showed that HOMA-IR was separately linked with BMI, and HOMA-IR were independently associated with CLU (P &lt; 0.05). Serum CLU exhibited a positive connection (P &lt; 0.05) with BMI, FSG, FINS, and HOMA-IR. Serum CLU in the PCOS group correlated well with TG, CLU, HOMA-IR, FSH, FSG, and FINS. The PCOS women group significantly outperformed the fertile, healthy women group regarding BMI, LH, FSH, FSG, FIN, HOMA-IR, TC, TG, and LDL-C levels. They also had lower levels of HDL-C and QUICKI values. Additionally, serum clustrein levels. 31.68 A cut-off value of CLU as a marker for diagnosing PCOS with a sensitivity of 90.0% and a specificity of 87.5% (AUC: P value = ˂0.0001, 0.887-1.000.

Molecular study of CYP21 gene polymorphism rs13405728 and CYP11A1 gene polymorphism rs4077582 in polycystic ovarian syndrome patients

BackgroundPCOS is a serious endocrine-metabolic condition characterized by hyperandrogenemia, anovulation, or oligo-ovulation, and links to obesity, insulin resistance, and an elevated risk of type 2 diabetes mellitus. The pathophysiology of PCOS is thought to involve both environmental and genetic factors. PCOS etiology has been linked to genetic factors, with the CYP21 and CYP11A1 genes identified as possible candidate genes. Previous research has linked the rs13405728 polymorphism in the CYP21 gene and the rs4077582 polymorphism in the CYP11A1 gene to PCOS. However, more research is needed to confirm these connections in specific populations. The purpose of this study was to look at the role of single gene polymorphisms in PCOS, specifically the rs13405728 polymorphism in the CYP21 (LHCGR) gene and the rs4077582 polymorphism in the CYP11A1 gene. Blood was drawn from 150 PCOS patients and 150 age- and gender-matched healthy people. The phenol–chloroform procedure was used to extract DNA, and gel electrophoresis was used to quantify it. To analyze polymorphisms, researchers used polymerase chain reaction (PCR) with the allele-specific amplification refractory mutation system (ARMS-PCR) to amplify specific areas of DNA. ARMS-PCR was used to detect mutations in the CYP21 and CYP11A1 genes, followed by sequencing to examine the rs13405728 polymorphism and rs4077582 polymorphism, respectively, in 150 PCOS patients and 150 control people. ARMS-PCR polymorphism study of the CYP21 (LHCGR) and CYP11A1 genes indicated significant correlations.ResultsFor the CYP21 gene, heterozygous (CT) carriers of the rs13405728 polymorphism had a fourfold greater incidence of PCOS (OR 4.10; CI 2.47–6.80; p = 0.0001), whereas homozygous mutant (TT) carriers had a significant connection with PCOS (OR 0.27; CI 0.16–0.45; p = 0.0001). These data imply that the CYP21 (LHCGR) gene polymorphism rs13405728 has a substantial impact on the development of polycystic ovarian syndrome. The data for the CYP11A1 gene show the SNP (rs4077582) heterozygous (CT) was associated with PCOS (OR 1.72; 95% CI 1.02–2.88; p = 0.0392). The identical SNP heterozygous (CT) raised the incidence of PCOS by up to onefold. The homozygous mutant SNP (TT) had no connection with illness onset (OR 1.377; 95% CI 0.85–2.2; p = 0.1855), while the mutant (TT) of the SNP nearly doubled the incidence of polycystic ovarian syndrome. The combined model of the same SNP (CT + TT) revealed a significant correlation with PCOS (OR 2.1905; 95% CI 1.355–3.53; p = 0.0014). The combination model (CT + TT) of the same SNP more than doubled the risk of polycystic ovarian syndrome. All the risk factors investigated had a substantial connection with PCOS.ConclusionIn conclusion, this study supports the role of the CYP21 (LHCGR) and CYP11A1 gene polymorphism in PCOS. More studies are needed to investigate the functional significance of this polymorphism as well as its possible clinical impact on the diagnosis and treatment of PCOS.

The Relationship Between Platelet Indices, Hormonal Status, and Insulin Resistance in Adolescents with Polycystic Ovary Syndrome: A Retrospective Case-Control Study

Aim: This study aimed to investigate the relationship between polycystic ovary syndrome in adolescents, a disease caused by inflammation and insulin resistance that is associated with metabolic disorders, and platelet indices, which provide information about platelet activity. Materials and methods: Patients with oligoovulation, hyperandrogenemia, or clinical signs of hyperandrogenism (hirsutism, acne, etc.) and polycystic appearance with ≥ 20 small follicles ≥ 2∼ 9 mm in diameter in both ovaries on ultrasound according to the newly updated Rotterdam criteria were included in the study with a diagnosis of polycystic ovary syndrome and formed PCOS group. Patients with similar age groups and body mass index (BMI) values who presented to the clinic for non-PCOS symptoms (vaginitis, dysmenorrhea, cystitis), whose complete blood count was checked during hormone testing, and who did not meet the Rotterdam criteria were selected as the control group. Platelet indices found in routine blood count parameters (platelet large cell ratio (P-LCR), platelet distribution width (PDW) and mean platelet volume (MPV)) were analyzed between the two groups. In addition, the relationship between these indices and hormone status and insulin resistance in PCOS patients was analyzed. Patients with diabetes mellitus, hypertension, malignant diseases, cardiovascular diseases, essential thrombocytopenia or other blood diseases and patients taking medication were excluded. Results: In the study of 123 patients, there was no statistically significant difference between the groups in terms of age and body mass index (p:&gt;0.05). When hemogram parameters were compared between the groups, hemogram parameters such as P-LCR (p: 0.002), PDW (p: 0.011) and MPV (p: 0.007), which indicate platelet activity, were statistically significantly higher in the PCOS group. When the data of PCOS patients were analyzed, platelet indices were found to be higher in the group with high insulin resistance (p:

Impaired left ventricular function in lean women with PCOS: Insights from speckle tracking echocardiography

Aims: We aimed to conduct a study examining left ventricular function (LVEF) in lean women PCOS patients with speckle tracking echocardiography. Methods: The study included 60 patients diagnosed with PCOS and 30 healthy controls matched for age and body mass index. Morning fasting blood samples were collected to measure levels of glucose, insulin, high-sensitivity C-reactive protein (hs-CRP), and lipids. Left ventricular function (LVF) was evaluated using two-dimensional speckle tracking echocardiography (2D-STE) and real-time three-dimensional echocardiography (3D-Echo). Global strain was assessed from three standard apical views using 2D-STE. Results: The hs-CRP levels in lean women with PCOS were significantly higher compared to the control group (2.34±1.07 vs. 1.13±0.54; p=0.01). The peak longitudinal strain values in the 2-chamber, 4-chamber, and long-axis views were lower in lean women with PCOS compared to the control group (15.9±1.2 vs. 19.4±1.2; p=0.01, 17.0±1.1 vs. 19.2±1.4; p=0.01, 16.3±1.3 vs. 19.2±1.5; respectively, p=0.01). According to the multiple regression model, global strain was independently associated with hs-CRP (β=0.31, p=0.04), the ratio of early diastolic mitral inflow velocity (E) to early diastolic annular velocity (E/E’ ratio) (β=0.33, p=0.01), and ejection fraction (EF) (β=0.35, p=0.01). Conclusion: Our findings reveal that lean women with PCOS exhibit significantly higher levels of high-sensitivity C-reactive protein (hs-CRP) compared to healthy controls. Furthermore, the peak longitudinal strain values across multiple cardiac views were notably lower in the PCOS group, suggesting impaired left ventricular function. These results highlight the importance of monitoring cardiovascular health in lean women with PCOS, as they are at an increased risk of developing left ventricular dysfunction despite their lean body mass index.