Polycystic Ovary Syndrome Phenotypes Research Articles

An overview on effects of micronutrients and macronutrients interventions in management of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the common endocrinopathies among women. Changing dietary behaviors for PCOS management has been an important research focus during the last decades. This review has discussed current evidence and clinical trial studies relating to the impact of macronutrients and micronutrients in the management of different clinical feature of PCOS. The possible relationship between the quality and quantity of micronutrients and macronutrients and PCOS as well as the necessity to manage PCOS as a complex condition highlights the importance of diet-related interventions. The growing number of clinical trials related to the effect of micronutrients (zinc, chromium, selenium, vitamin D, inositol, and vitamin E) and macronutrients interventions (manipulation of fat, carbohydrate, protein, and MedDiet, Calorie restriction, Low Glycemic Diet) have been demonstrated to be practical approaches for managing clinical and biochemical features of PCOS, however the potential benefit of micronutrient and macronutrient approaches could be different from one by one, particularly in different phenotypes of PCOS. To achieve optimum outcomes, providing information regarding safety and the best dose selection of micronutrients and macronutrients is necessary. Hence, to better understand the approaches' risk/benefit in women with PCOS, future trials with a large sample size are recommended.

Association of anti-mullerian hormone and free androgen index level on response to clomiphene citrate in PCOS infertile women

BackgroundPolycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. Clomiphene citrate, insulin-sensitizing drugs, aromatase inhibitors, gonadotropins, or laparoscopic ovarian drilling are various methods used for ovulation induction in women with PCOS. PCOS women with high levels of anti-mullerian hormone (AMH) and free androgen index (FAI) do not respond well to ovulation induction. This prospective observational study explores the relationship between FAI and AMH levels on ovarian response to clomiphene citrate in infertile women with PCOS. MethodsThis prospective observational study included 40 infertile with PCOS who underwent ovulation induction with clomiphene citrate with dose ranging from 50 to 150 ​mg. Participants were classified into four phenotypes by NIH(National Institute of Health) consensus panel criteria. The clinical and endocrine parameters of participants who were sensitive to clomiphene were compared to those who were resistant. ResultsThe most common phenotype was A, with all three features of PCOS: hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. There was no significant difference in clinical and endocrine parameters among the different phenotypes of PCOS except AMH and FAI values. The mean FAI was 9.39 ​± ​1.11 and AMH 7.26 ​± ​0.48 (ng/ml) in clomiphene resistant and 5.31 ​± ​1.93 and 3.69 ​± ​1.84 (ng/ml) respectively in clomiphene-sensitive women. Women with FAI > 7.5 and AMH >7 ​ng/ml might be resistant to clomiphene. ConclusionFAI and AMH values were significantly higher in women resistant to clomiphene induction. AMH and FAI may help women with PCOS to tailor their ovulation induction protocol.

Female sexual function in different phenotypes of polycystic ovarian syndrome: a comparative cross-sectional study

Polycystic ovary syndrome (PCOS) coexisting mood disorders along with a combination of aesthetic manifestations may have a detrimental effect on women's sexual function. Hence, different phenotypes of PCOS have different clinical and biochemical signs and symptoms. The aim of this study was to compare women's sexual function (SF) in different phenotypes of PCOS. This cross-sectional study was conducted on 364 women who met the Rotterdam diagnostic criteria to compare different PCOS phenotypes (A = 95, B = 79, C = 95, and D = 95) and 100 non PCOS women in control group. All participants were invited to fill out the female sexual function index (FSFI). Significant differences were observed between the different phenotypes and control group in terms of the total score, sexual desire, arousal, lubrication, and satisfaction (P < 0.001); however, no significant differences were found between different phenotypes in terms of pain (P > 0.05) and orgasm (P > 0.05) but difference was significant between different phenotypes and control group. In addition, phenotype B had the lowest mean score of total FSFI (P < 0.05). The results indicated that women's SF is significantly different in different PCOS phenotypes. It is concluded that in order to solve the SF problems of women with PCOS, different treatment and care measures should be considered according to the relevant phenotype.

Comparison of body mass index, anti-müllerian hormone and insulin resistance parameters among different phenotypes of polycystic ovary syndrome

BackgroundDiagnosis of polycystic ovary syndrome (PCOS) depends on 2003 Rotterdam Criteria. According to these criteria there are four possible combinations resulting in various phenotypes. We aimed (i)to confirm that the levels of body mass index (BMI), anti-müllerian hormone (AMH) levels and insulin resistance (IR) are higher in PCOS patients and higher in phenotype-A among PCOS patients, and (ii)to determine cut-off values for the diagnosis of PCOS and phenotype-A. Materials and methodsThis study was conducted in an IVF Center, between November 2019 and January 2021. Data of infertile women participating in the study was evaluated retrospectively. Parameters such as menstruation pattern, clinical hyperandrogenism, age, BMI, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, thyroid stimulating hormone (TSH), prolactin, AMH, dehydroepiandrosterone sulphate (DHEA-S), fasting blood glucose, fasting insulin levels, antral follicle counts (AFC) and ovarian volumes were recorded for each patient. Women were grouped as PCOS and non-PCOS, and PCOS group was further divided into 4 sub-groups according to their phenotypes. Data of infertile patients with PCOS patients were compared with infertile non-PCOS patients and PCOS phenotypes were compared among each other. ResultsData of 244 infertile patients was included in the study. BMI, AMH, AFC, and HOMA-IR were statistically higher in PCOS patients, compared to non-PCOS patients. We found the AMH level of >3.105 ​ng/ml to be having 90.8% sensitivity and 90% specificity to diagnose a patient as PCOS. Among different phenotypes, also BMI, AMH, and insulin resistance index (HOMA-IR) levels were significantly higher in infertile PCOS phenotype-A when compared to other three phenotypes (p:0.003, p:0.000, and p:0.000, respectively). The AMH cut-off value to estimate phenotype-A was found as 6.095 ​ng/ml with 69.2% sensitivity and 86.7% specificity. We did not found threshold levels of BMI and HOMA-IR with high sensitivity to identify phenotype-A. ConclusionProperly diagnosing PCOS and determining the phenotype are crucial due to the long-term health conditions. Therefore, we suggest that serum AMH level could be included in PCOS diagnosis criteria, and the value of 3.105 ​ng/ml would have a 90.8% sensitivity and 90% specificity. Also, to identify phenotype-A, AMH level could be used. Therefore, we speculate that AMH may serve to identify PCOS and PCOS phenotype-A in places where ultrasound imaging is not straightforward to perform or not easily accessible.

PMON245 Clinical Phenotypes of Polycystic Ovary Syndrome (PCOS) in Nigerian Women: Preliminary Results of the Nigeria PCOS Epidemiology &amp; Phenotype (Nigeria-Pep) Study

Abstract Background Although the phenotype of polycystic ovary syndrome (PCOS) is heterogeneous, there is paucity of data on the prevalence and phenotype of PCOS in sub-Saharan Africa. Methods We studied 75 consecutive consenting women, aged 18-45 years, who presented with features suggestive of PCOS. A standardized proforma was used to obtain relevant information. Anthropometric measurements were determined, and terminal hair growth was assessed using the modified Ferriman-Gallwey (mF-G) method. All subjects underwent an oral glucose tolerance test (OGTT) and pelvic ultrasonography on day 2-7 of the menstrual cycle. An mF-G score of ≥ 6 was regarded as evidence of clinical hyperandrogenism (HA). Menstrual dysfunction (MD) was defined as menstrual cycle lengths &amp;gt;35 or &amp;lt;25 days. Polycystic Ovarian Morphology (PCOM) was defined as an antral follicle count (AFC) of ≥12 2-9 mm follicles and/or an ovarian volume ≥10 cm3, in at least one ovary. Results The mean (SD) age of the study population was 28.6 (5.8) years, and the mean (SD) body mass index (BMI) was 26.3 (5.6) kg/m2. Three (4.0%) participants were underweighted, 27 (36.0%) had normal BMI, 30 (40%) were overweight, and 15 (20.0%) were obese. The mean (SD) systolic and diastolic blood pressures were 107.4 (12.6) mmHg and 72.6 (8.2) mmHg, respectively. OGTT results indicated that the mean (SD) fasting blood glucose was 86.6 (10.6) mg/dl and the mean (SD) 2-hr. postprandial glucose was 109.8 (22.2) mg/dl. Two women had impaired glucose tolerance and one had type 2 diabetes mellitus. Of the 75 subjects recruited, 26 (34.7%) had HA, 54 (72.0%) had MD, and 63 (84.0%) had PCOM. Of all subjects, 20 (26.7%) had HA+MD+PCOM, consistent with PCOS Phenotype A; one (1.3%) had HA+MD only, consistent with Phenotype B; four (5.3%) had HA+PCOM only, consistent with Phenotype C; and 28 (37.3%) had MD+PCOM only, consistent with Phenotype D. In 22 (29.4%) no evidence of PCOS was found. Overall, our results indicate that of subjects evaluated clinically, 53 (70.6%) had PCOS. Conclusions Our preliminary results indicate that in a referral (clinical) population in Lagos, Nigeria, using only the clinical presentation without circulating androgen measures, PCOS was detected in two-thirds, with Phenotype D (aka, 'non-hyperandrogenic PCOS’) being the most common presentation (53%), followed by Phenotype A (aka 'classic or full PCOS’) observed in 38% of all women with PCOS seen. However, as 72% of all subjects had MD and 63% had PCOM, many more of these women could have been diagnosed with PCOS if the presence of hyperandrogenemia could have been demonstrated. Overall, these observations suggest that accurate measurement of circulating androgen, lacking in many parts of Sub-Sahara Africa, may be critical to accurately detecting PCOS in that region. Studies are ongoing. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

PMON247 Prevalence of Polycystic Ovary Syndrome in Eastern Siberia: a Cross-Sectional Study.

Abstract Background There is a lack of data on the prevalence of PCOS and its phenotype in many geographic regions. Siberia is a unique region of the Russian Federation with a multi-raced population living in similar geographic and socio-economic conditions for centuries. Therefore, we considered this population optimal for epidemiological research. Objectives To determine the prevalence of PCOS and the PCOS phenotypes in unselected women in the Eastern Siberia region. Population: We performed the institution-based, cross-sectional Eastern Siberia PCOS Epidemiology &amp; Phenotype (ESPEP) Study during 2016-2019 (СlinicalTrials.gov ID: NCT05194384) and recruited 1148 premenopausal women aged 34.3±6.3 yrs., of which 63.2% were Caucasians, 27.6% Asians, and 9.2% Mixed-race. All subjects provided written informed consent. Exclusion criteria were: current pregnancy or lactation, history of hysterectomy, bilateral oophorectomy, endometrial ablation, uterine artery embolization; and current or previous hormonal medications or insulin-sensitizers intake. The study was approved by the Institutional Ethics Committee of the Scientific Center for Family Health a Human Reproduction (Irkutsk, Russian Federation). Methods include questionnaires, anthropometry, vital signs, gynecological examination, mF-G scoring, pelvic U/S, and blood sampling. For PCOS diagnosis we used the Rotterdam (2003) criteria. Serum samples were analyzed for total testosterone (TT) using LC-MS/MS. DHEAS, SHBG, prolactin, TSH, and 17-OHP were assessed by ELISA. Free Androgen Index (FAI) was calculated (i.e. [TT/SHBG]×100). The upper normal limit (UNL) for the mF-G score was 4, as determined using a 2k-cluster analysis in the total study population. The upper normal limits (UNL) for androgens were determined from the 98th percentiles for these parameters in 143 women, identified as the "super-controls". Pearson Chi-square and Fisher exact one-tailed tests were used to comparing proportions and categorical variables. A p-value of 0.05 was considered statistically significant. Results The total prevalence of PCOS in premenopausal women from Eastern Siberia was estimated as 13.3%, with the following distribution of PCOS phenotypes: 29.1% (A), 9.9% (B), 26.2%(C), and 34.8% (D). There was no significant difference in PCOS prevalence by race: 13.4% in Caucasians, 11.0% in Asians, and 19.8% in Mixed race women (pχ2=0.07). Classic PCOS phenotype A was found in a comparable number of PCOS women (28% in Caucasians, 31.2% in Asians, and 30% in Mixed race); whereas Asian PCOS patients demonstrated the highest proportion of phenotype B (25% vs 5.6% in Caucasians and 5% in mixed-race). The number of hirsute women (with mF-G score &amp;gt;4) was dependent on race and reached 22%, 29%, and 36% among Caucasians, Asians, and mixed-race women, respectively (p χ2=0.001). Conclusions The results of the ESPEP study, conducted in a multi-race unselected population of premenopausal women from Eastern Siberia demonstrated a 13.3% total prevalence of PCOS and race-dependent difference in the clinical manifestation of PCOS. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

ODP642 Differences in hormonal profiles and vitamin D status depending on the insulin sensitivity status in women with polycystic ovary syndrome (PCOS).

Abstract Background Depending on metabolic profile, two different PCOS phenotypes may be distinguished- the metabolic phenotype related to insulin resistance (IR) and the reproductive one, with persistent insulin sensitivity. Hyperandrogenemia, the main feature of PCOS, leads to increased visceral fat and muscle masses and thus to lower insulin sensitivity. In turn, IR leads to metabolic consequences and hormonal imbalance. Moreover, vitamin D deficiency, which is common in PCOS patients, is also associated with insulin resistance. Aim To compare the hormonal profiles and vitamin D status in women with PCOS depending on insulin sensitivity status. Materials and methods One thousand three hundred women with PCOS, aged 18 to 40, were recruited. The patients were divided into two groups depending on their insulin sensitivity status. Metabolic and hormonal parameters were assessed in subjects from each group. Blood samples were collected between the second and the sixth day of the menstrual cycle (follicular phase)for the quantification of hormonal parameters using the electrochemiluminescence immunoassay (ECLIA) methods or colorimetry. Results Patients with insulin resistance have a significantly higher concentration of DHEAS and TSH, higher Free Androgen Index, and significantly lower vitamin D concentration. Moreover, cortisol and estradiol concentrations are higher and prolactin is lower in patients with IR, but the differences are not statistically significant. There are no significant differences in the prevalence of Hashimoto disease between patients with IR and patients with persistent insulin sensitivity. Conclusions Metabolic phenotype of PCOS is associated with higher androgen concentration and higher TSH concentration compared to reproductive phenotype. Moreover, patients with PCOS and IR often have vitamin D deficiency compared to patients with persistent insulin sensitivity. Therefore the supplementation of vitamin D and regular TSH measurements are important in patients with metabolic PCOS phenotype. Presentation: No date and time listed

RF10 | PMON241 Temporal Changes in Phenotype and Gut microbiota in PCOS Mouse Model Induced by Prenatal Androgen Exposure.

Abstract PCOS is a complex multigenic disorder with strong epigenetic and environmental influence. Previous reports have suggested that fetal over-exposure to androgens contributes to the development of PCOS after birth. On the other hands, recent studies on both human and rodent models of PCOS have demonstrated the relationship between PCOS and gut microbiome in adulthood. Furthermore, gut microbiome in obese adolescent with PCOS are different from obese adolescent without PCOS. However, the mechanism has not been revealed and it is unclear which events appear first, PCOS phenotypes or gut microbiome. We wondered if prenatal androgen exposure leads gut microbial dysbiosis early in life and is associated with the development of PCOS in later life. To test this hypothesis, we examined the temporal changes in the phenotypes of PCOS and gut microbiome using prenatally androgenized (PNA) model mice, an well-established model of PCOS. PNA model was generated by subcutaneously injecting pregnant dams with dehydroepiandrosterone (DHT) on days 16, 17, and 18 of gestation. Phenotypes and gut microbiome activity were compared between PCOS model mice (n=12/group) and control mice (n=10/group) at each developmental stage of 4 weeks (prepuberty), 6 weeks (puberty), 8 weeks (adolescent), 12 weeks (young adulthood), and 16 weeks (adulthood), respectively. The determinants for PCOS development are onset of puberty, estrous cycle, morphology of ovaries, serum testosterone levels, body weight, the size of parametrial adipocytes, and insulin resistance. For evaluation of gut microbiome, next generation sequencing and bioinformatics analysis of 16S rRNA genes were performed on obtained DNA from mouse fecal samples. PNA groups resulted in delayed puberty onset, disrupted estrous cycle, and increased testosterone levels from 6 weeks. Increased atretic antral follicles were observed in PNA groups at 6, 12, and 16 weeks. Additionally, PNA groups showed increased body weight, hypertrophy of parametrial adipocytes, and insulin resistant from 12 weeks. As for gut microbiome, PNA exhibited altered alpha-diversity from 8 weeks and beta-diversity at 8 weeks. Composition of gut microbiome was already altered from 4 weeks. At phylum level, Firmicutes phylum are significantly increased in PNA groups at 4 and 8, and decreased at 16 weeks. Actinobacteria phylum showed significant decrease at 6 and 8 weeks in PNA groups. At genus level, relative abundance of several bacterial taxa differed significantly between control and PNA groups; Allobaculum, Adlercreutzia which produce equol, Roseburia which produce butyric acid, and Sutterella were significantly decreased in PNA groups at multiple stages of development. In conclusion, our findings suggest that the alteration of gut microbiome appears simultaneously or even earlier than the presence of PCOS phenotypes, and that normalizing microbiome could improve pathologic condition of PCOS. In addition, early intervention of gut microbiome might indicate preventive care for women at high-risk of developing PCOS. Presentation: Saturday, June 11, 2022 1:18 p.m. - 1:23 p.m., Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

THE ASSOCIATION BETWEEN ANTI-MULLERIAN HORMONE LEVEL AND BODY MASS INDEX IN INFERTILE PATIENTS

Polycystic ovarian syndrome (PCOS) is a common cause of ovulatory infertility. Evidence suggests the Anti-Müllerian hormone (AMH) concentrations are correlated with the degree of ovulatory dysfunction in PCOS patients. Furthermore, obesity appears to exacerbate many aspects of the PCOS phenotype and is associated with a poor response to infertility treatment. The relationship between obesity and AMH levels has been studied with heterogenous results (1,2). The present study was designed to analyze the correlation between AMH and BMI in PCOS and non-PCOS patients.

Bisphenol A exposure modulates reproductive and endocrine system, mitochondrial function and cellular senescence in female adult rats: A hallmarks of polycystic ovarian syndrome phenotype

Bisphenol A (BPA) mimics estrogen and consequently suspected to be detrimental to female reproductive system. Biomonitoring confirms the BPA burden in body leading to a complex condition called polycystic ovarian syndrome (PCOS) which is frequently attributed to female infertility. Due to unclear precise molecular pathomechanisms of BPA in PCOS, we intend to examine the molecular mechanisms of the reproductive, endocrine, mitochondrial features, and cellular senescence in BPA-treated rats. We analyzed vaginal smears and ovarian follicles using microscope, assessed sex hormones by ELISA, analyzed BPA target gene expression by semi-quantitative RT-PCR, assessed senescence induction by β-galactosidase staining and immunofluorescence in BPA-treated rats. Our data showed hormonal imbalance, impaired folliculogenesis, abnormal expression patterns of target genes, CDKN2A overexpression and enhanced ROS levels in BPA-treated rats. This study provides insights on the effects of BPA exposure on ovulatory, hormonal, mitochondrial dysfunction, and senescence that benefit in better understanding of PCOS induced by BPA.

Serum Anti-Mullerian Hormone (AMH) Levels are Effective in Predicting the Diagnosis of Four Polycystic Ovarian Syndrome (PCOS) Phenotypes

Purpose: Women with PCOS have higher levels of AMH than matched controls; however, the feasibility of using elevated serum AMH value as a criterion, in the diagnosis of PCOS, is still debatable. The goal of this study was to examine a population of women with elevated AMH (&gt;5.0 ng/mL) and evaluate whether high serum AMH value can be predictive of four different clinical PCOS phenotypes (phenotype A (AOM, amenorrhea/oligomenorrhea + HA, hyperandrogenism + PCO, polycystic ovaries); Phenotype B: AOM + HA; Phenotype C: HA + PCO; and phenotype D: AOM + PCO, as defined by the Rotterdam criteria. Methods: This retrospective study included 227 women with one or more diagnoses of PCOS (ICD-9 256.4, ICD-10 E28.2) and 103 women without PCOS. All serum AMH levels were measured using Beckman Access-2 automated chemiluminescence assay and the age, BMI and AMH levels were analyzed using univariate analysis of covariance. Received operator curves were used to determine the AMH thresholds for predicting PCOS features and phenotypes. Results: Mean serum AMH levels were 9.96, 6.84, 6.43, 6.03, and 1.98 ng/ml in women with PCOS phenotype A, B, C, D, and control respectively. 101 (44.5%) patients were oligo/amenorrheic PCOS, 98 (43.2%) were hyperandrogenic PCOS, and 103 (45.4%) were PCO. Women with all three PCOS features had a significantly higher mean serum AMH compared to those with less of these features. The area under the curve (AUC) estimates of AMH showed high value ranging from 0.76 (95% CI, 0.71-0.81) in AOM group to 0.82 (95% CI, 0.79-0.88) in the PCO group. Conclusion: This study confirms the diagnostic opportunity of AMH test for discriminating between patients with PCOS phenotype and controls. High AMH accurately predicted PCOS in 92% (209 out of 227) patients diagnosed with PCOS. AMH value can predict PCOS in 78% women with oligo/amenorrheic PCOS, 77% with hyperandrogenic PCOS, and 79% with PCO. In keeping with the view that women with PCOS have a variety of phenotypic presentation that can be challenging to diagnose, using AMH test in combination with oligo/ amenorrhea or hyperandrogenism offers a non-invasive objective tool to screen patients with clinical features of PCOS.

Tempol modulates lncRNA-miRNA-mRNA ceRNA networks in ovaries of DHEA induced PCOS rats

Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in reproductive age women. Our previous results demonstrated that tempol was able to ameliorate PCOS phenotype in rats. However, the exact pathophysiological effect of tempol on PCOS remains largely unknown. To extend this research, deep RNA-sequencing was performed to investigate the long noncoding RNA (lncRNA) associated ceRNA mechanisms in the ovarian tissues of control rats, dehydropiandrosterone (DHEA) induced PCOS rats and tempol treated PCOS rats. Our results identified total 164, 79, and 914 significantly dysregulated lncRNAs, miRNAs, and mRNAs in three groups, respectively. The total of 7 lncRNAs, 8 mRNAs and 5 miRNAs were involved in lncRNA-associated ceRNA networks were constructed. Among them, mRNAs including C1qtnf1, Dipk2a, IL4r and lncRNAs including MSTRG.16751.2, MSTRG.8065.2 had high RNA connectivity in the ceRNA network, which also showed significant alterations in these three groups by using qPCR validation. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses revealed that the involvement of the identified ceRNA networks in regulating the development of PCOS from distinct origins, such as metabolic pathway, immune cell differentiation. The study presents the first systematic dissection of lncRNA-associated ceRNA profiles in tempol treated PCOS rats. The identified ceRNA networks could provide insights that help facilitate PCOS diagnosis and treatment.

Need to Introduce the Finding of Obesity or Normal Body Weight in the Current Diagnostic Criteria and in the Classification of PCOS.

The diagnosis of PCOS is based on the Rotterdam guidelines: chronic anovulation, hyperandrogenism (biologic or clinical) and polycystic ovaries on ultrasound. Two of these three criteria are sufficient for making diagnosis of PCOS. However, one characteristic that is often associated to PCOS (obesity with severe insulin resistance and metabolic alteration regarding glucose metabolism and lipid pattern) has remained out of the current classification of PCOS. Because of this, patients with different metabolic and cardiovascular risk may be included in the same phenotype, and it makes more difficult to establish clear strategies of follow-up and treatment of the patients with increased risks, and also may hide genetic or environmental differences between PCOS patients. Our recent study has shown that metabolic alterations are linked to the weight and not to the Rotterdam phenotypes. Because of this, we suggest a new classification of PCOS phenotypes that divides each Rotterdam phenotype in obese (ob) or lean (l) sub-phenotype. An improved classification of PCOS may be essential for permitting new progress in our understanding of pathogenesis and treatment of PCOS (or of the different disorders that are part of PCOS).

Multi-omics analyses reveal the specific changes in gut metagenome and serum metabolome of patients with polycystic ovary syndrome.

The purpose of this study was to investigate the specific alterations in gut microbiome and serum metabolome and their interactions in patients with polycystic ovary syndrome (PCOS). The stool samples from 32 PCOS patients and 18 healthy controls underwent the intestinal microbiome analysis using shotgun metagenomics sequencing approach. Serum metabolome was analyzed by ultrahigh performance liquid chromatography quadrupole time-of-flight mass spectrometry. An integrative network by combining metagenomics and metabolomics datasets was constructed to explore the possible interactions between gut microbiota and circulating metabolites in PCOS, which was further assessed by fecal microbiota transplantation (FMT) in a rat trial. Fecal metagenomics identified 64 microbial strains significantly differing between PCOS and healthy subjects, half of which were enriched in patients. These changed species showed an ability to perturb host metabolic homeostasis (including insulin resistance and fatty acid metabolism) and inflammatory levels (such as PI3K/Akt/mTOR signaling pathways) by expressing sterol regulatory element-binding transcription factor-1, serine/threonine-protein kinase mTOR, and 3-oxoacyl-[acyl-cattier-protein] synthase III, possibly suggesting the potential mechanisms of gut microbiota underlying PCOS. By integrating multi-omics datasets, the panel comprising seven strains (Achromobacter xylosoxidans, Pseudomonas sp. M1, Aquitalea pelogenes, Porphyrobacter sp. HL-46, Vibrio fortis, Leisingera sp. ANG-Vp, and Sinorhizobium meliloti) and three metabolites [ganglioside GM3 (d18:0/16:0), ceramide (d16:2/22:0), and 3Z,6Z,9Z-pentacosatriene] showed the highest predictivity of PCOS (AUC: 1.0) with sensitivity of 0.97 and specificity of 1.0. Moreover, the intestinal microbiome modifications by FMT were demonstrated to regulate PCOS phenotypes including metabolic variables and reproductive hormones. Our findings revealed key microbial and metabolite features and their interactions underlying PCOS by integrating multi-omics approaches, which may provide novel insights into discovering clinical diagnostic biomarkers and developing efficient therapeutic strategies for PCOS.

Serum Vitamin D Levels in Different Phenotypes of Polycystic Ovarian Syndrome (PCOS) A Case-Control Study

Polycystic ovarian syndrome (PCOS) is the most common heterogeneous multisystem endocrinopathy in women of reproductive age, with an ovarian manifestation of various metabolic disturbances. Based on Rotterdam criteria, PCOS is further classified into four phenotypes. Vitamin D deficiency affects 65- 75% of PCOS patients. There is very little research on the relationship between vitamin D deficiency and PCOS phenotypes. As a result, we intended to investigate the relationship between vitamin D, PCOS, and various PCOS phenotypes. This is a case-control study where we had been 100 people in the study. A total of 50 PCOS participants were classified into phenotype A, phenotype B, phenotype C, and phenotype D using Rotterdam criteria. There were 50 participants who did not have PCOS. Serum vitamin D levels were measured in the study population. The CIDRF (Central Inter-Disciplinary Research Facility) used an ELISA kit and reader to quantify vitamins. The results obtained were further classified as deficient (20ng/ml), insufficient (21-29ng/ml), and sufficient (30ng/ml). SPSS version 17 was used to analyse the results. The mean vitamin D level among women with PCOS was 15.9±9.3, women without PCOS was 20.5±9.2, the difference between the means was statistically significant(p-0.015). Among the participants with PCOS Phenotype A accounted for 36%, phenotype B 26%, phenotype C 20%, phenotype D 18%. The serum vitamin D levels among different phenotypes of PCOS was not statistically significant (p-0.978). There was no statistically significant difference in the mean vitamin D levels, among the phenotypes of PCOS (p - 0.978). Vitamin D deficiency was found to be more prevalent in women with PCOS in this study. In PCOS, it is recommended to screen for and treat with vitamin D. There is no significant difference between phenotypes.

Increased Prevalence of Elevated DHEAS in PCOS Women with Non-Classic (B or C) Phenotypes: A Retrospective Analysis in Patients Aged 20 to 29 Years.

It is well known that a subgroup of women with PCOS present an excessive adrenal androgen production, generally associated with ovarian hyperandrogenism. In the past, it has been impossible to correlate adrenal hyperandrogenism to any clinical or hormonal pattern of PCOS. However, adrenal androgens are strictly dependent on age and their blood values reduce by 40% in patients moving from their twenties to thirties. Due to this, serum DHEAS values are strongly influenced by the age distribution of studied populations. To avoid this bias, in this study we retrospectively analyzed the clinical and hormonal data of PCOS women in their twenties (age between 20 and 29 years). Data of 648 young hyperandrogenic women with PCOS were evaluated. Serum DHEAS was increased in a third (33%) of studied patients and was associated with higher values of testosterone (T) and androstenedione (A). In each phenotype, patients with high DHEAS had higher values of T and A than patients with normal DHEAS of the same phenotype. Therefore, a DHEAS increase is generally part of a generalized higher androgen production in a subgroup of PCOS patients, independently of the finding of anovulatory or ovulatory cycles or of polycystic or normal ovaries. However, our study showed some important differences between PCOS phenotypes. A lower prevalence of increased DHEAS in A phenotype PCOS patients who generally have the highest androgen levels, versus non-classic (B or C) PCOS phenotypes, was observed. It was also found that patients with A phenotype PCOS present significantly lower BMI and serum insulin than patients with normal DHEAS of the same phenotype while, in patients with the B or C phenotype, the opposite occurs. We conclude that adrenal hyperandrogenism is more common in patients with non-classic (B and C) phenotypes of PCOS and is generally part of a generalized higher production of androgens in a subgroup of PCOS patients. However, other factors may increase the adrenal androgen production and influence the clinical expression of the syndrome. More studies in large, selected for age, populations of PCOS women with different phenotypes are needed.

Insulin Resistance in Polycystic Ovarian Syndrome.

Polycystic ovarian syndrome (PCOS) is one of the readily recognised endocrine gland illnesses in women, with an incidence range from 2.2% to 26% in India. Patients experiencing PCOS experience issues involving irregular menstrual periods, hirsutism, acne, being overweight, and impotence. Long-term, low-grade inflammation has emerged as a crucial factor leading to PCOS. A rise in glucose levels may stimulate oxidative stress and a troubling reaction from mononuclear cells (MNC) of females with PCOS, which normally do not rely on fat. This is required because MNC-derived macrophages are the major source of cytokine synthesis in big adipose tissue and similarly encourage adipocyte cytokine production. In summary, data reveal the substantial risks of insulin resistance in obese people who are suffering from PCOS. The findings of this specific lesson indicated that individuals with the conventional PCOS phenotype had obesity and higher insulin levels and insulin resistance, neglecting the absence of BMI differences from other phenotypes. These data show that insulin resistance is the most significant pathophysiological trait in people with PCOS.

Modern differentiated approach to the treatment of infertility in women with polycystic ovary syndrome

The article provides data on a differentiated approach to the treatment of patients with PCOS for the natural restoration of fertility. The study examined 150 patients who applied to the gynecological department of the regional Perinatal Center in Samarkand and the gynecological department of clinic No. 1 of the Samarkand State Medical University for infertility in 2017-2019. Fifty patients underwent an attempt to restore fertility without surgery. Endosurgical interventions were performed in 100 patients in order to normalize ovulatory function and treat infertility: in 64 women - drilling or unilateral ovarian resection, in 36 - bilateral ovarian resection.We analyzed the effect of surgical treatment of PCOS, taking into account the volume of surgery, on the levels of homocysteine, AMH, total testosterone, FSH, LH, the ratio of FSH / LH and total estradiol, which were determined before - and three months after the intervention. All patients were divided into 4 subgroups depending on the diagnosed phenotypes. Using the methods of differentiated conservative and surgical treatment of infertility in women with different phenotypes of PCOS based on the study of clinical, laboratory and ultrasound parameters, pregnancy occurs in 75.3% of patients.

ART OUTCOMES IN LEAN COMPARED TO OBESE PHENOTYPES OF POLYCYSTIC OVARIAN SYNDROME

To investigate differences in reproductive outcomes among patients with lean compared to obese PCOS phenotypes undergoing IVF.

Sexuality and psychological well-being in different polycystic ovary syndrome phenotypes compared with healthy controls: a cross-sectional study

IntroductionPolycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The present study aimed to compare the women with different PCOS phenotypes with the healty group in terms of sexual function, depression, anxiety and quality of life scale.Materials and methodsThe present cross-sectional study was carried out on 192 women with PCOS (classified on the basis of Rotterdam criteria into four categories) and 50 healthy controls. All participants were asked to fill out the valid and reliable questionnaires of FSFI (Female Sexual Function Index), HADS (Hospital Depression and Anxiety Scale) and SF-12.ResultsIn the HADS questionnaire, phenotype B achieved the highest mean score in anxiety and depression domains, whereas, phenotype B had the lowest mean score in the FSFI and SF-12 quassionnaires. Furthermore, there was a significant difference between the women with PCOS phenotypes and the control grroup in arousal, lubrication, pain, and mean total score of FSFI (P < 0.05). In regression logistic analysis, age, infertility and depression were predictors of sexual dysfunction (P < 0.05).ConclusionThe results indicated significant differences in terms of sexual dysfunction, depression, anxiety and quality of life in the women suffering from different phenotypes of PCOS compared with the healthy group. These results provide evidence that care and recommendations for improving women’s QoL and sexual function should be considered according to the relevant PCOS phenotypes.