Pregnancy In Polycystic Ovary Syndrome Research Articles

Correlation of Polycystic Ovarian Syndrome Phenotypes With Pregnancy and Neonatal Outcomes.

To compare pregnancy and neonatal outcomes in women with hyperandrogenic polycystic ovarian syndrome (PCOS) phenotypes compared with nonhyperandrogenic PCOS phenotypes. We conducted a retrospective cohort study of participants in the PPCOS (Pregnancy in Polycystic Ovary Syndrome) I and II randomized controlled trials; all of the participants met the National Institutes of Health diagnostic criteria for PCOS and were then sorted into three of the four Rotterdam criteria categories based on medical interview, demographics, physical examination, and laboratory data. The two hyperandrogenic (A and B) Rotterdam categories were compared with the nonhyperandrogenic phenotype of PCOS (phenotype D). Our outcomes of interest were clinical pregnancy, pregnancy loss, live birth, obstetric complications (including preterm labor, preeclampsia, gestational diabetes, intrauterine growth restriction, and premature rupture of membranes), and neonatal outcomes (including jaundice, respiratory distress syndrome, neonatal hospitalization, and neonatal infection). Of the 1,376 participants included in the study, 1,249 (90.8%) had hyperandrogenic PCOS phenotypes compared with 127 (9.2%) nonhyperandrogenic PCOS (nonhyperandrogenic PCOS). Compared with participants with nonhyperandrogenic PCOS, those with hyperandrogenic PCOS had higher body mass index (BMI) (35.5±8.9 vs 31.9±9.3 kg/m2, P<.001), fasting insulin (21.6±27.7 vs 14.7±15.0 micro-international units/mL, P<.001), and homeostatic model assessment for insulin resistance score (5.01±9.1 vs 3.4±4.1, P=.0002). Age and race were similar between groups. Months attempting pregnancy were greater in participants with hyperandrogenic PCOS compared with nonhyperandrogenic PCOS (41.8±37.3 vs 33.9±32.0). The proportion of participants who achieved pregnancy (29.9% vs 40.2%, P=.02) and live birth rates (20.1% vs 33.1%, P=.001) were lower among those with hyperandrogenic PCOS compared with nonhyperandrogenic PCOS, although pregnancy loss rates did not differ significantly (23.9% vs 32.3%, P=.06). The hyperandrogenic PCOS group had lower odds of live birth compared with the nonhyperandrogenic PCOS group (odds ratio [OR] 0.51, CI, 0.34-0.76), even after adjusting for BMI (adjusted odds ratio [aOR] 0.59, CI, 0.40-0.89). The hyperandrogenic PCOS group also had lower odds of achieving pregnancy compared with the nonhyperandrogenic PCOS group (OR 0.63, CI, 0.44-0.92); however, this association was no longer significant after adjusting for BMI (aOR 0.74, CI, 0.50-1.10). The overall low prevalence of prenatal complications and neonatal outcomes precluded a meaningful comparison between the two groups. Participants with hyperandrogenic PCOS achieved lower rates of pregnancy and live birth compared with those with nonhyperandrogenic PCOS. Evaluating distinct PCOS phenotypes may allow for individualized guidance regarding the probability of pregnancy and live birth. ClinicalTrials.gov, NCT00068861 and NCT00718186.

Unveiling therapeutic potentials and exploring maternal-fetal health benefits of metformin in pregnancy: A scoping review.

This scoping review synthesizes evidence on metformin's use during pregnancy, encompassing diverse conditions like gestational diabetes, type 1 and type 2 diabetes, polycystic ovary syndrome (PCOS), and obesity. Metformin demonstrates comparable efficacy to insulin in gestational diabetes, positive outcomes in type 2 diabetes pregnancies, and potential benefits in reducing complications. The review highlights nuances in its effects across conditions, indicating advantages such as reduced risk of macrosomia and cesarean section in gestational diabetes. However, its prophylactic role in preventing gestational diabetes and associated complications remains inconclusive. In obese pregnant women, mixed results are observed, with potential benefits in reducing pre-eclampsia risk. Metformin shows promise in preventing preterm birth and late miscarriage in PCOS pregnancies. Categorizing patient subgroups is crucial for identifying advantages, especially in gestational diabetes and type 2 diabetes. Challenges arise from study heterogeneity, necessitating standardized indications for dosage, timing, and postpartum follow ups. Efforts to identify patient characteristics influencing metformin efficacy are crucial for tailored therapy. Although metformin emerges as a viable option in complicated pregnancies, comprehensive research, standardized protocols, and subgroup identification efforts will enhance clinical utility, ensuring evidence-based therapies and optimal maternal and fetal outcomes. Bridging existing knowledge gaps remains imperative for advancing metformin's role in pregnancy management.

Pregnancy, delivery, and neonatal outcomes among women with PCOS and endometriosis: a population database cohort.

PCOS and endometriosis are independent risk factors for perinatal outcomes. Little research has evaluated the concomitant effects of these conditions, nor have studies been conducted on a population database. We sought to identify the pregnancy, delivery, and neonatal outcomes in women with polycystic ovary syndrome (PCOS) and endometriosis vs. PCOS without endometriosis. A retrospective population-based cohort study was performed extracting data using ICD-9 codes from the HCUP-NIS Database from 2004 to 2014. Endometriosis in women with PCOS represented the study group (n = 163), and the remaining PCOS, non-endometriosis patients constituted the reference group (n = 14,719). Subjects were included once per delivery. Demographics were compared using chi-squared tests. Confounding effects in pregnancy outcomes were controlled using binary logistic regression analysis. Concomitant endometriosis and PCOS patients were more likely to be white (88.5% vs.71.0%, p < 0.001), with BMI < 30kg/m2 (87.1% vs.77.8%, p < 0.004) and from lower income quartiles (27.1% vs.17.1%, p < 0.017) when compared to PCOS without endometriosis. Comparing pregnancy complication rates, placental abruption (p < 0.018, aOR 3.01, 95% CI 1.21-7.50), Cesarean section (p < 0.003, aOR 1.75, 95% CI 1.21-2.53), deep venous thromboses (p < 0.002, aOR 74.31, 95% CI 4.57-1209.21), and venous thromboembolic events (p < 0.031, aOR 10.40, 95% CI 1.24-87.37), were increased in the study group compared to the reference group. Women with PCOS and endometriosis were more likely to be white, of lower socioeconomic status, lean, and experience abruptio-placenta, cesarean deliveries, and venous thromboembolisms. Since little was previously known about the combined outcomes of PCOS and endometriosis, it is difficult to counsel patients on risks. Our findings can help clinicians manage pregnant PCOS patients with endometriosis to minimize complications such as abruptio placenta and VTE.

The effect of bariatric surgery on polycystic ovary syndrome patients' obstetric and neonatal outcomes: a population-based study.

To examine the effect of bariatric surgery (BS) on obstetric and neonatal outcomes in patients with polycystic ovary syndrome (PCOS). A retrospective population-based cohort study utilizing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database, including women who delivered in the third trimester or had a maternal death in the USA (2004-2014). We compared obstetric and neonatal outcomes between groups in three analyses: (1) Primary analysis-women with an ICD-9 PCOS diagnosis who underwent BS compared to pregnant PCOS patients without BS. (2) Sub-group analysis-PCOS women with BS compared to obese PCOS women (body mass index (BMI) ≥ 30 kg/m2) without BS. (3) Women with and without PCOS who underwent BS. In the primary analysis, pregnant PCOS women who underwent BS (N = 141), compared to pregnant PCOS women without BS (N = 14,741), were less likely to develop pregnancy-induced hypertension (PIH) (9.2% vs. 16.2%, respectively, aOR 0.39, 95% CI 0.21-0.72) and gestational diabetes mellitus (GDM) (9.9% vs. 18.8, aOR 0.40, 95% CI 0.23-0.70). In the sub-group analysis, PCOS women with BS, compared to obese PCOS women without BS (N = 3231), were less likely to develop gestational hypertension, preeclampsia, and preeclampsia or eclampsia superimposed on hypertension (P < 0.05). Lastly, PCOS patients with BS had a higher cesarean section rate when compared to non-PCOS patients with BS (N = 9197) (61.7% vs. 49.2%, aOR 1.48, 95% CI 1.05-2.09), with otherwise comparable obstetric and neonatal outcomes. BS in PCOS patients was associated with reduced risks for GDM and PIH when compared to PCOS controls without BS and reduced risk for gestational hypertension, preeclampsia, and preeclampsia or eclampsia superimposed on hypertension when compared to obese PCOS controls without BS. Moreover, BS was associated with reduced inherent pregnancy risks of PCOS, almost equating them to those of non-PCOS counterparts.

Immune dysfunction mediated by the competitive endogenous RNA network in fetal side placental tissue of polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS), a common endocrine and metabolic disorder affecting women in their reproductive years. Emerging evidence suggests that the maternal-fetal immune system is crucial for proper pregnancy. However, whether immune function is altered at the end of pregnancy in PCOS women and the underlying molecular mechanisms is currently unexplored. Herein, the basic maternal immune system was investigated (n = 136 in the control group; n = 103 in the PCOS group), and whole-transcriptome sequencing was carried out to quantify the mRNAs, miRNAs, and lncRNAs expression levels in fetal side placental tissue of women with PCOS. GO, KEGG, and GSEA analysis were employed for functional enrichment analysis. The process of identifying hub genes was conducted utilizing the protein-protein interaction network. CIBERSORT and Connectivity Map were deployed to determine immune cell infiltration and predict potential drugs, respectively. A network of mRNA-miRNA-lncRNA was constructed and then validated by qRT-PCR. First, red blood cell count, neutrophil count, lymphocyte count, hypersensitive C-reactive protein, and procalcitonin were significantly elevated, while placental growth factor was hindered in PCOS women. We identified 308 DEmRNAs, 77 DEmiRNAs, and 332 DElncRNAs in PCOS samples. Functional enrichment analysis revealed that there were significant changes observed in terms of the immune system, especially the chemokine pathway. Eight genes, including FOS, JUN, EGR1, CXCL10, CXCR1, CXCR2, CXCL11, and CXCL8, were considered as hub genes. Furthermore, the degree of infiltration of neutrophils was dramatically decreased in PCOS tissues. In total, 57 ceRNA events were finally obtained, and immune-related ceRNA networks were validated. Some potential drug candidates, such as enalapril and RS-100329, could have a function in PCOS therapy. This study represents the inaugural attempt to evaluate the immune system at the end of pregnancy and placental ceRNA networks in PCOS, indicating alterations in the chemokine pathway, which may impact fetal and placental growth, and provides new therapy targets.

Effect of vitamin D on pregnancy in women with polycystic ovary syndrome: retrospective and prospective studies

Research question: Does vitamin D (VD) affect the pregnancy of polycystic ovary syndrome (PCOS) patients receiving ovulation-induction therapy?Design: The retrospective study included 200 patients with PCOS and 200 healthy women, and the prospective study included 160 patients with PCOS. Serum levels of 25-(OH) D3, luteinizing hormone (LH), follicle stimulating hormone (FSH), progesterone (P), estradiol (E), testosterone (T), and fasting insulin (FINS) were measured, and the LH/FSH ratio and BMI (body mass index) were calculated.Result(s): For the retrospective study, PCOS patients had lower levels of 25-(OH) D3 than healthy women (P<0.001). Pregnant PCOS patients had higher levels of 25-(OH) D3 than non-pregnant PCOS patients (P<0.01), and the pregnancy rate was lower in the VD-deficient group than in the VD non-deficient group (P<0.05). In the prospective study, compared with the placebo (PB) supplementation, VD supplementation significantly increased serum levels of 25-(OH) D3 (P<0.001) and reduced the LH/FSH ratio (P<0.05), LH level (P<0.01), and T level (P<0.05). After the intervention, it was found that the LH/FSH ratio, and LH, T levels significantly decreased in both groups compared to the pre-intervention (P<0.001). After ovulation-induction, the pregnancy rate in patients in the VD group was found to be higher than that in the PB group (P<0.05).Conclusion(s): VD deficiency is common in PCOS patients, and VD-deficient PCOS patients often have lower pregnancy rates after ovulation-induction. VD supplementation can improve pregnancy rates and mitigate basic hormone disorders. Therefore, monitoring VD supplementation and checking VD levels before and during intervention are essential for PCOS patients.

Placental mRNA Expression of Neurokinin B Is Increased in PCOS Pregnancies with Female Offspring.

Current research suggests that polycystic ovary syndrome (PCOS) might originate in utero and implicates the placenta in its pathogenesis. Kisspeptin (KISS1) and neurokinin B (NKB) are produced by the placenta in high amounts, and they have been implicated in several pregnancy complications associated with placental dysfunction. However, their placental expression has not been studied in PCOS. We isolated mRNA after delivery from the placentae of 31 PCOS and 37 control women with term, uncomplicated, singleton pregnancies. The expression of KISS1, NKB, and neurokinin receptors 1, 2, and 3 was analyzed with real-time polymerase chain reaction, using β-actin as the reference gene. Maternal serum and umbilical cord levels of total testosterone, sex hormone-binding globulin (SHBG), free androgen index (FAI), androstenedione, dehydroepiandrosterone sulfate (DHEAS), Anti-Mullerian hormone (AMH), and estradiol were also assessed. NKB placental mRNA expression was higher in PCOS women versus controls in pregnancies with female offspring. NKB expression depended on fetal gender, being higher in pregnancies with male fetuses, regardless of PCOS. NKB was positively correlated with umbilical cord FAI and AMH, and KISS1 was positively correlated with cord testosterone and FAI; there was also a strong positive correlation between NKB and KISS1 expression. Women with PCOS had higher serum AMH and FAI and lower SHBG than controls. Our findings indicate that NKB might be involved in the PCOS-related placental dysfunction and warrant further investigation. Studies assessing the placental expression of NKB should take fetal gender into consideration.

Association between Polycystic Ovary Syndrome (PCOS) and Pregnancy Complications

Background: Polycystic ovarian syndrome (PCOS) pregnant women appear to be more vulnerable to poor maternal and neonatal outcomes. The purpose of this study was to assess the outcome of pregnancies in women with PCOS. Methord: This descriptive study was conducted at a tertiary care hospital Jashore Medical College hospital, Jashore Bangladesh, on 115 pregnant PCOS patients. SPSS version 20 was used for data analysis on the recent pregnancy, PCOS, and maternal and perinatal outcomes. Parity and others perinatal and maternal outcomes were examined as categorical variables. Result: The average age was 25.07 years, 82% had a history of primary infertility, and 66% had a high BMI. The percentage of pregnant women with hypertensive problems was 18.26%, PROM was 33.91%, and the low APGAR score at five minutes was 12.17%. gestational diabetes (23.47%), miscarriage (2.1%), preterm delivery (13.91%), caesarean delivery (37.39%), low birth weight babies (2.6%), macrosomia (0.7%), PPROM (19.52%), perinatal mortality (1.73%) and NICU admission (21.74%). Conclusion: Pregnant women with PCOS were identified with either similar or lower rates of GDM, miscarriage, preterm delivery, meconium-stained liquor, caesarean delivery, small for gestational age/IUGR, macrosomia, PPROM, perinatal mortality, NICU admission, and congenital anomalies, but higher rates of hypertensive conditions of pregnancy, PROM, low birth weight babies, and low five-minute APGAR scores.

Antimüllerian hormone level predicts ovulation in women with polycystic ovary syndrome treated with clomiphene and metformin

ObjectiveTo describe serum anti-Müllerian hormone (AMH) concentrations in a large, well-phenotyped cohort of women with polycystic ovary syndrome (PCOS) and evaluate whether AMH predicts successful ovulation induction (OI) in women treated with clomiphene and metformin. DesignSecondary analysis of randomized controlled trial Subjects333 women with anovulatory infertility attributed to PCOS who participated in thedouble blind randomized trial entitled The Pregnancy in Polycystic Ovary Syndrome I (PPCOSI) study (registration number NCT00068861) who had serum samples from baselinelaboratory testing available for further serum analysis were studied. Main Outcome MeasuresThe association between baseline AMH concentration in each of the three treatment groups and ovulation rates, pregnancy rates and live birth rates were assessed. Results322 individuals had a baseline AMH concentration available, of which the mean AMH was 11.7 ± 8.3 ng/mL with a range from 0.1 to 43.0 ng/mL. With each unit (1 ng/mL) increase in baseline AMH, the odds of ovulation decreased by 10 percent (OR 0.90, 95% CI 0.86-0.93); this effect did not differ by treatment group. Women with a high baseline AMH concentration (>8 ng/mL) were significantly less likely to ovulate compared to those with a normal baseline AMH concentration (<4 ng/mL) (OR 0.23, 95% CI 0.05-0.68). This remained statistically significant when controlling for confounders, including age, body mass index, time in study, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score (p=0.008). Ovulation occurred even at very high AMH concentrations; there was no maximum level noted at which no ovulation events occurred. Baseline AMH concentration was not associated with pregnancy or live birth rates when controlling for confounders (p=0.947 and p=0.848, respectively). ConclusionThese AMH values of well-phenotyped individuals with PCOS adds to the literature and will aid in identifying AMH criteria for the diagnosis of PCOS. In women with infertility and PCOS, a higher AMH concentration was associated with reduced odds of ovulation with OI with clomiphene, clomiphene+metformin and metformin.

Pregnancy and Early Life Complications of PCOS

This presentation delves into the wide-ranging effects of Polycystic Ovary Syndrome (PCOS) on women’s lives, specifically exploring its manifestations during adolescence and pregnancy. Starting with PCOS in early life, we delve into the hormonal shifts of puberty and their connection to PCOS development. Challenges of diagnosing PCOS in adolescents are discussed, along with the distinct cardiometabolic and psychological issues they face. The section concludes with pragmatic insights into the 2023 PCOS Guideline’s recommendations for managing PCOS during these pivotal years. Moving to PCOS during pregnancy, attention shifts to the complex hormonal and physiological adjustments the female body undergoes to support foetal growth. PCOS-related mechanisms that might contribute to pregnancy complications are examined. In addition, we present evidence from 2023 PCOS Guideline meta-analyses revealing the various pregnancy complications in this high-risk population. Concluding, we navigate antenatal care terrain aligned with the 2023 Guideline and present evidence on metformin’s role in PCOS pregnancies. This presentation provides a comprehensive view of PCOS from adolescence to pregnancy. By integrating up-to-date guidelines and evidence, it aims to equip healthcare professionals with practical insights for navigating PCOS’s complexities, ultimately improving patient care.

P-589 How Does Hypothyroidism Alter Perinatal Outcomes in Patients with Polycystic Ovary Syndrome? - An Evaluation of a Population Database

Abstract Study question Does concomitant hypothyroidism in polycystic ovary syndrome (PCOS) patients have an additive effect on the risk for adverse pregnancy, delivery and neonatal outcomes? Summary answer In patients with PCOS, hypothyroidism significantly increases the risk for preeclampsia, however risks of other adverse perinatal outcomes are unaltered. What is known already PCOS and hypothyroidism are common endocrinopathies during reproductive age, and each has been shown to be associated with pregnancy complications. While PCOS has been associated with gestational diabetes, gestational hypertension, and preeclampsia, overt hypothyroidism has been associated with pregnancy loss, intrauterine growth restriction, preeclampsia, and preterm birth. Furthermore, PCOS and thyroid abnormalities are known to be linked, with a higher prevalence of thyroid dysfunction in pregnant PCOS patients compared to controls. However, information on obstetric and neonatal outcomes in women with both PCOS and hypothyroidism is lacking. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. This population-based cohort study included 14,882 women with an International Classification of Diseases (ICD)-9 diagnosis of PCOS in the United States. IN 2015 data was converted to ICD-10 codes which are not comparable to ICD-9 codes. Participants/materials, setting, methods All pregnancy admissions that resulted in delivery or maternal death were included so that patients were counted only once per pregnancy. We compared PCOS women with a concurrent diagnosis of hypothyroidism to those without. Women with hyperthyroidism were excluded. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Multivariate logistic regression analysis was used to adjust for confounding effects. Main results and the role of chance Overall, 14,882 women met the inclusion criteria. Amongst them, 1,882 (12.65%) had a concomitant diagnosis of hypothyroidism, and 13,000 (87.35%) did not. Women with concomitant hypothyroidism, compared to those without, were characterized by increased maternal age (25.5% ≥35 years vs. 18%, p &amp;lt; 0.001, respectively), and had a higher rate of multiple gestations (7.1% vs. 5.7%, p = 0.023). Interestingly, pregnancy, delivery, and neonatal outcomes were comparable between the groups, except for a higher rate of small-for-gestational-age (SGA) neonates in the group with hypothyroidism (4.1% vs. 3.2%, p = 0.033), when not accounting for confounding effects. In a multivariate logistic regression adjusting for potential confounders, hypothyroidism was no longer found to be associated with SGA (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 0.99-1.75, p = 0.057), but was found to increase the odds for preeclampsia (aOR 1.30, 95% CI 1.06-1.59, p = 0.012). Of note when controlling for confounding effects, all other pregnancy, delivery, and neonatal outcomes were comparable between the groups, including pregnancy-induced hypertension; eclampsia; gestational diabetes mellitus; preterm premature rupture of membranes; preterm delivery; placental abruption; cesarean delivery; hysterectomy; post-partum hemorrhage; wound complications; maternal death; blood transfusions; maternal infection; venous thromboembolism; disseminated intravascular coagulation; SGA; intrauterine fetal death; and congenital anomalies. Limitations, reasons for caution Due to our study’s retrospective nature, some data is missing such as TSH levels, TPO antibody status, the time period in which hypothyroidism was diagnosed (pre-gestationally or during the 1st, 2nd or 3rd trimesters), and Levothyroxine treatment dose and compliance. Wider implications of the findings Patients with PCOS and hypothyroidism during pregnancy should be managed with consideration of instituting both preventive measures for preeclampsia development and heightened blood pressure, proteinuria, and symptom monitoring. Interestingly, hypothyroidism did little to affect the already increased rates of pregnancy complications in PCOS. This should be further studied. Trial registration number not applicable

Association of polycystic ovary syndrome with multiple health factors and adverse pregnancy outcomes

Polycystic ovary syndrome (PCOS), an endocrine and metabolic disorder in women of reproductive age, is characterized by high androgen levels, irregular periods, and small cysts in the ovaries. PCOS affects approximately 10% of reproductive age women of all races and ethnicities. PCOS has been recognized to affect women of reproductive age since antiquity and in the 21st century, it emerges as the most widespread and serious reproductive metabolic disorder in the world. PCOS is a multifactorial disorder that affects both the reproductive and metabolic health of women. In addition, PCOS is a leading symptom of infertility in women. Nevertheless, women with PCOS who become pregnant unfortunately have an increased risk of complications, such as gestational diabetes mellitus (GDM), preterm birth. Many people believe GDM disappears after childbirth, despite the fact that GDM is a warning symptom of type 2 diabetes mellitus, metabolic syndrome, and cardiovascular disease. According to growing evidence, GDM complicates 40% of PCOS pregnancies, suggesting that PCOS is a risk factor for GDM. Hence, PCOS is a lifelong disorder that can eventually lead to various long-term health complications, including chronic menstrual irregularity, infertility, endometrial hyperplasia, and endometrial cancer. Thus, it’s a scientific fact that both PCOS and GDM are significantly associated with each other. However, most studies on the risk of GDM in PCOS patients are retrospective. Therefore, there is no strong evidence whether PCOS is a risk factor for GDM or any other related factor. PCOS, a polygenic endocrinopathy, is in a true sense a set of diseases that worsen the state of the body. Reproductive and metabolic disorders associated with PCOS cause several clinical symptoms, such as irregular and painful periods, hirsutism, acanthosis nigricans, acne, psoriasis, anxiety, mood swings, patterned baldness, cardiovascular problems, type 2 diabetes, infertility, pelvic pain, low libido, low self-esteem, etc. Further studies are needed to understand the genetic and epigenetic contributions of PCOS, PCOS-related comorbidities, the role of placenta in nutrient availability, and influence of medications that may affect the long-term offspring health.

Free leptin index, excessive weight gain, and metformin treatment during pregnancy in polycystic ovary syndrome: What about inflammation?

Free leptin index, excessive weight gain, and metformin treatment during pregnancy in polycystic ovary syndrome: What about inflammation?

Granulosa cells from immature follicles exhibit restricted glycolysis and reduced energy production: a dominant problem in polycystic ovary syndrome.

We hypothesized that immature oocytes are associated with impaired energy production in surrounding granulosa cells (GCs) in polycystic ovary syndrome (PCOS). Thus, this study investigated mitochondrial function, determined expression of glycolytic regulatory enzymes, and measured ATP levels in GCs of PCOS patients. GCs were isolated from forty-five PCOS patients and 45 control women. Intracellular concentration of reactive oxygen species (ROS), mitochondrial membrane potential (Δψm), the rate of glycolysis, total antioxidant capacity (TAC), activities of catalase (CAT) and superoxide dismutase (SOD), and ATP level were measured in GCs. The gene expression and protein levels of glycolytic enzymes (hexokinase, muscular phosphofructokinase, platelet derived phosphofructokinase, and muscular pyruvate kinase) were determined. Association of GC energy level with oocyte maturation was further validated by measuring glycolysis rate and ATP level in GCs isolated from mature and immature follicles from new set of fifteen PCOS patients and 15 controls. PCOS patients showed higher ROS level, decreasedTAC, reduced CAT and SOD activities, and lower Δψm together with reduced expression of key glycolytic enzymes. ATP concentration and biochemical pregnancy were lower in PCOS compared with control group. ATP levels werefound to besignificantly correlated with ROS and Δψm (r = - 0.624 and r = 0.487, respectively). GCs isolated from immature follicles had significantly lower ATP levels and rate of glycolysis compared with the GCs separated from mature follicles in both PCOS patients and control. Declined energy due to the mitochondrial dysfunction and restrained glycolysis in GCs is associated with the immature oocytes and lower biochemical pregnancy in PCOS.

Sexual and reproductive health aspects in women with polycystic ovary syndrome: An integrative review.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women worldwide, affecting their sexual and reproductive health (SRH). This integrative review aimed to identify SRH aspects in women with PCOS by consolidating the findings from previous studies. The present integrative review was conducted through an electronic systematic review search of 1052 manuscripts published from April 2000 to March 2020 using PubMed, SCOPUS, Web of Science, Embase, Google Scholar, MEDLINE, Science Direct, Ovid, and the Cochrane Library. After at least 2 researchers evaluated the articles based on the inclusion and exclusion criteria, 27 papers were accepted. The data were analyzed by thematic analysis. 9 main themes of SRH were obtained: 1) the impact of PCOS-related complications on reproductive health; 2) the lifelong effect of PCOS on reproductive patterns; 3) PCOS and adverse reproductive and pregnancy outcomes; 4) women's need for understanding complications; 5) the financial burden of the disease; 6) women's life experiences and quality of life; 7) sexual disorders; 8) psychological concerns and issues; and 9) femininity feelings and roles. We were able to identify and categorize various aspects of SRH needs for women with PCOS. These categories can facilitate a more comprehensive assessment of SRH, including previously neglected areas. We suggest that these aspects should be considered in the health plans of women with PCOS.

Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion.

Polycystic ovary syndrome (PCOS) is associated with a higher risk for pregnancy and birth complications according to the specific features associated with PCOS. The features include obesity before and during pregnancy, hyperandrogenism, insulin resistance, infertility, cardiometabolic risk factors, and poor mental health. PCOS is not often recognized as a risk factor for poor pregnancy and birth outcomes in pregnancy care guidelines, while its associated features are. Pregnancy‐related risk profile should ideally be assessed for modifiable risk factors (e.g., lifestyle and weight management) at preconception in women with PCOS. Hyperglycaemia should be screened using a 75‐g oral glucose tolerance test at preconception or within the first 20 weeks of pregnancy if it has not been performed at preconception and should be repeated at 24–28 weeks of pregnancy. In the absence of evidence of benefit for strategies specific to women with PCOS, the international evidence‐based guidelines for the assessment and management of PCOS recommend screening, optimizing, and monitoring risk profile in women with PCOS (at preconception, during and postpregnancy) consistent with the recommendations for the general population. Recommended factors include blood glucose, weight, blood pressure, smoking, alcohol, diet, exercise, sleep and mental health, emotional, and sexual health among women with PCOS. The guidelines recommend Metformin in addition to lifestyle for assisting with weight management and improving cardiometabolic risk factors, particularly in those with overweight or obesity. Letrozole is considered the first‐line pharmacological treatment for anovulatory infertility in PCOS. Individualized approach should be considered in the management of pregnancy in PCOS.

Myo-inositol in polycystic ovary syndrome: a systematic review and positioning of its use

Introduction: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disease among women of reproductive age 6 to 15% its presentation is complex and heterogeneous and is characterized by clinical and laboratory findings of hyperandrogenism, oligo-anovulation, metabolic abnormalities such as insulin resistance (IR), overweight, obesity, type 2 diabetes mellitus, dyslipidemia and increased risk of cardiovascular disease. Objective: To evaluate the effects of myo-inositol in pregnant and non-pregnant women with polycystic ovary syndrome in relation to fertility improvement, gestational outcomes, and metabolic and hormonal parameters. Methods: Data from randomized clinical trials on the efficacy of myo-inositol in women with PCOS were used in this review. The PubMed database was used for literature search. Results: Insulin resistance is one of the mechanisms that explain the emergence of metabolic and reproductive changes in women with PCOS. When compared to placebo, myo-inositol was effective in improving fertility, increasing ovulation and fertilization rates, in addition to improving metabolic parameters as indicators of insulin resistance (HOMA index). Even when compared to more traditional insulin sensitizers like metformin, myoinositol showed similar efficacy in restoring fertility. Myo-inositol was also effective when associated with clomiphene acetate and in women undergoing in vitro fertilization processes. There was also an improvement in pregnancy outcomes and a reduction in the risk of developing gestational diabetes with the use of myo-inositol. Conclusions: Myo-inositol improves clinical and laboratory parameters in both pregnant and non-pregnant PCOS patients, increasing the fertility rate and improving pregnancy outcomes.

Antimullerian Hormone Levels and Association with Abortion and Preterm Delivery in Patients with Polycystic Ovary Syndrome Who Conceived with Assisted Reproductive Techniques.

Pregnant PCOS patients were found to suffer from many adverse outcomes of pregnancy. Prediction of the fate of pregnancy and labor in PCOS patients was highly needed. There were recently discovered roles of serum AMH in those patients who were seeking for pregnancy and who were conceiving with assisted reproductive techniques. To analyze the predictive roles of measuring serum levels of AMH in patients with PCOS who became pregnant spontaneously or used assisted reproductive techniques regarding abortion and preterm delivery. A total of 100 females with PCOS were included in the study and they underwent assisted reproductive techniques were included in the study and underwent measurement of AMH levels regularly. We found that a total of 70 patients had a term delivery, and 30 patients had a preterm delivery. We found no statistically significant differences between both groups regarding their age or body mass index (BMI). We showed that serum AMH levels were higher in the group of PCOS patients who had preterm delivery than in the group of patients with term delivery (p < .0.001). High serum AMH levels were found to be associated with higher risks of occurrence of preterm labor in patients with PCOS who underwent assisted reproductive techniques. Our results gave a clue to clinicians for better management of the pregnancy process in these patients.

Modeling Pregnancy Outcomes Through Sequentially Nested Regression Models

The polycystic ovary syndrome (PCOS) is a most common cause of infertility among women of reproductive age. Unfortunately, the etiology of PCOS is poorly understood. Large-scale clinical trials for pregnancy in polycystic ovary syndrome (PPCOS) were conducted to evaluate the effectiveness of treatments. Ovulation, pregnancy, and live birth are three sequentially nested binary outcomes, typically analyzed separately. However, the separate models may lose power in detecting the treatment effects and influential variables for live birth, due to decreased sample sizes and unbalanced event counts. It has been a long-held hypothesis among the clinicians that some of the important variables for early pregnancy outcomes may continue their influence on live birth. To consider this possibility, we develop an -norm based regularization method in favor of variables that have been identified from an earlier stage. Our approach explicitly bridges the connections across nested outcomes through computationally easy algorithms and enjoys theoretical guarantee of estimation and variable selection. By analyzing the PPCOS data, we successfully uncover the hidden influence of risk factors on live birth, which confirm clinical experience. Moreover, we provide novel infertility treatment recommendations (e.g., letrozole vs. clomiphene citrate) for women with PCOS to improve their chances of live birth. Supplementary materials for this article are available online.

NEWBORNS OF WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) HAVE HIGHER ANTI-MULLERIAN HORMONE (AMH) LEVELS: A SYSTEMATIC REVIEW AND META-ANALYSIS

The first-degree female relatives of individuals with PCOS were more often diagnosed with PCOS in their sexual maturity, and they were further reported to exhibit higher levels of AMH during peripuberty, suggesting that the follicular alterations might happen early. AMH, as a reflection of increased stock of preantral and small antral follicles, was found significantly higher in pregnant PCOS women during the early trimester and at delivery. Animal studies also supported the hypothesis of exposure to excessive steroid or AMH during intrauterine life might develop PCOS-like phenotypes in the offspring. However, there was little human evidence substantiating a relationship between the exposure to maternal PCOS state and subsequent alteration of ovarian functions in neonates. By evaluating the AMH levels of newborns, the present meta-analysis was constructed to find potential evidence of influence by the intrauterine environment. A search of the literature was conducted in the PubMed, MEDLINE, EMBASE and Cochrane Library for articles assessing AMH levels in offspring of PCOS and non-PCOS mothers. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS) scoring system. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were adopted to calculate the overall estimates with random-effects models. Subgroup analyses and meta-regression were performed to investigate the potential source of inconsistencies. Funnel plots and Egger’s test were used to assess the publication bias. Sensitivity analysis was performed to determine the robustness of the results. 6 high-quality studies involving 846 participants were included. The pooled analysis found an increased AMH level in the umbilical cord blood in newborns of PCOS mothers (SMD =0.62, 95% CI [0.28, 0.95]). Subgroup analyses revealed an elevation of AMH concentrations in female neonates (SMD = 0.64, 95%CI = [0.14, 1.14]), neonates born to American and Asian PCOS mothers (SMD = 0.81, 95%CI = [0.47, 1.16]; SMD = 1.12, 95%CI = [0.79, 1.46], respectively). In addition, higher AMH levels were also found in studies diagnosed by the National Institute of Health (NIH) criteria (SMD =0.97; 95%CI = [0.74, 1.21]), maternal clinical/biochemical hyperandrogenism (SMD =0.66; 95%CI = [0.21, 1.11]), or maternal body mass index (BMI) >30 kg/m2 (SMD =0.78; 95%CI = [0.39, 1.17]). Meta-regression analysis suggested that diagnostic criterion contributed mostly to the high heterogeneity (p＜0.01). There was no publication bias and our results remained constant after sensitivity analysis. In summary, the positive findings of this study suggested that AMH levels in neonates born to PCOS mothers were noticeably higher than those in neonates born to healthy controls. We found that AMH might play a potential part in the PCOS pathogenesis which inhibits folliculogenesis in the fetal stage.