Is there a role for diet in ameliorating the reproductive sequelae associated with chronic low-grade inflammation in polycystic ovary syndrome and obesity?

Immune imbalance in the pre-ovulatory follicular microenvironment of overweight and obese women during IVF

BACKGROUND

Overweight and obesity can induce an inflammatory milieu in the oocyte microenvironment and are closely associated with reduced assisted reproductive outcomes.

OBJECTIVE

How are immune cells, cytokines and lipid profiles altered in the pre-ovulatory microenvironment of overweight and obese women?

METHODS

32 women undergoing in vitro fertilization (IVF) were included, with 14 overweight or obese (OW) and 18 normal weight (NW) participants. Serum was collected before ovulation induction, follicular fluid (FF) and aspirates were obtained during oocyte retrieval for flow cytometry, cytokines, hormone, and lipid profiles measurement. Clinical outcomes were recorded through a one-year follow-up.

RESULTS

The percentage of T cells in the pre-ovulatory follicular microenvironment, especially CD4+ T cells, increased significantly in the OW group, which positively related with BMI. Notably, type 2 cytokine IL4 and IL13 transcription level in OW group had significantly increased, while the type 1 cytokine IFNG only showed a non-statistically significant upward trend. Lipid profiles were screened, revealing no difference between the two groups, however, levels were higher in serum compared to FF. Additionally, the concentration gradient of TG between serum and FF was 22-fold in OW group (2.92 ± 3.66 vs. 0.13 ± 0.03), which was significantly higher than the 12-fold gradient observed in NW group (1.72 ± 0.95 vs. 0.14 ± 0.08). Furthermore, day 3 high quality embryos rate is negatively associated with BMI and exhibits a decreasing trend in OW group.

CONCLUSION

Overweight and obesity can disrupt immune hemostasis in the pre-ovulatory follicular microenvironment, potentially leading to adverse effects on assisted reproductive outcomes.

Metabolic disparities between obese and non-obese patients with polycystic ovary syndrome: implications for endometrial receptivity indicators

OBJECTIVE

To investigate the differences in the metabolic indicators and sex hormones between obese and non-obese patients with polycystic ovary syndrome (PCOS), and their impacts on endometrial receptivity (ER).

METHODS

We selected 255 individuals with PCOS, and categorized them into the obese groups, including the OP group (obese patients with PCOS) and the ON group (obese patients without PCOS), and selected 64 individuals who were categorized in the non-obese groups, namely, the control groups, which comprise the NP group (non-obese patients with PCOS) and the NN group(non-obese patients without PCOS). The one-way analysis of variance (ANOVA) and Mann-Whitney U tests were used to compare the metabolic indicators, and sex hormone-associated and ER-associated indicators between the groups. The correlation between the aforementioned clinical markers and ER was analyzed using the Pearson's correlation coefficient.

RESULTS

(1) In comparison with the NP group, the OP group exhibited higher levels (p < .01) of free androgen index (FAI), anti-müllerian hormone (AMH), fasting insulin (FINS), insulin level within 60 min, 120 min, and 180 min-60minINS, 120minINS, and 180minINS, respectively, fasting blood glucose (FBG), blood glucose level within two hours (2hGlu), homeostatic model assessment for insulin resistance (HOMA-IR), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), waist-to-hip ratio (WHR), waist circumference, hip circumference, the ratio of the maximum blood flow velocity of the uterine artery during systole to the blood flow velocity of the uterine artery at the end of diastole (uterine artery S/D), and blood flow resistance index (RI) of the uterine artery. In comparison with the NP group, the OP group exhibited lower levels (p < .01) of sex hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), high molecular weight adiponectin (HMWA), and high-density lipoprotein cholesterol (HDL-C). (2) In the PCOS group, RI was significantly positively correlated with FAI, FINS, 120minINS, HOMA-IR, and WHR (p < .01), and significantly negatively correlated with SHBG, HDL-C, and HMWA (p < .01); uterine artery S/D was significantly positively correlated with FAI, FINS, 2hGlu, HOMA-IR, LDL-C, and WHR (p < .01), significantly positively correlated with 120minINS and FBG (p < .05), and significantly negatively correlated with SHBG and HMWA (p < .01).

CONCLUSION

(1) The OP group exhibited obvious metabolic disorders and poor ER, which was manifested as low levels of SHBG and HMWA, and high levels of FAI, HOMA-IR, WHR, uterine artery S/D, and RI. (2) In patients with PCOS, there was a substantial correlation between ER-associated indicators RI and uterine artery S/D and FAI, FINS, 120minINS, HOMA-IR, WHR, SHBG, and HMWA.

High prevalence of chronic endometritis is associated with metabolic abnormality and reduced live birth rate among IVF women with non-uniform endometrial echogenicity

OBJECTIVE

To assess the prevalence of chronic endometritis (CE) among women with non-uniform endometrial echogenicity, and to evaluate the association between CE and metabolic characteristics as well as pregnancy outcomes in the subsequent frozen-thawed embryo transfer (FET) cycles.

DESIGN

Retrospective cohort study.

SETTING

University-based hospitals and an academic medical center.

PATIENTS

A total of 315 patients included in this research underwent hysteroscopy and endometrial biopsy before the first FET cycle after whole embryos freezing. Patients were divided into CE (histopathologic CE or hysteroscopic CE) and non-CE groups.

INTERVENTION(S)

Freeze-all strategy, hysteroscopy and endometrial biopsy.

MAIN OUTCOME MEASURES

Baseline and cycle characteristics, hysteroscopic, and histopathological profile, as well as pregnancy outcomes.

RESULTS

The prevalence of histopathologic CE and hysteroscopic CE were 78.1% and 34.9%, respectively. CE was associated with higher homocysteine level and BMI, independent of insulin response and dyslipidemia. High homocysteine level and BMI were risk factors for histopathologic CE (OR: 1.182; 95% CI: 1.01-1.384; p = .037) and hysteroscopic CE (OR: 1.117; 95% CI: 1.041-1.199; p = .002), respectively. Histopathologic CE was a risk factor for live birth (OR:2.167; 95% CI: 1.037-4.525; p = .04), and hysteroscopic CE was an independent risk factor for both live birth (OR: 4.239; 95% CI: 1.929-9.313; p = .001) and cumulative live birth (OR: 3.963; 95% CI: 1.875-8.376; p = .001).

CONCLUSIONS

Infertile women with non-uniform endometrial echogenicity have a high prevalence of CE which significantly reduces the live birth rate. Diagnosing CE by hysteroscopy is important to assess the cumulative probability of pregnancy in IVF patients.

Daidzein supplementation improved fecundity in sows via modulation of ovarian oxidative stress and inflammation

Adequate ovarian hormones secretion is essential for pregnancy success. Oxidative damage and following inflammation can destroy the ovarian normal function in mammals. Daidzein (DAI) is a classical isoflavonic phytoestrogen with specific oestrogenic activity. This study aimed to explore the effects of daidzein supplementation on fertility and ovarian characteristics of sows through biochemical analysis and RNA-seq technology. Twelve multiparous Yorkshire × Landrace sows were randomly divided into CON and DAI groups. We found that DAI increased total number of embryos as well as P4 and E2 levels of serum. DAI not only elevated the activities of T-AOC and GSH-Px, but also tended to decrease the content of MDA and IL-6 in the serum. In ovary, RNA-Seq identified 237 differentially expressed genes (DEGs), and GO analysis showed that these DEGs were linked to functions associated with immune dysfunction. Moreover, STRING analysis demonstrated that most interacting nodes were TLR-4, LCP2, and CD86. Furthermore, DAI decreased the content of MDA, IL-1β, IL-6, and TNF-α, and increased the activities of T-AOC and CAT in ovarian tissue. Interestingly, a partial mantel correlation showed that T-AOC was the strongest correlation between the ovarian dataset and selected DEGs. Additionally, DAI supplementation not only increased the protein expressions of Nrf2, HO-1, and NQO1, but also decreased the protein expressions of TLR-4, p-NFκB, p-AKT, and p-IκBα. Altogether, our results indicated that DAI could ameliorate ovarian oxidative stress and inflammation in sows, which might be mediated by suppressing the TLR4/NF-κB signaling pathway and activating the Nrf2/HO-1 signaling pathway.

Genetic polymorphisms -137 (G > C) (rs187238) and -607 (C > A) (rs1946518) and serum level of interleukin 18 in Fars ethnic groups with metabolic syndrome in Northern Iran

INTRODUCTION

We aimed to determine the genetic polymorphisms and serum level of interleukin 18 in Fars ethnic groups.

MATERIAL AND METHODS

226 Fars ethnic groups were participated. The ATP III criteria were used to assess MS components. The SNPs of the IL-18 gene were determined with ARMS-PCR.

RESULTS

The GG, GC, and CC genotypes of -137 were 50%, 40%, and 10%. The CC, CA, and AA genotypes of -607 were 45%, 37%, and 18%. The GG, GC, and CC genotypes of -137 were 44.20%, 43.40%, and 12.40%, and were 55.75%, 36.28%, and 7.97% in subjects with and without MS, respectively. The CC, CA, and AA genotypes of -607 were 48.70%, 37.20%, and 14.20% and were 41.60%, 37.20%, and 21.20% in both groups, respectively.

CONCLUSION

IL-18 gene may different in specific populations, different ethnic groups and geographic regions. The IL-18 polymorphisms might not be used as a marker of metabolic syndrome.

The Disorders of Endometrial Receptivity in PCOS and Its Mechanisms

Polycystic ovary syndrome (PCOS) is a mysterious and complicated endocrine disease with the combination of metabolic, reproductive, psychological dysfunctions. Impaired endometrial receptivity and ovulation disorders/anovulation are both important causes of PCOS-related infertility. However, change in endometrium has never received the same attention as ovulatory dysfunction. Besides, putting emphasis on endometrial function may be more realistic for PCOS-related infertility, given the wide use of assisted reproductive technology. The present review focuses on the disorders of endometrial receptivity of patients with PCOS, summarizes the changes of the indicators of endometrial receptivity including leukemia inhibitory factor, homeobox genes A, pinopodes, αvβ3-integrin, and intercellular junctions and also analyzes the possible mechanisms of decreased endometrial receptivity and its relationship with the main endocrine and metabolic disorders of PCOS such as hyperandrogenism, inflammation, insulin resistance, and obesity. Despite several biomarkers have been found to be associated with decreased endometrial receptivity in PCOS, the clinical relevance of these findings still awaits future clarification.

Antioxidant Intervention Attenuates Aging-Related Changes in the Murine Ovary and Oocyte

Advanced maternal age (AMA) is associated with reduced fertility due in part to diminished ovarian follicle quantity, inferior oocyte quality, chromosome aneuploidy, and lower implantation rates. Ovarian aging is accompanied by increased oxidative stress and blunted antioxidant signaling, such that antioxidant intervention could improve reproductive potential. The first aim of this study was to determine the molecular effects of antioxidant intervention in the ovaries and oocytes of aged mice, utilizing a supplement containing only naturally occurring açaí (Euterpe oleracea) with an oxygen radical absorbance capacity of 208,628 μmol Trolox equivalent (TE)/100 g indicating high antioxidant activity. Nine month old female CF-1 mice were administered 80 mg/day antioxidants (n = 12) or standard diet (n = 12) for 12 weeks. In the ovary, antioxidant treatment upregulated β-adrenergic signaling, downregulated apoptosis and proinflammatory signaling, and variably affected cell growth and antioxidant pathways (p < 0.05). Exogenous antioxidants also increased the oocyte expression of antioxidant genes GPX1, SOD2, and GSR (p < 0.05). A feasibility analysis was then conducted on female AMA infertility patients as a proof-of-principle investigation. Patients (n = 121; <45 years old) consented to receiving 600 mg antioxidants three times daily for ≥8 weeks preceding infertility treatment. Preliminary results indicate promising outcomes for AMA patients, warranting further investigation.

The burden of the probable polycystic ovarian syndrome and its associated factor among college going late adolescents and young adults: a cross sectional analytical study in urban Puducherry, South India

Objectives Polycystic Ovarian Syndrome (PCOS) is one of the most common metabolic and reproductive disorders among women of reproductive age. In low income and developing countries like India, there are very high chances of developing PCOS due to marked variation between culture, ethnic groups, diet, lifestyle and genetic factors. This study aims to determine the burden of probable PCOS among college going students in Puducherry. Methods A cross sectional study was carried out among students aged 18 years and above in a Government College for Women located in urban Puducherry. A total of 610 students were selected through a cluster random sampling technique. A pretested validated proforma was administered after obtaining informed consent. Results 25.1% (21.8-28.7) of women were having probable PCOS, 18.7% (15.8-22.0) had irregular menstrual history, 8.4% (6.4-10.8) had Hirsutism and 2% (1.8-3.3) had both the symptoms. Regarding food habits, 43.1% were vegetarians and were having probable PCOS and this association was found to be statistically significant. No significant association was found between prevalence of probable PCOS and factors such as higher age, parental income, higher BMI and physical inactivity. Conclusions The present study found a high prevalence of probable PCOS among college going students, especially among study respondents who were obese, physically inactive and vegetarians compared to the counterpart. Earlier detection and proper management of the symptoms can avoid some major co-morbidity in the future. Therefore, screening is an important part in the diagnosis and management of PCOS among adolescent girls.

Decreased Insulin Resistance by Myo-Inositol Is Associated with Suppressed Interleukin 6/Phospho-STAT3 Signaling in a Rat Polycystic Ovary Syndrome Model

Myo-inositol supplementation may reduce insulin resistance (IR) with few serious side effects in patients with polycystic ovary syndrome (PCOS). To explore the mechanism of this action in an animal model, a PCOS-IR rat model was generated. Enzyme-linked immunosorbent assay was used to assess changes in ovulation function during treatment with a myo-inositol supplement, and Western blotting, real-time polymerase chain reaction, and immunohistochemistry were performed to investigate the underlying molecular mechanisms. The results showed that the myo-inositol supplement decreased the homeostatic model assessment of insulin resistance (HOMA-IR) index and significantly decreased the serum levels of luteinizing hormone (LH), LH/follicle-stimulating hormone ratio, and testosterone, while increasing the serum level of estradiol. Upregulation of interleukin 6 (IL-6), phospho-STAT3 (p-STAT3), Mir-21, and Mir-155 and significant downregulation of PPAR-γ and GLUT4 were detected in the untreated PCOS-IR rat model. However, downregulation of IL-6, p-STAT3, miR-21, and miR-155 and significant upregulation of PPAR-γ and GLUT4 were detected with myo-inositol supplementation. Thus, myo-inositol supplementation may reduce Mir-21 and Mir-155 levels by downregulating IL-6 and p-STAT3 and, subsequently, reverse the expression of PPAR-γ and GLUT4, leading to a decreased HOMA-IR index. In conclusion, the identification of an IL-6/p-STAT3/Mir-155/Mir-21/PPAR-γ/GLUT4 system in the PCOS-IR rat model provides insight into the pathogenesis of PCOS and may indicate a possible therapeutic strategy. Amelioration of the basal serum glucose levels and of the HOMA/HOMA-IR index may be achieved by the reversal of the expression of PPAR-γ and GLUT4 through the downregulation of IL-6, p-STAT3, miR-21, and miR-155 with myo-inositol supplementation.

The Potential for Plant-Based Diets to Promote Health Among Blacks Living in the United States

Plant-based diets are associated with reduced risks of various chronic diseases in the general population. However, it is unclear how these benefits translate to Blacks living in the United States, who are disproportionately burdened with heart disease, cancer, diabetes, obesity, and chronic kidney disease. The objectives of this study were to: (1) review the general evidence of plant-based diets and health outcomes; (2) discuss how this evidence translates to Blacks following a plant-based diet; and (3) provide recommendations and considerations for future studies in this area. Interestingly, although the evidence supporting plant-based diets in the general population is robust, little research has been done on Blacks specifically. However, the available data suggests that following a plant-based diet may reduce the risk of heart disease and possibly cancer in this population. More research is needed on cardiovascular disease risk factors, cancer subtypes, and other chronic diseases. Further, attention must be given to the unique individual, familial, communal, and environmental needs that Blacks who follow plant-based diets may have. Interventions must be culturally appropriate in order to achieve long-term success, and providing low-cost, flavorful, and nutritious options will be important.

Why does Polycystic Ovary Syndrome (PCOS) Need Long-term Management?

BACKGROUND

Polycystic ovary syndrome (PCOS) is a frequent female reproductive endocrine disease. It has been associated with a number of severe reproductive and metabolic abnormalities. However, there are still open questions especially regarding the best long-term management.

METHODS

We summarized the literature focused on the symptoms and negative long-term consequences of untreated PCOS and the existing options for the treatment. We reviewed the Pubmed and China National Knowledge Infrastructure databases and the relevant literature for the last 20 years. Included in this review also are new results of own (published) research and own experience from treating daily more than 100 PCOS patients.

RESULTS

Obesity is one of the most common findings. It can cause abnormal ovulations which can lead to infertility. Important long-term consequences can be adverse pregnancy outcomes. There is an agreement that the risk of endometrial cancer can be increased. Insulin resistance, important within the pathophysiology of PCOS, predisposes patients to metabolic dysfunction and increased risk of type 2 diabetes mellitus. Lifestyle modifications including dietary changes, exercise and weight loss are first-line interventions for many patients. Well known drug treatments such as metformin, oral contraceptives, etc. should be selected according to the individual situation and patients' needs. Regarding newer methods in the long-term management of PCOS, we found that orlistat may help to achieve weight loss and to improve lipid and glucose metabolism.

CONCLUSION

In addition to pharmacological interventions, long-term standardized individualized management of PCOS patients is needed to achieve fertility and to reduce the risk of metabolic related diseases.

Total flavonoids extracted from Nervilia Fordii function in polycystic ovary syndrome through IL-6 mediated JAK2/STAT3 signaling pathway

Large doses of flavonoids could cure many diseases with no serious side effects. However, the role of flavonoids in the treatment of polycystic ovary syndrome (PCOS) has not been reported. Therefore, total flavonoids extracted from Nervilia Fordii were selected to explore its therapeutic efficiency in PCOS. PCOS rat model was constructed to explore the role of total flavonoids in the treatment of PCOS. ELISA was used to assess the changes of ovulation function under the treatment of total flavonoids with or without exogenous interleukin-6 (IL-6). Western blot, real-time PCR and immunohistochemistry were carried out to assess the related molecular mechanisms. We explored that total flavonoids obviously increased the serum levels of follicle-stimulating hormone (FSH), and sharply decreased the serum levels of luteinizing hormone (LH), testosterone (T) and insulin (INS) in the PCOS-IR rats via partly inhibiting the activation of JAK2/STAT3 pathway, partially up-regulating the IL-6 expression and partially down-regulating the suppressor of cytokine signaling 3 (SOCS3) expression in ovaries of PCOS rats. The effect of total flavonoids on estrous cycles, serum levels of FSH, LH, T and INS were partially attenuated by IL-6 in PCOS rat model. Moreover, IL-6 significantly reversed the effect of total flavonoids on the phosphorylation of JAK2/STAT3, the expression of IL-6 and SOCS3 in ovaries of PCOS rats. Total flavonoids extracted from Nervilia Fordii might induce the expression of IL-6 in ovary and act as a potential therapeutic drug for the treatment of PCOS.

Chromium supplementation and polycystic ovary syndrome: A systematic review and meta-analysis

INTRODUCTION

polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. Some vitamins and mineral can play role in improvement of PCOS. Chromium (Cr) is an essential element in glucose and insulin homeostasis. However, findings are not consistent regarding PCOS improvement. Therefore, the purpose of this paper was to assess the effect of Cr supplementation in PCOS that have not yet fully been elucidated.

METHODS

We searched ISI Web of Science, MEDLINE (1966 to June 2016), Google Scholar databases and Proquest and identified eligible papers and extracted the following terms: total testosterone, DHEAS, insulin sensitivity, fasting glucose, fasting insulin, OGTT 1h glucose, OGTT 2h glucose (mg/dL), LH (mIU/mL), FSH, DHEAS, ferriman-Galwey score (FG score). We calculated overall effect size with random effects model, between-study heterogeneity with I square (I²) statistic. Publication bias was assessed using Begg's test regression.

RESULT

Totally, 7 RCTs were selected. Results indicated that Cr supplementation had a beneficial effect on BMI with effect size: -2.37 (kg/m²), 95% CI: -2.99, -1.76, p=0.001 and free testosterone concentration with effect size=-0.52 (pg/mL), 95% CI: -0.83, -0.23, p=0.001. Cr reduced fasting insulin in subgroup of studies with >10 participants with effect size: -0.86mIU/ml, 95% CI: -0.67, -0.17; p=0.001. Cr supplementation had no beneficial effects on reducing total testosterone, FG score, DHEA, FSH and LH.

CONCLUSION

This systematic review and meta-analysis shows that using Cr picolinate supplementation has beneficial effects on decreasing BMI, fasting insulin and free testosterone in PCOS patients.

Airway exposure to multi-walled carbon nanotubes disrupts the female reproductive cycle without affecting pregnancy outcomes in mice

BACKGROUND

The use of multiwalled carbon nanotubes (MWCNT) is increasing due to a growing use in a variety of products across several industries. Thus, occupational exposure is also of increasing concern, particularly since airway exposure to MWCNTs can induce sustained pulmonary acute phase response and inflammation in experimental animals, which may affect female reproduction. This proof-of-principle study therefore aimed to investigate if lung exposure by intratracheal instillation of the MWCNT NM-400 would affect the estrous cycle and reproductive function in female mice.

RESULTS

Estrous cycle regularity was investigated by comparing vaginal smears before and after exposure to 67 μg of NM-400, whereas reproductive function was analyzed by measuring time to delivery of litters after instillation of 2, 18 or 67 μg of NM-400. Compared to normal estrous cycling determined prior to exposure, exposure to MWCNT significantly prolonged the estrous cycle during which exposure took place, but significantly shortened the estrous cycle immediately after the exposed cycle. No consistent effects were seen on time to delivery of litter or other gestational or litter parameters, such as litter size, sex ratio, implantations and implantation loss.

CONCLUSION

Lung exposure to MWCNT interfered with estrous cycling. Effects caused by MWCNTs depended on the time of exposure: the estrous stage was particularly sensitive to exposure, as animals exposed during this stage showed a higher incidence of irregular cycling after exposure. Our data indicates that MWCNT exposure may interfere with events leading to ovulation.

Meat and Nicotinamide: A Causal Role in Human Evolution, History, and Demographics

Hunting for meat was a critical step in all animal and human evolution. A key brain-trophic element in meat is vitamin B3 / nicotinamide. The supply of meat and nicotinamide steadily increased from the Cambrian origin of animal predators ratcheting ever larger brains. This culminated in the 3-million-year evolution of Homo sapiens and our overall demographic success. We view human evolution, recent history, and agricultural and demographic transitions in the light of meat and nicotinamide intake. A biochemical and immunological switch is highlighted that affects fertility in the 'de novo' tryptophan-to-kynurenine-nicotinamide 'immune tolerance' pathway. Longevity relates to nicotinamide adenine dinucleotide consumer pathways. High meat intake correlates with moderate fertility, high intelligence, good health, and longevity with consequent population stability, whereas low meat/high cereal intake (short of starvation) correlates with high fertility, disease, and population booms and busts. Too high a meat intake and fertility falls below replacement levels. Reducing variances in meat consumption might help stabilise population growth and improve human capital.

Oocyte Competence in Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and affects fertility and pregnancy in cases of oligoanovulation. Ovulation induction is often used to treat anovulatory patients with PCOS, but many of these women fail to conceive and resort to assisted reproductive technologies. Alterations in oocyte competence (OC) are considered potential causative factors for subfertility in women with PCOS. In this review we present and critically assess all recent clinical and experimental data regarding OC in women with PCOS. Our analysis demonstrates that the contribution of OC to reproductive potential in women with PCOS varies and largely depends on the PCOS phenotype and comorbidities associated with PCOS.