Presence Of Polycystic Ovaries Research Articles

AI-Driven Hormonal Profiling: A Game-Changer in Polycystic Ovary Syndrome Prevention

Abstract: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that impacts women during their reproductive years. It is characterized by hormonal imbalances, irregular menstrual cycles, and the presence of polycystic ovaries [1]. The incorporation of Artificial Intelligence (AI) in healthcare has provided new opportunities for the prevention and early detection of PCOS [2]. This article delves into the potential of AI in addressing the risk factors linked to PCOS. By utilizing machine learning algorithms, it can analyze intricate health data, detect patterns that indicate hormonal imbalances, and create personalized prevention strategies [3, 4].

Comparative Analysis of Polycystic Ovary Syndrome Detection Using Machine Learning Algorithms

INTRODUCTION: Polycystic Ovary Syndrome is a condition in which the ovaries manufacture androgen, seen in small traces, resulting in the production of cysts. Menstrual cycle abnormalities, clinical and/or biochemical hyperandrogenism, and the presence of polycystic ovaries on ultrasound should all be used to diagnose PCOS. PCOS appears to be a multifaceted illness influenced by both genetic and environmental factors and the symptoms include excessive hair on the face and body, weight gain, voice changes, skin type changes, and irregular periods.
 OBJECTIVES: This is the objective of this paper is to identify PCOS in its initial stage.
 METHODS: To address this issue the study proposes a comparison of various machine learning algorithms and optimization techniques Among which GSCV gave the best result of 94% accuracy, followed by TPOT with 91% accuracy. Additionally, we also applied Feature selection methods to eliminate zero-importance features to increase the accuracy of algorithms.
 RESULTS: The main results obtained in this paper This study explored various Feature selection techniques, ML and DL models. It is shown that Grid Search CV and TPOT classifier were best classifiers with 94% and 91% respectively.
 CONCLUSION: These are the conclusions of this paper and this study will explore various DL methodologies and try to find out best optimal results for the PCOS Detection. And also, to develop an PCOS detection application to keep track of menstrual cycles and track activities and symptoms for PCOS.

The details matter: personalized prediction of live birth after in vitro fertilization in women with polycystic ovary syndrome

ObjectiveTo derive and internally validate a clinical prediction model for live birth in women with polycystic ovary syndrome (PCOS) undergoing in-vitro fertilization (IVF) DesignRetrospective cohort study SettingFour academic reproductive endocrinology clinics Patients207 women with PCOS confirmed by Rotterdam criteria undergoing their first fresh IVF cycle InterventionsNone Main Outcome MeasureThe primary outcome was cumulative live birth (LB) per IVF cycle start. This included any LB that resulted from either fresh embryo transfer or any subsequent frozen embryo transfer from embryos obtained at the index oocyte retrieval. A prediction model was derived using multivariable logistic regression. Covariates considered for inclusion in the prediction model included demographic characteristics, medical history, and prior fertility treatment. Predicted probabilities for live birth were calculated using the prediction model which included the 90% shrinkage factor for each adjusted OR. ResultsThe final model, based on maximization of the area under the receiver operating characteristic curve (AUROC), included age <35 years, White race, presence of polycystic ovaries on ultrasound (PCOM), normal BMI (<25 kg/m2), being metabolically healthy (no metabolic risk factors), and being a non-responder to ovulation induction (OI) agents including letrozole and clomiphene citrate. The AUROC for the model was 0.68 (95% CI: 0.60, 0.77). Predicted probabilities of live birth ranged from 8.1% (95% CI 2.8, 21.5) for a woman who had no favorable predictors to 74.2% (95% CI: 59.5, 84.9) for a woman who had all favorable predictors. ConclusionOur study demonstrates that in addition to anovulation, the underlying pathophysiology and associated co-morbidities alter the likelihood of a successful pregnancy in women with PCOS undergoing IVF. Further validation of this model is needed before it, can serve as a tool to personalize prediction estimates for probability of live birth in women with PCOS.

Development of mental disorders in patients with polycystic ovary syndrome

Polycystic ovary syndrome is one of the most common hormonal disorders in women of reproductive age, causing alterations in the reproductive, metabolic, and psychological systems. Although its pathophysiology is not fully understood, it is possible to determine the symptoms through genetic, endocrine, and lifestyle factors. The aim of this study was therefore to analyze the association between depression and anxiety in women with PCOS. To this end, a qualitative, descriptive methodological approach was adopted through a literature review in the PubMed, Embase, and VHL databases. The inclusion criteria were: clinical trial articles, randomized or non-randomized, cohort studies, case-control studies, and open access, published in Portuguese, English, and Spanish, between 2018 and 2023 with topics associated with polycystic ovary syndrome, depression, and anxiety. The exclusion criteria were bibliographic and editorial reviews, as well as texts that were not available in full or free of charge. In this context, based on the bibliographic findings, polycystic ovary syndrome is a common disease among women of reproductive age characterized by hyperandrogenism, chronic anovulation, and the presence of polycystic ovaries on ultrasound. Metabolic alterations cause a variety of PCOS symptoms, including chronic anovulation or amenorrhea, infertility, hirsutism, and obesity. In this way, PCOS is related to body dissatisfaction, depression, anxiety, decreased sexual satisfaction, eating disorders, and lower health-related quality of life. In addition, the risk of depression and anxiety increases with prolonged exposure to hyperandrogenism. In addition, people with PCOS are four to seven times more likely to have moderate to severe depressive and anxiety symptoms. Therefore, women with PCOS experience significant social pressure, which maximizes the prevalence of mental disorders associated with the syndrome, such as anxiety and depression.

Testosterone or dihydrotestosterone: what should be evaluated in hirsutism?

Dihydrotestosterone is a more potent androgen derived from testosterone and androstenediones, but its measurement has not been routinely recommended in women with hirsutism, and there is limited information in this regard with equivocal findings. This study aimed to evaluate serum dihydrotestosterone level in patients with hirsutism compared to women without hirsutism. In this case-control study (during 2021-2022), serum levels of total testosterone, free testosterone, and dihydrotestosterone were evaluated in 101 women with hirsutism and 101 healthy women. Hormonal levels were measured with chemiluminescent immunoassay method. Age and hormonal levels in each group, body mass index, menstrual status, complaint of decreased scalp hair density, and ovarian ultrasound findings in hirsutism group were collected and analyzed. There was significant difference in free testosterone and dihydrotestosterone levels (P < 0.001) and no significant difference in total testosterone level between two groups (P = 0.628). Dihydrotestosterone level was significantly higher in women with hirsutism with menses irregularity, complaint of decreased scalp hair density, and presence of polycystic ovary on ultrasound (P < 0.05). Measuring dihydrotestosterone level is not considered in routine evaluation of hirsutism, but we think that this significant difference shows that elevated level of dihydrotestosterone hormone in women with hirsutism is an important factor.

Short-time effects of ketogenic diet or modestly hypocaloric Mediterranean diet on overweight and obese women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women during reproductive age. It is characterized clinically by oligo-ovulation or anovulation, hyper-androgenism, and the presence of polycystic ovaries. Often comorbid with insulin resistance, dyslipidemia, and obesity, it also carries significant risk for the development of cardio-vascular and metabolic sequelae, including diabetes and metabolic syndrome. In light of these evidences, the most therapeutic option prescribed to PCOS women with obesity, regardless of the phenotype from the severity of clinical expression, is lifestyle correction by diet and physical activity. The aim of this study was to evaluate the association between PCOS with KD in overweight and/or obese women with PCOS, and evaluate the possible beneficial effects on metabolic and endocrine parameters, compared to a standard, balanced hypocaloric diet such as Mediterranean diet (MD). Participants were assigned to receive, in a 1:1 ratio, one of the two following dietary sequences: KD or MD. In all subjects anthropometric parameters, body composition and metabolic and endocrine parameters were obtained at baseline and after dietetic treatment. Our results showed a significant change in the anthropometric and biochemical parameters in both groups after both diet therapies, with statistically significant differences (p < 0.001). Though, the reductions of all parameters were significantly greater in KD group than in MD group. Our results suggest that a reduction of dietary intake of carbohydrates by KD may be considered as a valuable non-pharmacological treatment for PCOS.

Polycystic Ovary Syndrome in Girls With Type 2 Diabetes

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

EFFECT OF BODY MASS INDEX ON OVULATION IN NIGERIAN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME UNDERGOING TREATMENT WITH CLOMIPHENE CITRATE: A SONOGRAPHIC STUDY.

Background: Obesity, overweight and elevated BMI are clinical features of PCOS, and between 40-80% of women with PCOS are reported to be overweight or obese. This study aimed to categorize values of patient anthropometric variables such as BMI with change in follicular sizes as determined by sonography following postCLOMID inducement therapy. Materials and Methods: This was an experimental cohort study carried out in some selected hospitals in Anambra State, Nigeria, from June 2018 to May 2022.Convenient sampling technique was adopted to select the subjects based on the inclusion criteria, which were women of child bearing age (18 to 45 years) for both groups. Confirmation of patients with PCOS was ascertained with the presence of polycystic ovaries in ultrasound. The ultrasound examinations and anthropometry measurements were carried out on each subject, and data such as BMI, follicular sizes before and post treatment were recorded. The obtained data were subjected to SPSS analysis using both descriptive and inferential statistical tools. Results: The mean values of the BMI of the participants in the experimental group before and after treatment with clomid were 25.69±5.99 kg/m2 , 25.92±5.55 kg/m2 respectively, while the mean BMI value for the control group was 23.09±3.41 kg/m2 .There were no statistically significant differences in body mass index, and maximal follicular size in women with failed and successful ovulation in the experimental group before treatment (p&gt;0.05). There were statistically significant mean differences in the BMI (t= 8.75, p = 0.001) and follicular size (t= 2.04, p = 0.04) of participants in the experimental group after treatment with clomid. There were statistically significant mean differences in the BMI (t= 2.41, p = 0.02) and follicular size (t= 4.88, p = 0.001) of participants in the control group after treatment with clomid. Conclusion: There was higher ovulation failure rate among the overweight and obese subjects in both the experimental and control groups. Also significant increase in mean follicular sizes after clomid inducement in the experimental group was noted. Body mass index has significant negative impacts on ovulation.

In-Silico Screening of Prime PCOS Biomarkers for the Identification of a Potential Model Organism

Polycystic ovarian syndrome (PCOS) is a multigenic endocrine disorder observed in women of reproductive age. Although the condition is characterized by the presence of polycystic ovaries and excess production of androgens, the exact aetiology has not been well deciphered due to the unavailability of a suitable model organism. Defects in the two prime biomarkers namely CYP11A and CYP19A1, have been found to play a role in disease progression. The objective of this study was to carry out an in-silico assessment of these two genes to identify a potential model organism for the efficacious study of PCOS. Bioinformatics tools such as BLAST and EMBOSS were used for local and global alignment respectively, to find sequence homology and thereby, establish a model organism. Sequence comparison was followed by phylogenetic analysis and secondary structure prediction of the enzymes encoded by the respective genes. Our in-silico study revealed Gorilla gorilla to be an ideal candidate for the study of PCOS owing to its high sequence and structural similarities with the human gene counterparts. Future prospects of the research include in-vitro analysis of the biomarkers on Gorilla gorilla ovarian theca cell line to pave the way for therapy.

Anti-Müllerian Hormone in Pathogenesis, Diagnostic and Treatment of PCOS.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women. It is characterized by chronic anovulation, hyperandrogenism, and the presence of polycystic ovary in ultrasound examination. PCOS is specified by an increased number of follicles at all growing stages, mainly seen in the preantral and small antral follicles and an increased serum level of Anti-Müllerian Hormone (AMH). Because of the strong correlation between circulating AMH levels and antral follicle count on ultrasound, Anti-Müllerian Hormone has been proposed as an alternative marker of ovulatory dysfunction in PCOS. However, the results from the current literature are not homogeneous, and the specific threshold of AMH in PCOS and PCOM is, therefore, very challenging. This review aims to update the current knowledge about AMH, the pathophysiology of AMH in the pathogenesis of PCOS, and the role of Anti-Müllerian Hormone in the treatment of this syndrome.

COMPARATIVE STUDY OF PATHOGENESIS OF PCOS AND ITS CORRELATION CITED IN VARIOUS AYURVEDIC AND MODERN RESEARCH PAPERS PUB-LISHED

PCOS is the most common endocrine condition in reproductive-aged women. The word “Syndrome” is used to describe PCOD because, it is a complex manifestation involving many factors and organs. It is characterized by reproductive, endocrine, metabolic and physiological features. The presence of polycystic ovaries is an important diagnostic criterion for PCOS. This syndrome can also be associated with metabolic issues including obesity, insulin resistance, hyperinsulinemia. Recently, there has been an increase in inter-est in the field of PCOS research. It is categorized as a chronic disease with treatments that only address symptoms, the condition is terrifying to most because of its painful and uncomfortable side effects, ad-verse impact on fertility, and high risk of complications. PCOS in Ayurveda is correlated with Ar-tavakshaya. It needs early diagnosis and long-term management for avoiding long term complications. This article aims to provide a balanced review of the latest advances and current limitations in our knowledge about PCOS while also providing a few clear and simple principles, based on current evidence-based clini-cal guidelines, for the proper study of pathogenesis of PCOS, also by looking at the findings of modern medicine we are correlate here the exhibiting features of the disease with the dominate Dosha responsible for the disorder.

Identification of Variants in Mitochondrial D-Loop and OriL Region and Analysis of Mitochondrial DNA Copy Number in Women with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a multifactorial disorder characterized by irregular menstrual problems, hyperandrogenism, and presence of polycystic ovaries. Till date, molecular mechanism underlying PCOS remains elusive. Recently mitochondrial displacement loop (D-loop) variants have been identified to be novel players in the pathogenesis of PCOS. At present, rare variants, besides common variants, are also the focus of research as it is believed to make essential contribution to the risk of complex diseases. However, rare and low hetroplasmic variants in mitochondrial D-loop are still not investigated in PCOS women. Furthermore, variants in light-strand origin of DNA replication (OriL) of mitochondrial DNA (mtDNA) have not been explored in PCOS. Hence, in this study, we investigated rare to common mitochondrial D-loop and OriL region variants obtained using mtDNA next-generation sequencing in women with PCOS. Furthermore, we also assessed mtDNA copy number, a biomarker of mitochondrial dysfunction (MD) in women with PCOS, as the variants in mtDNA are known to be associated with low mtDNA copy number in PCOS women. A total of 67 D-loop variants including 6 novel variants were identified in 30 PCOS women. Among 67 variants, 29 variants were reported in PCOS women. A single variant, 5746A was found in OriL region in two PCOS women. Both transition and transversion variants were found but transition variants occur at very high frequency compared with transversions (82.35% vs. 17.64%, respectively). As transition variants in mtDNA are known to arise because of polymerase γ errors, occurrence of high transition rates indicates that most mutation arises because of defect in replication errors that causes mtDNA damage leading to MD. Furthermore, mtDNA copy number was found to be low in women with PCOS compared with healthy control women suggesting that MD may be the contributing factor in the pathogenesis of PCOS.

Chromohysteroscopy and Laparoscopy Findings in Infertile Patients with Persistent Midluteal Phase Central Endometrial Echo

Objective: To study the relationship between persistent midluteal central endometrial echo versus polycystic ovaries and chromohysteroscopy and laparoscopy findings in infertile patients with regular menstruation. Material and methods: 164 infertile patients with regular menstruation were investigated with ultrasound monitored cycles followed by chromohysteroscopy and laparoscopy. Persistent midluteal central endometrial echo was assessed against presence of polycystic ovaries, micropolyps and deep endometrial staining with methylene blue and presence of endometriosis diagnosed laparoscopically. Results: 51 patients (31.1%) showed persistent central midluteal endometrial echo and 72 (43.9%) showed polycystic ovaries. During chromohysteroscopy 21 patients (12.8%) showed micropolyps and 26 (15.9%) showed deep endometrial staining with methylene blue. Moreover, 30/51 patients with central midluteal endometrial echo (58.8%) showed polycystic ovaries versus 42/113 patients (37.2%) with homogeneous endometrium, p=0.011. Furthermore, 18/51 patients (35.3%) with central endometrial echo showed dark endometrial discolouration with methylene blue versus 08/113 patients (7.1%) with homogenous endometrium, p<0.001. Similarly, 14/51 patients (27.5%) with central midluteal endometrial echo showed micropolyps versus 7/113 (6.2%) with homogeneous endometrium, p=0.001. Polycystic ovaries showed no significant association with either sign of chronic endometritis. During laparoscopy, 31/164 patients (18.9%) showed pelvic endometriosis. 14 of them (45.2%) developed deep endometrial discolouration with methylene blue versus 12/113 patients (9.0%) without endometriosis, p<0.001. Likewise, 21/31 patients with endometriosis (67.7%) had central midluteal endometrial echo versus 30/133 patients (22.6%) with no endometriosis, p<0.001. This association was maintained after excluding patients with chronic endometritis. Conclusion: Persistent midluteal central endometrial echo might reflect chronic endometritis as it was significantly associated with deep endometrial discolouration with methylene blue and micropolyps. The significant association between endometriosis and midluteal central endometrial echo in cases with and without chronic endometritis indicated that endometriosis might affect the endometrium through more than one mechanism. Conversely, the association of polycystic ovaries with midluteal endometrial echo was independent of chronic endometritis.

Effects of a ketogenic diet in overweight women with polycystic ovary syndrome

BackgroundPolycystic ovary syndrome (PCOS) is the most common endocrine disorder in women during reproductive age. It is characterised clinically by oligo-ovulation or anovulation, hyper-androgenism, and the presence of polycystic ovaries. It is associated with an increased prevalence of metabolic syndrome, cardiovascular disease and type 2 diabetes. The onset of PCOS has been associated to several hereditary and environmental factors, but insulin resistance plays a key pathogenetic role. We sought to investigate the effects of a ketogenic diet (KD) on women of childbearing age with a diagnosis of PCOS.MethodsFourteen overweight women with diagnosis of PCOS underwent to a ketogenic Mediterranean diet with phyoextracts (KEMEPHY) for 12 week. Changes in body weight, body mass index (BMI), fat body mass (FBM), lean body mass (LBM), visceral adipose tissue (VAT), insulin, glucose, HOMA-IR, total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TGs), total and free testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH); dehydroepiandrosterone sulfate (DHEAs), estradiol, progesterone, sex hormone binding globulin (SHBG) and Ferriman Gallwey score were evaluated.ResultsAfter 12 weeks, anthropometric and body composition measurements revealed a significant reduction of body weight (− 9.43 kg), BMI (− 3.35), FBM (8.29 kg) and VAT. There was a significant, slightly decrease of LBM. A significant decrease in glucose and insulin blood levels were observed, together with a significant improvement of HOMA-IR. A significant decrease of triglycerides, total cholesterol and LDL were observed along with a rise in HDL levels. The LH/FSH ratio, LH total and free testosterone, and DHEAS blood levels were also significantly reduced. Estradiol, progesterone and SHBG increased. The Ferriman Gallwey Score was slightly, although not significantly, reduced.ConclusionsOur results suggest that a KD may be considered as a valuable non pharmacological treatment for PCOS. Longer treatment periods should be tested to verify the effect of a KD on the dermatological aspects of PCOS.Trial registration Clinicaltrial.gov, NCT04163120, registrered 10 November 2019, retrospectively registered, https://clinicaltrials.gov.

Reproductive health, obesity, and cardiometabolic risk factors among Samoan women.

Obesity leads to deleterious effects on not only cardiovascular health but also on the reproductive health of women. We estimate the prevalence of menstrual irregularity and of polycystic ovarian syndrome (PCOS) in Samoan women, among whom obesity prevalence is extremely high. We explore the association of these reproductive health conditions with adiposity, cardiometabolic risk factors, and androgen levels. A cross-sectional sample of Samoan women 25-39 years of age (n = 470) from a larger population-based genome-wide association study of adiposity and cardiometabolic disease was assessed for the prevalence of oligomenorrhea/amenorrhea (OM/AM) using a self-reported questionnaire. Serum androgens and anti-Müllerian hormone levels were assayed to determine hyperandrogenemia and presence of polycystic ovaries (PCO), respectively, using criterion values. PCOS was classified using NIH guidelines of having at least two of the three conditions: menstrual irregularity, hyperandrogenism, and PCO. We contrasted socio-demographic, reproductive health, and cardiometabolic risk factors between those with and without OM/AM and similarly for PCOS. The prevalence of OM/AM was 7.4% (95% CI: 5.1, 9.8), and women with OM/AM had significantly higher central adiposity. PCOS was estimated at 6.8% (95% CI: 4.5, 9.1), and those with PCOS were younger but had higher overall and central adiposity measures, higher triglycerides, and higher prevalence of insulin resistance than women without PCOS. The prevalence of menstrual irregularity and PCOS are less than hypothesized given the high levels of adiposity in this population. Nevertheless, Samoan women with menstrual irregularity and other features of PCOS have significantly poorer metabolic health.

Clinical and metabolic characteristics of Turkish adolescents with polycystic ovary syndrome

The aim of this study was to investigate the clinical, endocrine, metabolic features and prevalence of metabolic syndrome (MBS) in Turkish adolescents with polycystic ovary syndrome (PCOS) and the differences in metabolic parameters between adolescent PCOS with or without the presence of polycystic ovaries (PCO) on ultrasound. Subjects (n = 77) were classified into two groups: oligomenorrhea (O) and clinical and/or biochemical hyperandrogenism (HA) (n = 38), without PCO and O + HA with PCO (n = 39). The control group consisted of 33 age-matched adolescents. Adolescents with PCOS had a significantly higher body mass index (BMI), waist circumference and levels of LH, LH/FSH ratio, triglyceride, insulin, HOMA-IR, free androgen index and lower levels of SHBG and FSH. After adjustment for BMI, LH, LH: FSH ratio remained significantly higher. Adolescents with PCOS had a higher prevalence of MBS. No significant differences in lipid profiles, insulin levels and insulin sensitivity in both the PCOS groups were seen. HDL-C levels were lower in the O + HA + PCO group compared to the controls. BMI may be the major contributing factor in the development of metabolic abnormalities in adolescents with PCOS. Impact statement Many studies have investigated the effect of PCOS on metabolic and cardiovascular risks. It is thought that PCOS increases metabolic and cardiovascular risks. Increase in metabolic and cardiovascular risks associated with PCOS may be handled with early diagnosis and early intervention of PCOS in adolescents, although the diagnosis of PCOS in adolescents could be hard because of the features of PCOS overlapping normal pubertal physiological events. However, early identification of adolescent girls with PCOS may provide opportunities for prevention of well-known health risks associated with this syndrome and reduction of long-term health consequences of PCOS by reducing androgen levels and improving metabolic profile. Our results also support that BMI may be the major contributing factor in the development of metabolic abnormalities in adolescents with PCOS.

Effect of polycystic ovaries on in vitro fertilization and intra-cytoplasmic sperm injection treatment outcome

Abstract Objective The reproductive performance of women with polycystic ovaries (PCO) with regular ovulatory menstrual cycles undergoing in vitro fertilization and intra-cytoplasmic sperm injection (IVF/ICSI) treatment has not been well described. This study aimed to investigate the outcome of IVF/ICSI in ovulatory women with PCO. Methods A retrospective cohort study of women aged ≤ 42 years with infertility and regular ovulatory menstrual cycles who underwent their first IVF/ICSI cycle using the long down regulation protocol at IVF Australia-EAST in Sydney between 2000 and 2011. A pre-treatment baseline transvaginal pelvic ultrasound (TVS) had been performed by a single tertiary level diagnostic ultrasound center. Patients were divided into either group NO (normal ovaries) or group PCO according to the pre-treatment TVS. The primary outcome measure was live birth rate per patient. Results A total of 200 patients (135 in group NO and 65 in group PCO) were included in the data analysis. There was no difference in live birth rate per patient between the two groups (25.2% vs 26.2%) with both raw ( OR [95% CI ] = 1.05 [0.54–2.07]) and logistic regression adjusted (for maternal age) (Adjusted OR [95% CI ] = 0.99 [0.50–1.98]) data. Conclusions The presence of PCO in ovulatory women did not adversely affect IVF/ICSI outcome at our unit. However, the results are not conclusive and further large, well-designed prospective cohort studies are required in order to confirm our findings.

Polycystic Ovary Syndrome (PCOS) and Fertility

The polycystic ovary syndrome (PCOS) is defined as a combination of hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding), with or without the presence of polycystic ovaries on ultrasound. It represents the main endocrine disorder in the reproductive age, affecting 6% - 15% of women in menacme. It is the most common cause of infertility due to anovulation, and the main source of female infertility. When in the presence of a menstrual disorder, the diagnosis of PCOS is reached in 30% - 40% of patients with primary or secondary amenorrhoea and in 80% of patients with oligomenorrhea. PCOS should be diagnosed and treated early in adolescence due to reproductive, metabolic and oncological complications which may be associated with it. Treatment options include drugs, diet and lifestyle improvement.

American Association Of Clinical Endocrinologists, American College Of Endocrinology, And Androgen Excess And Pcos Society Disease State Clinical Review: Guide To The Best Practices In The Evaluation And Treatment Of Polycystic Ovary Syndrome - Part 2

Polycystic ovary syndrome (PCOS) is recognized as the most common endocrine disorder of reproductive-aged women around the world. This document, produced by the collaboration of the American Association of Clinical Endocrinologists and the Androgen Excess Society aims to highlight the most important clinical issues confronting physicians and their patients with PCOS. It is a summary of current best practices in 2014. Insulin resistance is believed to play an intrinsic role in the pathogenesis of PCOS. The mechanism by which insulin resistance or insulin give rise to oligomenorrhea and hyperandrogenemia, however, is unclear. Hyperinsulinemic-euglycemic clamp studies have shown that both obese and lean women with PCOS have some degree of insulin resistance. Insulin resistance is implicated in the ovulatory dysfunction of PCOS by disrupting the hypothalamic-pituitary-ovarian axis. Given the association with insulin resistance, all women with PCOS require evaluation for the risk of metabolic syndrome (MetS) and its components, including type 2 diabetes, hypertension, hyperlipidemia, and the possible risk of clinical events, including acute myocardial infarction and stroke. Obese women with PCOS are at increased risk for MetS with impaired glucose tolerance (IGT; 31 to 35%) and type 2 diabetes mellitus (T2DM; 7.5 to 10%). Rates of progression from normal glucose tolerance to IGT, and in turn to T2DM, may be as high as 5 to 15% within 3 years. Data suggest the need for baseline oral glucose tolerance test every 1 to 2 years based on family history of T2DM as well as body mass index (BMI) and yearly in women with IGT. Compared with BMI- and age-matched controls, young, lean PCOS women have lower high-density lipoprotein (HDL) size, higher very-low-density lipoprotein particle number, higher low-density lipoprotein (LDL) particle number, and borderline lower LDL size. Statins have been shown to lower testosterone levels either alone or in combination with oral contraceptives (OCPs) but have not shown improvement in menses, spontaneous ovulation, hirsutism, or acne. Statins reduce total and LDL cholesterol but have no effect on HDL, C-reactive protein, fasting insulin, or homeostasis model assessment of insulin resistance in PCOS women, in contrast to the general population. There have been no long-term studies of statins on clinical cardiac outcomes in women with PCOS. Coronary calcification is more prevalent and more severe in PCOS than in controls. In women under 60 years of age undergoing coronary angiography, the presence of polycystic ovaries on sonography has been associated with more arterial segments with >50% stenosis, but the relationship between PCOS and actual cardiovascular events remains unclear. Therapies for PCOS are varied in their effects and targets and include both nonpharmacologic as well as pharmacologic approaches. Weight loss is the primary therapy in PCOS--reduction in weight of as little as 5% can restore regular menses and improve response to ovulation- inducing and fertility medications. Metformin in premenopausal PCOS women has been associated with a reduction in features of MetS. Clamp studies using ethinyl estradiol/drosperinone combination failed to reveal evidence of an increase in either peripheral or hepatic insulin resistance. Subjects with PCOS have a 1.5-times higher baseline risk of venous thromboembolic disease and a 3.7-fold greater effect with OCP use compared with non-PCOS subjects. There is currently no genetic test to screen for or diagnose PCOS, and there is no test to assist in the choice of treatment strategies. Persistent bleeding should always be investigated for pregnancy and/or uterine pathology--including transvaginal ultrasound exam and endometrial biopsy--in women with PCOS. PCOS women can have difficulty conceiving. Those who become pregnant are at risk for gestational diabetes (which should be evaluated and managed appropriately) and the microvascular complications of diabetes. Assessment of a woman with PCOS for infertility involves evaluating for preconceptional issues that may affect response to therapy or lead to adverse pregnancy outcomes and evaluating the couple for other common infertility issues that may affect the choice of therapy, such as a semen analysis. Women with PCOS have multiple factors that may lead to an elevated risk of pregnancy, including a high prevalence of IGT--a clear risk factor for gestational diabetes--and MetS with hypertension, which increases the risk for pre-eclampsia and placental abruption. Women should be screened and treated for hypertension and diabetes prior to attempting conception. Women should be counseled about weight loss prior to attempting conception, although there are limited clinical trial data demonstrating a benefit to this recommendation. Treatment for women with PCOS and anovulatory infertility should begin with an oral agent such as clomiphene citrate or letrozole, an aromatase inhibitor.

Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a heterogeneous and complex disorder that has both adverse reproductive and metabolic implications for affected women. However, there is generally poor understanding of its etiology. Varying expert-based diagnostic criteria utilize some combination of oligo-ovulation, hyperandrogenism, and the presence of polycystic ovaries. Criteria that require hyperandrogenism tend to identify a more severe reproductive and metabolic phenotype. The phenotype can vary by race and ethnicity, is difficult to define in the perimenarchal and perimenopausal period, and is exacerbated by obesity. The pathophysiology involves abnormal gonadotropin secretion from a reduced hypothalamic feedback response to circulating sex steroids, altered ovarian morphology and functional changes, and disordered insulin action in a variety of target tissues. PCOS clusters in families and both female and male relatives can show stigmata of the syndrome, including metabolic abnormalities. Genome-wide association studies have identified a number of candidate regions, although their role in contributing to PCOS is still largely unknown.