Characteristics of obesity in polycystic ovary syndrome: Etiology, treatment, and genetics

Effects of melatonin in polycystic ovary syndrome: is there Hippo pathway crosstalk?

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among reproductive women, characterized by hyperandrogenism, oligo-ovulation and polycystic ovarian morphology. Incorporating complementary medicine alongside traditional lifestyle therapies for PCOS may offer additional benefits for affected women. Melatonin (MT), a hormone secreted by the pineal gland, has emerged as a potential treatment for regulating ovarian function in PCOS. However, the specific effects and underlying mechanisms of MT on PCOS need to be elucidated.

METHODS

This review consolidates evidence from randomized controlled trials, original research articles, systematic reviews, and meta-analyses regarding MT supplementation in PCOS, with a particular focus on its interaction with the Hippo pathway, to provide a comprehensive overview of current knowledge.

RESULTS

Current evidence suggests that MT plays a role in modulating PCOS through various mechanisms and is associated with the Hippo pathway. However, several uncertainties and key limitations in the existing literature must be addressed before these treatments can be integrated into standard clinical practice.

CLINICAL TRIAL NUMBER

Not applicable.

Genetic-epigenetic targets for PCOS-associated diabesity

Polycystic ovary syndrome (PCOS) and diabesity are interconnected endocrine disorders driven by a complex interplay of genetic, epigenetic and environmental factors. This review examines the molecular crosstalk between PCOS and diabesity, focusing on shared pathophysiological pathways and their regulatory mechanisms. Key genetic predispositions (such as polymorphisms) associated with insulin resistance, androgen biosynthesis and inflammation have been conferred that could significantly contribute to their overlapping phenotypes. Additionally, epigenetic modifications, including DNA methylation, histone modifications and non-coding RNAs, have been discussed that further participate in regulation of gene expression and metabolic dysfunction. Understanding these molecular interconnections highlights crucial signaling nodes that can serve as potential therapeutic targets. This review underscores emerging avenues for drug development, aiming to mitigate disease progression and improve patient outcomes.

Unraveling the Connection between PCOS and renal Complications: Current insights and Future Directions

Polycystic ovary syndrome (PCOS) represents the most prevalent endocrine disorder among women of reproductive age, affecting approximately 5-18% of females worldwide. Characterized by irregular ovulation, hyperandrogenism, and polycystic ovaries, hyperandrogenism is the defining feature. Recent evidence highlights that, in addition to its notable reproductive and metabolic consequences, PCOS may also contribute to an elevated risk of renal complications. This increased risk is attributed to chronic low-grade inflammation, hormonal dysregulation, and disturbances in lipid metabolism inherent to the condition. However, the pathological mechanisms, clinical manifestations, and progression of secondary renal damage in this cohort remain insufficiently studied. This review consolidates current understanding of the relationship between PCOS and chronic kidney disease (CKD), aiming to clarify potential mechanisms by which PCOS may induce secondary renal dysfunction, encompassing both direct renal impairment and indirect damage mediated through systemic alterations. Furthermore, it advocates for comprehensive management strategies to mitigate renal risks in patients with PCOS, emphasizing the necessity of multidisciplinary approaches and further research to address these critical gaps.

Effects of weight loss on testosterone, sex hormone-binding globulin, adiposity, and insulin sensitivity in women and men

OBJECTIVE

Testosterone and glucose disposal (Rd) are positively associated in adult men, whereas the opposite is reported in women. Sex-specific relationships between testosterone or sex hormone-binding globulin (SHBG) and Rd in men and women with and without obesity and following weight loss were examined.

METHODS

Adult men and women (n = 27/28; BMI = 20-41 kg/m2) underwent measurements of body composition, Rd, SHBG, and bioavailable (BioA) and total testosterone. Men and women (n = 17/15) with obesity completed a 16-week dietary weight-loss program with repeat testing.

RESULTS

BioA testosterone was lower in men with obesity and was related to Rd positively in men and negatively in women (p < 0.05). Across participants, weight loss increased Rd and SHBG (p < 0.01). BioA testosterone was unchanged in men; however, individual changes were independently related to Rd (p = 0.031). In women, BioA testosterone declined (p < 0.009) but was not related to Rd.

CONCLUSIONS

BioA testosterone was associated with Rd, positively in men and negatively in women. Weight loss reduced BioA testosterone in women; however, individual changes were associated with improved Rd in men. SHBG was a better correlate of improved Rd in women. Additional studies should identify mechanisms that drive sex differences and interventions that modify testosterone, reduce adiposity, and improve Rd across both sexes.

Effects of carbohydrate reduced diet associated with strength training on clinical signs of women with polycystic ovary syndrome: Randomized clinical trial

OBJECTIVE

To evaluate the effects of a low-carbohydrate diet associated with strength training on the clinical signs of polycystic ovary syndrome (PCOS).

RESEARCH METHODS AND PROCEDURES

A randomized clinical trial was carried out including 29 women over 18 years old diagnosed with PCOS, randomized into two groups, with follow-up for 12 weeks: the low-carbohydrate diet group associated with strength exercise (LCDE); and the standard diet group associated with strength exercise (SDE). We evaluated manifestations of acne, hirsutism by the Ferriman-Gallwey scale and alopecia by the Ludwig-Savin scale, and assessed laboratory tests for total and free testosterone, dehydroepiandrosterone, follicle-stimulating hormone, and luteinizing hormone. The collected data were analyzed using IBM-SPSS software version 21.

RESULTS

The study showed statistically significant differences in the hormonal levels of dehydroepiandrosterone (P = 0.045), luteinizing hormone (P = 0.017) and follicle-stimulating hormone (P = 0.014) when comparing the LCDE and SDE groups.

CONCLUSIONS

the intervention used can promote an improvement in the clinical presentation of PCOS, especially in hormonal parameters. The clinical trial was registered on the REBEC platform (Brazilian Registry of Clinical Trials) under number RBR4wjqxcv (Carbohydrate Reduction and Exercise in Women with PCOS) and is available on the website: https://ensaiosclinicos.gov.br/rg/RBR-4wjqxcv.

The Therapeutic Potential of Theobromine in Obesity: A Comprehensive Review

Obesity, characterized by chronic low-grade inflammation, is a significant health concern. Phytochemicals found in plants are being explored for therapeutic use, particularly in combating obesity. Among these, theobromine, commonly found in cocoa and chocolate, shows promise. Although not as extensively studied as caffeine, theobromine exhibits positive effects on human health. It improves lipid profiles, aids in asthma treatment, lowers blood pressure, regulates gut microbiota, reduces tumor formation, moderates blood glucose levels, and acts as a neuroprotective agent. Studies demonstrate its anti-obesity effects through mechanisms such as browning of white adipose tissue, activation of brown adipose tissue, anti-inflammatory properties, and reduction of oxidative stress. This study aims to suggest theobromine as a potential therapeutic agent against obesity-related complications.

The Role of Nutraceuticals and Probiotics in Addition to Lifestyle Intervention in the Management of Childhood Obesity-Part 2: Comorbidities

Pediatric obesity is associated with a wide range of comorbidities beyond metabolic changes, affecting cardiovascular, endocrine, reproductive, musculoskeletal systems, and also mental health. Hypertension, commonly observed in children with obesity, increases the risk of long-term cardiovascular disease. Polycystic ovary syndrome (PCOS) presents another significant endo-reproductive challenge that often develops during adolescence in females, leading to further comorbidities in adulthood. Additionally, excess adiposity can negatively impact bone health by modifying bone metabolism and increasing fracture risk. Obesity is also strongly linked to mental health disorders, including depression, anxiety, and low self-esteem, which can further exacerbate unhealthy lifestyle behaviors and disorders. Given the limitations and poor adherence of traditional treatment strategies, nutraceuticals have emerged as potential complementary therapies due to their bioactive properties. Various compounds have demonstrated antihypertensive, insulin-sensitizing, and anti-inflammatory effects, while others support bone metabolism and promote mental well-being. Herewith, we discuss the role of nutraceuticals in managing hypertension, PCOS, bone health, and mental health issues in individuals with obesity, evaluating their mechanisms of action and clinical relevance. Integrating nutraceutical compounds with dietary and lifestyle interventions may improve treatment outcomes and prevent obesity-related comorbidities. Further, we emphasize the need for further large-scale clinical studies, especially in pediatric patients.

Therapeutic effects and potential mechanisms of caffeine on obese polycystic ovary syndrome: bioinformatic analysis and experimental validation

The risk of PCOS is significantly increased in obese women, and studies have shown that weight loss can improve symptoms of PCOS. Coffee has been shown to be effective in reducing body weight. In this study, we focused on the SLC16A6 gene using bioinformatics and searched for coffee and its monomers using reverse network pharmacology. The gene expression omnibus (GEO) database was searched to screen for differentially expressed genes (DEGs) in PCOS patients. Gene ontology (GO) functional enrichment analysis and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis were then performed. The effects of caffeine on body weight, estrous cycle, ovarian pathology, serum insulin concentration and insulin resistance index, and SLC16A6 transporter gene expression in ovarian tissue of obese PCOS rats were monitored. The common differentially expressed gene SLC16A6 was identified in this study, and animal experiments confirmed the efficacy of caffeine in the treatment of obese PCOS rats. Caffeine can effectively improve the symptoms of obese PCOS rats. The mechanism by which caffeine can treat obese patients with PCOS is related to increasing the expression of the SLC16A6 gene.

Autoantibodies Targeting the Hypothalamic-Pituitary-Ovarian Axis in Polycystic Ovary Syndrome: Emerging Key Players in Pathogenesis?

Polycystic ovary syndrome (PCOS) is a common female endocrinopathy associated with reproductive and metabolic abnormalities. PCOS is characterized by complex pathogenesis and pathophysiology. Its multifactorial etiology and heterogeneous presentation make effective treatment difficult. Endocrine abnormalities in PCOS create a vicious cycle of overriding dysfunction involving the hypothalamic-pituitary-ovarian (HPO) axis. Most research has primarily focused on identifying genetic, epigenetic, or immunological factors underlying PCOS. In recent years, new reports have emerged on the possible involvement of antibodies directed against HPO axis components in the development of PCOS. Some of these have been shown to be able to interfere with hormone receptors or receptor binding by targeting the key domains for their function. However, the evidence is heterogeneous and challenging to interpret, given the overall predisposition to high levels of various autoantibodies found in women with PCOS. This review focuses on autoantibodies affecting the HPO axis in PCOS and their potential role in the pathogenesis of PCOS. The authors discuss PCOS as a potential antibody-mediated autoimmune disease in light of recent reports on its possible pathogenesis.

PCOS and genetics: Exploring the heterogeneous role of potential genes in ovarian dysfunction, a hallmark of PCOS - A review

PCOS is an endocrine disorder that affects women of reproductive age. The root of PCOS is ovarian dysfunction, which presents as hormonal disturbances affecting normal ovarian function to cause the symptoms and complications of the disease. This dysfunction causes symptoms like impaired maturation of follicles and disorders of various origins with multiple treatment regimens that are not always clear. Therefore, the present review mainly concentrates on the genetic level of ovarian dysfunction of PCOS. The articles were identified through a vigorous literature search where search engines such as PubMed, Google Scholar, databases, and Science Direct were used, and the articles published from 2015 to 2025 were referred. We identified that the key genes involved in the ovarian dysfunctions in PCOS include CYP11A1, CYP17A1, CYP19A1, AR, FSHR, LHCGR, AMH, INSR, SHBG, IRS1, GATA4, ADIPOQ, YAP1, TCF7L2, and DENND1A, which play a role in gonadotropin action, steroidogenesis, and folliculogenesis. Furthermore, epigenetic factors and miRNAs miR-93, 222, 155, 146a, 132, 320, 27a, 483, 21, 378, 17-92 Cluster, and 375, 221 are also involved in it. Abnormal expression of these genes is known to play a critical role in the etiology and pathogenesis of PCOS. Present treatment includes the use of oral contraceptives, anti-androgen agents, insulin-sensitizing agents, and ovulation-inducing agents, and future treatment may consist of miRNA therapy, drug repositioning, and genetic markers that might be used for early identification and better management of ovarian dysfunction. Thus, the current review discusses ovarian dysfunction in PCOS, the involvement of potential genes and epigenetic factors, and miRNAs concerning ovulation and its therapeutic implications.

Pharmacological effects of bile acids on polycystic ovary syndrome via the regulation of chemerin

BACKGROUND

Polycystic ovary syndrome (PCOS) poses significant health risks for women of reproductive age, and conventional treatments typically involve anti-hormonal interventions or surgical procedures, which often lead to lifelong medication cycles and potential side effects. Bile acids have been applied in the treatment of PCOS-related conditions, including obesity and type 2 diabetes. This study aimed to investigate the effects of bile acids on a PCOS rat model and explore the underlying mechanisms involved.

METHODS

Morphological index evaluation, histopathological examination, and hormonal profiling were employed to assess the therapeutic effects of eight bile acids. A targeted proteomics was utilized to characterize and quantify highly homologous chemerin isoforms in rat serum. Network pharmacology analysis was conducted to identify potential targets and molecular mechanisms involved. Molecular docking was performed to evaluate the affinity between bile acids and farnesoid X receptor (FXR).

RESULTS

Five of the eight bile acids markedly restored morphological indices, histopathological manifestations, hormonal imbalances, and chemerin isoform dysregulation. Notably, the therapeutic effects of TDCA and GUDCA on PCOS were reported for the first time. As the severity of the disease decreased, chemerin-157S was negatively correlated with progesterone (P4), estradiol (E2), antral follicles, and corpus luteum, respectively. Several chemerin-associated pathways have been identified via network pharmacology analysis. Additionally, a 7β-hydroxy group carried on the steroid skeleton of bile acids has been found to exhibit positive therapeutic efficacy in PCOS.

CONCLUSIONS

Downregulating chemerin levels via specific bile acids may be a promising therapeutic strategy for PCOS patients.

Polycystic ovary syndrome as a metabolic disease

Polycystic ovary syndrome (PCOS) is a heterogeneous familial disorder affecting up to one in five women. The aetiology remains unclear, but available evidence suggests it is a polygenic disorder with epigenetic, developmental, and environmental components. The diagnostic criteria for PCOS are based on reproductive features, and the syndrome is categorized into several phenotypes that can vary by race and ethnicity. Insulin resistance and metabolic dysfunction have a crucial role in the pathogenesis of the syndrome and contribute to many adverse metabolic outcomes that place a substantial burden on the health of women with PCOS across their lifespan. Metabolic abnormalities like those identified in women with PCOS are also present in their female and male first-degree relatives. Overall, more emphasis is required on defining PCOS as a metabolic disorder in addition to a reproductive one. This approach could affect the management and future treatment options for the syndrome. The rationale of the current review is to identify and analyse existing evidence for PCOS as a metabolic, as well as a reproductive, disease.

Decorin alleviates non-alcoholic fatty liver disease in rats with polycystic ovary syndrome

Endocrine multisystem defect polycystic ovary syndrome (PCOS) causes hyperandrogenism and infertility. Half of PCOS women have (non-alcoholic fatty liver disease) NAFLD, which increases metabolic disease risk. We tested decorin's effect on NAFLD and related processes in PCOS. NAFLD+PCOS, PCOS+decorin, and control rats were studied. Decorin was evaluated on NAFLD/PCOS rats. Test group rats received HF for eight weeks to generate NAFLD. The rats got 1 mg/kg letrozole orally daily for 21 days to diagnosis PCOS. Afterward, rats got injectable decorin for 14 days. Body weight, liver weight, liver coefficient Abdominal Circumference (AC) and body mass index (BMI) were determined. Blood triglycerides (TG), total cholesterol, LDL-c, AST, and glucose were measured. The insulin, testosterone, estrogen, LH, and FSH were measured by ELISA. GPx, SOD, MDA, TNF-, and Caspase-3 liver immunohistochemistry were evaluated. NAFLD liver tissues in PCOS models showed biochemical and histological alterations. NAFLD+PCOS raised BMI, AC, liver weight, and coefficient. Blood glucose, insulin resistance, TG, ALT, and AST increased. Lipid abnormalities (TG, cholesterol, LDL-c, and HDL-c), oxidative stress markers (MDA, SOD, and GPx), and liver dysfunction were found. Low serum E2 and high T supported PCO. Decorin reduced model rat BMI, liver weight, coefficient, insulin resistance, TG, ALT, and AST. It reduced liver inflammation, improved liver extract lipids, and normalized MDA, SOD, and GPx. In the model group, decorin lowered serum T, E2, LH, caspase 3, and TNF-alpha. Decorating improved NAFLD/PCOS group liver histology and function. Decorin reduces hepatosteatosis by reducing liver inflammation, oxidative stress, and dyslipidemia.

Hormonal and metabolic influences on outcomes in PCOS undergoing assisted reproduction: the role of BMI in fresh embryo transfers

BACKGROUND

This retrospective study aimed to examine the influence of hormonal and metabolic parameters across varying body mass index (BMI) levels on embryo quality and pregnancy outcomes in fresh embryo transfer cycles using assisted reproductive technology (ART) in patients diagnosed with polycystic ovary syndrome (PCOS).

METHODS

A total of 167 women diagnosed with PCOS and 266 women without PCOS (control group) were included. Metabolic and hormonal parameters was compared between the two groups to evaluate their relationship with embryo quality and pregnancy outcomes. Subgroup analyses were performed to assess these effects in patients with normal and high BMI.

RESULTS

In the PCOS group, hormonal and metabolic parameters such as insulin, blood lipids, luteinizing hormone (LH), anti-Müllerian hormone (AMH) and antral follicle counting (AFC) were significantly higher than in the control group. The PCOS group also produced more blastocysts and a higher proportion of high-quality blastocysts. However, pregnancy rate and clinical pregnancy rates were similar between the two groups, regardless of BMI. Among the high-BMI PCOS patients, the miscarriage rate was significantly higher compared to the control group, and its rate showed a positive correlation with BMI, LH, and total testosterone (TSTO) levels.

CONCLUSION

Hormonal imbalances and glucose-lipid metabolism have minimal influence on embryo development in PCOS patients. However, hormonal factors-particularly in PCOS patients with high BMI-significantly influence pregnancy outcomes, with elevated BMI and androgen levels increasing the risk of miscarriage. These findings underscore the importance of addressing metabolic and hormonal factors in the management of PCOS patients undergoing ART.

Micronutrients and polycystic ovary syndrome in the IEU OpenGWAS project: a two-Sample unidirectional Mendelian randomization analysis

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine and metabolic disorder. Research suggests a potential link between certain micronutrients and PCOS development, but the exact cause-and-effect relationship is unclear. This research utilizes data from extensive genome-wide association studies (GWAS) to investigate the possible association between micronutrients and PCOS via Mendelian randomization (MR). The findings aim to inform future research and guide clinical practice. We performed a two-sample unidirectional MR analysis using genetic data from European populations. The MR analysis revealed no statistically significant association between the 11 micronutrient-related genes and PCOS (all P-values > 0.05). Phosphate, magnesium, folate, vitamin B12, D, iron, selenium, and copper odds ratios (ORs) less than 1, calcium, vitamin C, and zinc ORs greater than 1. Sensitivity analyses revealed no indications of heterogeneity, pleiotropy, or outliers, hence affirming the robustness of these findings. High serum phosphate, magnesium, folate, vitamin B12, D, iron, selenium and copper levels may be potentially protective against PCOS. High serum calcium, vitamin C and zinc levels may be potential risk factors for PCOS. These insights are important for understanding PCOS's pathophysiology and improving clinical management.

Waist circumference mediates the relationship between atherogenic index of plasma and infertility

Background

A newly developed technique, Atherogenic Index of Plasma (AIP), is linked to numerous metabolic disorders. Prior researches have indicated strong correlation between AIP and waist circumference (WC), as well as between WC and infertility. Yet no investigation has examined link involving the AIP and infertility, as well as the potential mediating role of WC in this relationship.

Methods

The study included 1,322 women from the 2013-2018 NHANES. Infertility was the outcome variable. Moreover, mediation analysis explored the mediating role of WC in the above relationships.

Results

There were 1,163 controls and 159 infertile participants among the 1,322 participants. The study demonstrated increased WC and elevated AIP among infertile women. Also, the AIP demonstrated an independent correlation with a higher likelihood of infertility, regardless of adjustments for confounding factors. Subgroup analysis indicated the AIP was related to the prevalence of infertility even among women aged 35 years or younger with no history of cardiovascular disease (CVD), pelvic infections, or use of female hormones. Finally, WC had a substantial mediating effect on correlation between AIP and infertility, accounting for 54.49% of the association. Yet, it appears that the various IR surrogates did not demonstrate variability in their predictive ability for infertility [AIP: 0.642 (95% CI: 0.599, 0.683) vs. WC 0.658 (95% CI: 0.618, 0.705) vs. HOMA-IR 0.637 (95% CI: 0.593, 0.686)].

Conclusion

A notable positive correlation exists between AIP and female infertility. It provides the first evidence to demonstrate the mediating role of WC in the above relationship. Managing abdominal obesity and monitoring AIP levels may contribute to reduce the likelihood of infertility.

Biochemical, sex hormonal, and anthropometric predictors of non-alcoholic fatty liver disease in polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is linked to non-alcoholic fatty liver disease (NAFLD). Biochemical, sex hormonal, and anthropometric indicators have been explored for screening NAFLD in PCOS patients. However, the accuracy of NAFLD screening using these indicators in PCOS patients remains uncertain. This study aimed to identify biochemical, sex hormonal, and anthropometric indicators associated with NAFLD in overweight and obese PCOS patients and assess the diagnostic efficacy of combined indicators.

METHODS

This cross-sectional study (Clinical trial number ChiCTR1900020986; Registration date January 24th, 2019) involved 87 overweight or obese women with PCOS (mean age 29 ± 4 years). Measurements included anthropometric indices, biochemistry, sex hormone levels, and liver proton density fat fraction (PDFF). Correlation analysis, intergroup comparisons, and logistic regression analysis were used to identify risk factors for NAFLD (PDFF > 5.1%). The receiver operating characteristic curve, area under the curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value were used to determine cut-off values and evaluate diagnostic accuracy.

RESULTS

Liver PDFF was 7.69% (3.93%, 14.80%) in overweight and obese PCOS patients, with 67.8% diagnosed with NAFLD. NAFLD was associated with increased body mass index (BMI), abdominal circumference (AC), and triglyceride, total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), glucose, insulin, and free testosterone (FT) levels, and with decreased high-density lipoprotein-cholesterol (HDL-C) and sex hormone-binding globulin (SHBG) levels (P < 0.05). Risk factors for NAFLD in PCOS included BMI > 26.8 kg/m2, AC > 88.3 cm, triglyceride > 1.57 mmol/L, TC > 4.67 mmol/L, LDL-C > 3.31 mmol/L, glucose > 4.83 mmol/L, insulin > 111.35 pmol/L, FT > 7.6 pg/mL and SHBG < 25 nmol/L (β = 1.411-2.667, P < 0.005). A multi-indicator model including triglycerides, LDL-C, glucose, insulin, and SHBG showed higher diagnostic accuracy (AUC = 0.899, P < 0.001) for screening NAFLD in PCOS patients than single indicators (AUC = 0.667-0.761, P < 0.05).

CONCLUSIONS

Overweight and obese PCOS patients have higher incidences of liver PDFF and NAFLD. A multi-indicator model including triglycerides > 1.57 mmol/L, LDL-C > 3.31 mmol/L, glucose > 4.83 mmol/L, insulin > 111.35 pmol/L, and SHBG < 25 nmol/L is highly accurate for screening NAFLD in overweight and obese PCOS patients.

Impact of Polycystic Ovary Syndrome Hyperandrogenic Phenotypes A and Non-Hyperandrogenic D on Pregnancy Outcomes After in vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI)

Objective

This study aims to evaluate the association between polycystic ovary syndrome (PCOS) phenotypes A and D with primary and secondary pregnancy outcomes among PCOS vs non-PCOS patients after in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).

Methods

A retrospective cohort design using data of eligible women aged 20-40 years who had their first IVF treatment. The data were obtained from medical records. The women were either diagnosed with PCOS according to Rotterdam Criteria, namely phenotypes A and D or non-PCOS. Pregnancy outcome including (1) the rate of biochemical pregnancy and (2) ongoing clinical pregnancy and (3) the rate of miscarriage were measured. Furthermore, secondary outcome data were collected on (1) the number of oocytes retrieved, (2) the number and percentage of mature oocytes, (3) fertilization rate, (4) the percentage of grade 1 embryos on day 3 and (5) the percentage of grade 1 embryos on day 5.

Results

A sample of 149 women was analyzed. For secondary pregnancy outcomes, PCOS women in groups A and D have lower oocyte maturity rate and lower fertilization oocyte ratio, as well as fewer grade 1 oocytes on day 3 in comparison to the control. Primary pregnancy outcomes have significantly lower values among PCOS women in group A with respect to biochemical pregnancy and ongoing clinical pregnancy and higher miscarriage rates in comparison to group D and the control group. Finally, group D and control did not differ significantly in the primary pregnancy outcomes.

Conclusion

Patients with phenotype D have better IVF outcomes in comparison to phenotype A. Phenotype A, affects the IVF outcomes negatively possibly due to hyperandrogenism.

The impact of high-intensity interval training on insulin sensitivity and quality of life in women with overweight polycystic ovary syndrome

BackgroundPolycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age, characterized by menstrual irregularities, hyperandrogenism, and polycystic ovaries. Insulin resistance is central to its pathophysiology, contributing to metabolic disturbances and increased cardiometabolic risks. High-Intensity Interval Training (HIIT) has emerged as a promising intervention to improve metabolic health.ObjectiveThis study aimed to investigate the specific effects of HIIT on insulin sensitivity, body composition, metabolic profile, and quality of life in women with overweight PCOS.MethodsA retrospective analysis was conducted on 107 female patients with overweight PCOS who were divided into two groups: the Regular Interval Training Group (n = 54) and the HIIT Group (n = 53). Baseline data, including insulin sensitivity, glucose metabolism, body composition, metabolic profile, and quality of life, were measured and compared between the two groups.ResultsThe HIIT Group demonstrated significantly improved insulin sensitivity, reduced fasting glucose levels, lower HOMA-IR index, lower body fat percentage, decreased waist and hip circumferences, improved favorable changes in metabolic profile, and significant improvements in quality of life compared to the Regular Interval Training Group. These findings suggest that HIIT led to beneficial outcomes across various metabolic and clinical parameters in women with overweight PCOS.ConclusionThe findings of this study highlight the potential of personalized exercise prescriptions, such as HIIT, in optimizing health outcomes in women with overweight PCOS. The observed improvements in insulin sensitivity, body composition, metabolic profile, and quality of life underscore the promising role of HIIT in addressing the multifaceted implications of PCOS and its associated metabolic and reproductive implications.

Polycystic Ovary Syndrome and Sex Hormones in Bariatric Surgery Candidates

BACKGROUND

Polycystic ovary syndrome (PCOS) is a prevalent metabolic and endocrine disorder affecting women of reproductive age, particularly those with obesity. This syndrome is characterized by clinical/biochemical hyperandrogenism and/or ovulatory dysfunction, which can result in infertility.

PURPOSE

To investigate the prevalence of PCOS in candidates for bariatric surgery and to examine the correlation between PCOS and sex hormones in women with obesity.

METHODS

A retrospective study analyzed 577 bariatric surgery candidates from 2015 to 2021 using RStudio. Normally distributed data were expressed as x ± s and compared with ANOVA or T-test, while the Kruskal-Wallis test was used for non-normal data. Count data, presented as M [Q1, Q3], were analyzed with the Chi-square test. Logistic regression identified influencing factors, with P < 0.05 indicating statistical significance.

RESULTS

The findings of our study reveal that the prevalence of PCOS among bariatric surgery candidates stands at 14.04%. Conversely, high-density lipoprotein cholesterol (HDL-C) levels tended to decrease with higher BMI categories (P = 0.02). Compared to the non-PCOS group, the PCOS group exhibits lower age and HDL-C levels. Still, they showed significantly elevated HOMA-IR, fasting blood glucose (FBG), luteinizing hormone (LH), total testosterone (TT), and luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio (P < 0.05). The logistic regression analysis of PCOS indicates that, compared to the control group, those with FBG levels exceeding 7 mmol/L (OR = 2.28, 95% CI 1.19 to 4.37, P = 0.01) and individuals with TT levels greater than 2.01 ng/ml (OR = 2.36, 95% CI 1.23 to 4.71, P = 0.01) exhibited an increased risk of PCOS.

CONCLUSION

PCOS is highly prevalent among female bariatric surgery candidates. It is significantly associated with younger age, lower HDL, higher FBG, and elevated TT levels. These factors may also serve as indicators for evaluating PCOS improvement and assessing surgical outcomes postoperatively.

Hyperoside mitigates PCOS-associated adipogenesis and insulin resistance by regulating NCOA2-mediated PPAR-γ ubiquitination and degradation

AIMS

Polycystic ovary syndrome (PCOS) is closely associated with metabolic disorders such as insulin resistance and obesity, but the role of adipogenesis in its pathophysiology remains unclear. This study investigates the role of adipogenesis in PCOS development and evaluates whether hyperoside (HPS), an anti-adipogenic herbal compound, can improve PCOS by inhibiting adipogenesis.

MAIN METHODS

A combination of in vivo and in vitro models was used to assess the impact of HPS on ovarian function, insulin resistance, and adipogenesis. PCOS mice were treated with HPS, and their ovarian function and insulin resistance were evaluated. In vitro adipocyte differentiation assays were conducted to examine the effects of HPS on adipogenesis. The target of HPS was analyzed by Surface plasmon resonance. The expression levels of NCOA2 and PPAR-γ ubiquitination and degradation were analyzed using quantitative real-time PCR and Western blotting. Additionally, NCOA2 knockdown experiments were performed to investigate its role in ovarian function, insulin resistance, and adipogenesis in PCOS mice.

KEY FINDINGS

HPS treatment significantly improved ovarian function, reduced insulin resistance, and suppressed adipogenesis in PCOS mice. Mechanistically, HPS inhibited adipogenesis by reducing NCOA2 expression, thereby preventing PPAR-γ ubiquitination and degradation. Knockdown of NCOA2 further validated its role by improving ovarian function, insulin resistance, and adipogenesis in PCOS models.

SIGNIFICANCE

These findings demonstrate that HPS alleviates PCOS by regulating NCOA2-mediated PPAR-γ ubiquitination and degradation, offering new insights into the role of adipogenesis in PCOS pathophysiology.

Prospective associations of adolescent obesity phenotypes with self-reported polycystic ovary syndrome diagnosis in young adulthood

STUDY QUESTION

Are empirically derived adolescent overweight/obesity phenotypes differentially associated with polycystic ovary syndrome (PCOS) in young adulthood?

SUMMARY ANSWER

Self-reported PCOS diagnosis risk in young adulthood varied by empirically derived adolescent overweight/obesity phenotypes, with the highest risk observed among those in the 'mothers with obesity' and 'early puberty' phenotypes.

WHAT IS KNOWN ALREADY

Overweight and obesity during puberty are postulated to promote the development of PCOS. Much of the prior literature in this area is cross-sectional and defines weight status based solely on BMI, yet emerging research suggests that not all people with overweight/obesity have the same risk for chronic health conditions, including PCOS.

STUDY DESIGN, SIZE, DURATION

Data came from 4838 female participants in the Growing Up Today Study (GUTS), an ongoing prospective cohort study in the USA that has followed children aged 9-14 into young adulthood (ages 31-37, with 16 waves of data collection between 1996 and 2019).

PARTICIPANTS/MATERIALS, SETTINGS, METHODS

We previously used latent class analysis to empirically derive obesity phenotypes among 2038 female participants aged 14-19 years with overweight/obesity in the sample, as determined by participants' self-reported height and weight status. Indicators in the latent class analysis were participants' maternal weight status, disordered eating behaviors, body image and weight concerns, depressive symptoms and pubertal timing. The derived obesity phenotypes included 'mothers with obesity', 'early puberty', 'high weight concerns', and 'mixed'. Among these participants and female participants without adolescent overweight/obesity, we used logistic regression with generalized estimating equations to examine associations of adolescent obesity phenotypes with self-reported PCOS diagnosis after age 19. Analyses were adjusted for potential confounders.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants in all four obesity phenotypes were more likely than participants without overweight/obesity to report a PCOS diagnosis ('mothers with obesity' phenotype: odds ratio (OR) = 4.50, 95% CI = 2.61, 7.77; 'early puberty' phenotype: OR = 2.51, 95% CI = 1.59, 3.97; 'high weight concerns' phenotype: OR = 2.01, 95% CI = 1.24, 3.24; 'mixed' phenotype: OR = 1.94, 95% CI = 1.33, 2.82). Individuals in the 'mothers with obesity' phenotype had a significantly greater risk of PCOS diagnosis compared to those in the 'mixed' and 'high weight concerns' phenotypes (P < 0.05).

LIMITATIONS, REASONS FOR CAUTION

Participants self-reported PCOS diagnosis, which may underestimate new-onset PCOS and limit our ability to establish a temporal order between overweight/obesity and PCOS development. Residual confounding may also explain some of the observed associations in our analysis. Despite the fact that participants were from all regions across the USA, the results may not be generalizable to non-White and socioeconomically diverse populations.

WIDER IMPLICATIONS OF THE FINDINGS

Among females, the risk of PCOS in young adulthood varied by distinct adolescent obesity phenotypes. Those in the 'mothers with obesity' and 'early puberty' phenotypes had higher risks of PCOS, which suggests a potential underlying biological component. It may be beneficial to tailor PCOS surveillance according to these high-risk adolescent obesity phenotypes.

STUDY FUNDING/COMPETING INTEREST(S)

This project was funded by research grants from the National Institutes of Health (R01 DK127585, U01 HL145386, and U01 CA176726). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no competing interests to disclose.

TRIAL REGISTRATION NUMBER

N/A.

The Influence of Dietary Patterns on Polycystic Ovary Syndrome Management in Women: A Review of Randomized Controlled Trials with and Without an Isocaloric Dietary Design

Polycystic ovary syndrome (PCOS) is an endocrine disorder that causes cardiometabolic and reproductive disorders in women of reproductive age. Women with PCOS are more likely to have obesity, type 2 diabetes mellitus, and cardiovascular disease. There is an inconclusive consensus on which dietary modification could be most effective in PCOS prevention and treatment. This review aimed to examine the effects of diverse dietary patterns on PCOS in women according to randomized controlled trials (RCTs) with and without an isocaloric dietary design. A literature search was performed in the PubMed®®/MEDLINE®® database up to 14 November 2024. A total of 21 RCTs were reviewed after screening the records, including 15 RCTs with a calorie-restricted dietary design and 6 RCTs with a non-calorie-restricted dietary design. This review found beneficial effects of the calorie-restricted Dietary Approaches to Stop Hypertension (DASH) diet on weight loss and glucose control in women with PCOS in four RCTs with an isocaloric dietary design. The calorie-restricted low-glycemic index (GI) diets from three RCTs and high-protein diets from four RCTs with an isocaloric dietary design showed no significant differences in anthropometric parameters, glucose control, lipids, and gonadal parameters compared with the control diet in women with PCOS. Non-calorie-restricted low-carbohydrate diets from four RCTs with an isocaloric dietary design showed similar results to the calorie-restricted low-GI diets and high-protein diets. However, the existing number of RCTs is insufficient to conclude the association between dietary patterns and PCOS in women. Further, well-designed dietary intervention studies are needed to assess the role of dietary patterns in PCOS beyond calorie restriction.

Does Magnesium Affect Sex Hormones and Cardiometabolic Risk Factors in Patients with PCOS? Findings from a Systematic Review and Meta-Analysis

Background and Objectives: Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with various cardiometabolic risk factors, including insulin resistance, dyslipidemia, hypertension, and obesity, which contribute to an increased risk of cardiovascular diseases. This inaugural systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the impact of magnesium supplementation on various cardiometabolic risk factors and hormonal parameters in patients with polycystic ovary syndrome (PCOS). Materials and Methods: We systematically searched the MEDLINE, Web of Science, Scopus, and Cochrane databases until 30 March 2024 for studies comparing magnesium supplementation to control in improving cardiometabolic and hormonal factors in PCOS patients. Endpoints were summarized as mean differences (MD) and 95% confidence intervals (CIs) in a random-effects model. Results: The primary search yielded 176 studies. After screening, six studies met our inclusion criteria. Our meta-analysis showed no significant effects of magnesium supplementation on cardiometabolic risk factors and hormonal parameters in patients with PCOS. Conclusions: Magnesium supplementation does not appear to influence the cardiometabolic and hormonal factors in PCOS patients. Further rigorous RCTs are needed to strengthen the evidence and support comprehensive analysis in this area. PROSPERO database (CRD42024526110).

Six-month randomized, placebo controlled trial of synbiotic supplementation in women with polycystic ovary syndrome undergoing lifestyle modifications

PURPOSE

To determine whether long-term administration of synbiotics affects clinical, endocrine and metabolic aspects of polycystic ovary syndrome (PCOS) in overweight and obese subjects undergoing intensive lifestyle modifications.

METHODS

During six-month trial, all subjects underwent intensive lifestyle modifications (diet and exercise). The subjects were randomized (1:1) to receive synbiotic supplementation (Synbiotic Group) or placebo (Placebo Group).

RESULTS

Subjects in the Placebo Group and the Synbiotic Group experienced significant reduction of BMI (- 8% and - 11%, respectively; both at P < 0.0001) and body fat percentage (- 11% and - 14%, respectively; both at P < 0.0001). These effects were statistically comparable for both groups. Total testosterone was not significantly changed in the Placebo Group (- 5%, P = 0.41) while it greatly declined in the Synbiotic Group (- 40%; P < 0.0001); the difference between these groups was significant (P = 0.0002). Synbiotic supplementation was superior to placebo in reducing LH (- 21%; P = 0.047), total cholesterol (- 6%; P = 0.002), low-density lipoprotein cholesterol (- 6%; P = 0.044), triglycerides (- 29%; P = 0.049), LPS (- 23%; P = 0.001) and LPS-binding protein (- 21%; P = 0.001).

CONCLUSIONS

Synbiotic supplementation led to a marked improvement of several key clinical and laboratory aspects of PCOS including an improvement of hyperandrogenism, lipid profile, and markers of endotoxemia.

TRIAL REGISTRATION

Clinical Trial Registration Number: NCT03325023 (URL, clinicaltrials.gov; date of registration 10/26/2017).

Comparing the Effect of Heat Therapy and Mitochondrial-Targeted Antioxidants in Polycystic Ovarian Syndrome Phenotype Induced by Junk Food Consumption

Polycystic ovarian syndrome (PCOS) is a complex endocrine-metabolic disorder, and multiple factors contribute to its pathophysiology. The current study assessed a PCOS-like animal model induced by consuming a high-fat sugar (HFHS) diet and compared the treatment outcome of mitochondrial-targeted antioxidants versus heat therapy. Sixty rats were divided into the following study groups: three control groups (negative and positive for the treatments used), HFHS, hot tub therapy (HTT) treatment, and MitoQ10 treatment (500 µmol/L MitoQ10 in clean drinking water daily, from week fourteen till week twenty-two of the study). At week fourteen, PCOS was confirmed by vaginal smear examination; measurements of blood testosterone (T), anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), glucose, and insulin; and determination of the homeostatic model assessment of IR (HOMA-IR). At week 22, blood samples were collected for measurement of the serum LH, FSH, AMH, T, insulin, glucose, lipid profile, kisspeptin, ADAM metallopeptidase with thrombospondin type 1 motif 19 (ADAMTS19), S100 calcium-binding protein B (S100B), fibulin 1 (FBLN1), immunoglobulin free light chains (FLCs), kappa and lambda. Ovaries were examined for morphological changes; for the levels of glutathione (GSH), catalase, SOD, malondialdehyde (MDA), and nitric oxide (NO); and the expression of FK506 binding protein 52 (FKBP52) and the androgen receptor (AR). The consumption of HFHS diet-induced PCOS-like features, which have been ameliorated by both HTT and mitoQ10 as potential therapies, with MitoQ10 showing a superior effect over HTT.

The Global Burden of Polycystic Ovary Syndrome in Women of Reproductive Age: Findings from the GBD 2019 Study

Purpose

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder and the primary cause of anovulatory infertility among women aged 15-49 years. Despite its significance, it has been largely overlooked in global health discussions, with persistently high prevalence and incidence rates. This public health challenge necessitates attention both domestically and internationally. Between 1990 and 2017, the age-standardized prevalence of female infertility and associated DALYs rose by 0.70% and 0.396%, respectively. Economically, addressing women's endocrine and metabolic health can bolster the overall well-being of the female population using existing resources. For judicious utilization of available resources, data regarding the burden of PCOS is pivotal for comprehending women's health status and for devising and refining policies related to women's endocrine health. Consequently, this study scrutinizes and assesses the age-standardized PCOS incidence rate and DALYs for 1990 and 2019, traces the trends of these metrics from 1990 to 2019, examines the composition of various populations and diseases, and offers international comparisons. This aims to furnish critical insights for future health policy development and adjustments in the realm of female endocrine and metabolic health.

Patients and Methods

This study employed the Global Health Data Exchange to obtain PCOS burden data based on GBD 2019. It collected incidence, DALYs, and age-standardized rates (ASRs) from 1990 to 2019 across global, regional, national, and SDI quintile levels, spanning 21 regions and 204 countries. To analyze trends, ASRs and estimated annual percentage changes (EAPCs) were calculated, with standardization crucial for comparability. EAPC was derived using a generalized linear model with a Gaussian distribution.

Results

The global burden of PCOS increased significantly from 1990 to 2019, with estimated annual percentage change (EAPCs) of 0.56 for incidence and 0.83 for DALYs. The highest incidence rates were observed in the High-income Asia Pacific region, particularly in Japan and New Zealand, while the lowest rates were in Central Europe. Equatorial Guinea and Qatar exhibited the most pronounced increases in incidence and DALYs, attributed to urbanization and enhanced healthcare infrastructure. The incidence and DALYs of PCOS showed variation across SDI quintiles, with the greatest burden found in the middle-SDI quintile. Women between the ages of 20-29 years had the highest incidence and DALYs, emphasizing the importance of targeted interventions during this critical period. In contrast, regions with lower SDI levels, such as Central and Eastern Europe, reported the lowest burdens of PCOS, likely due to underdiagnosis and limited healthcare resources.

Conclusion

From 1990 to 2019, there was a significant increase in the global burden of PCOS, with variations seen across regions and SDI quintiles. Countries such as Italy, Japan, New Zealand, and Australia had the highest burdens, while Central and Eastern Europe had the lowest. The age group most affected was women aged 20-29 years, emphasizing the necessity for targeted interventions.

Effects of non-pharmacological interventions on biochemical hyperandrogenism in women with polycystic ovary syndrome: a systematic review and network meta-analysis

OBJECTIVE

To systematically evaluate the effectiveness of non-pharmacological interventions (NPIs), including electroacupuncture, exercise, diet, and lifestyle changes, in reducing androgen levels in women with polycystic ovary syndrome (PCOS) through a systematic review and network meta-analysis.

METHODS

Comprehensive searches were conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang up to June 2024. Randomized controlled trials (RCTs) comparing NPIs with other NPIs or placebo treatments in adult women with PCOS were included. Study selection was independently performed by three authors. Quality assessment followed PRISMA guidelines using the Cochrane RoB2 tool. The confidence of evidence was examined using Confidence in Network Meta-Analysis (CINeMA). Traditional meta-analysis of continuous variables was conducted using Stata 17.0 software with a random-effects model, reporting effect sizes as standardized mean differences (SMD) and weighted mean differences (WMD). Network meta-analysis (NMA) was used to synthesize data, with network diagrams illustrating comparisons between NPIs. We assessed the consistency of the results, performed sensitivity analyses, and examined publication bias to evaluate the influence of individual studies. Furthermore, subgroup analysis and network meta-regression analysis were conducted to explore potential sources of heterogeneity.

RESULTS

The review included 21 studies with 1,196 participants, with meta-analysis focusing on 17 studies involving 1,013 participants. NPIs significantly reduced serum testosterone (SMD = -0.57; 95% CI: -0.86 to -0.29, p < 0.01), A4 (SMD = -1.37; 95% CI: -2.63 to -0.12, p = 0.03), and mFG score (WMD = -0.81; 95% CI: -1.26 to -0.37, p < 0.01). Notably, the reduction in testosterone levels achieved with NPIs met the Minimum Clinically Important Difference (MCID) of 12.47 ng/dL (WMD = -12.57; 95% CI: -18.92 to -6.23; p < 0.01), affirming the clinical relevance of these reductions. No significant effects were observed on Free Androgen Index (FAI), Sex Hormone-Binding Globulin (SHBG), Dehydroepiandrosterone (DHEA), DHEA Sulfate (DHEAS), Free Testosterone (FT), or Dihydrotestosterone (DHT) levels (all p > 0.05). The NMA (18 studies, 1,067 participants) identified electroacupuncture combined with diet and exercise as the most effective intervention for reducing serum testosterone (WMD = -21.75; 95% CI: -49.58 to 6.07; SUCRA 72.3%). Evidence certainty for many interventions was low, highlighting the need for higher-quality studies. Sensitivity analysis confirmed the robustness of the findings, and no publication bias was detected.

CONCLUSIONS

NPIs, particularly electroacupuncture combined with exercise and dietary management, effectively reduce androgen levels in PCOS patients. These findings provide valuable guidance for clinicians and women with PCOS, with multi-component approaches recommended for more substantial clinical benefit.

TRIAL REGISTRATION

PROSPERO CRD42023426226.

Evaluating the effects of time-restricted eating on overweight and obese women with polycystic ovary syndrome: A randomized controlled trial study protocol

BACKGROUND

Time-restricted eating (TRE) manages weight effectively, but choosing how long and what time window remain debatable. Although an 8:00 a.m. to 16:00 p.m. time frame is reported to show positive results in most weight loss trial, its safety and efficacy in overweight and obese women with polycystic ovary syndrome (PCOS) is uncertain. This randomized controlled trial is conducted to evaluate the safety and efficacy of TRE in specific populations.

OBJECTIVE

This study aims to assess the 6-month effects of TRE on weight change, metabolic improvement, reproductive recovery, and health-related quality of life in overweight and obese women with polycystic ovary syndrome (PCOS), compared to those who did not receive TRE.

METHODS

This randomized controlled trial will enroll 96 overweight and obese women with polycystic ovary syndrome (PCOS), who will be randomly assigned to either a TRE group (with an eating window from 8:00 a.m. to 16:00 p.m.) or a control group (without eating time restrictions), with 49 participants in each group. Evaluators and data analysts will remain blinded to group allocation throughout the study. The primary outcomes, including changes in weight and body mass index (BMI), will be assessed weekly. Secondary outcomes, encompassing alterations in sex hormones, metabolic parameters, body composition, sleep quality, quality of life, anxiety, and depression, will be evaluated monthly. Compliance and safety will be continuously monitored throughout the study. Additionally, a 6-month follow-up will be conducted at the end of the trial to assess the long-term effects of TRE. Statistical analysis will include the Anderson-Darling test for normality, T-test/Wilcoxon test based on distribution, mixed-effects models for assessing time/group effects, Cox model for time-to-event analysis, repeated ANOVA for change analysis, and sensitivity analysis. All tests will be conducted using appropriate software, with a significance level set at P<0.05. Missing data will be imputed.

DISCUSSION

The purpose of this study protocol is to further evaluate the effects of TRE in overweight and obese women with PCOS through a randomized controlled trial (RCT). Findings from this study are expected to provide new dietary intervention strategies for overweight and obese PCOS participants.

ETHICS AND DISSEMINATION

This study has received ethics approval from the Medical Ethics Committee of the University of South China (Number: NHHL027). Participants are included after signing informed consent. Results will be submitted for publication in peer-reviewed journals.

TRAIL REGISTRATION

Trail registration number: ChiCTR2400086815.

Hydroxychloroquine enhances insulin sensitivity and ameliorates abnormal lipid metabolism in obese women with polycystic ovary syndrome

BACKGROUND

Hydroxychloroquine (HCQ) is frequently utilized in rheumatic immune disorders and has been discovered to exert hypoglycemic effects in some obese women with polycystic ovary syndrome(PCOS), however, the precise efficacy and mechanism of action remain ambiguous.

OBJECTIVE

To examine the impact of HCQ on glucose and lipid metabolism as well as sex hormone levels in obese women with PCOS.

METHOD

Fifty obese women with PCOS were randomly allocated into two groups: HCQ group (n = 25) and metformin (MET) group (n = 25). The HCQ group received a daily dose of 200 mg hydroxychloroquine, while the MET group received a daily dose of 1000 mg metformin. Body fat parameters, glucose and lipid metabolism levels, as well as hormone levels were evaluated. Additionally, the incidence of pregnancy within six months following treatment was also assessed. Network pharmacology was also employed to analyze the potential molecular mechanism.

RESULT

Patients in the HCQ group (n = 20) and MET group (n = 23) were ultimately included for analysis. Following treatment, both groups exhibited significant improvements in body fat distribution and glucose metabolism status, with the HCQ group demonstrating a notable advantage over the MET group in increasing insulin sensitivity index (ISI)(HCQ:1.87 ± 0.21,MET:1.75 ± 0.29). Serum lipid levels [Serum total cholesterol(TC, mmol/L)(HCQ:4.51 ± 0.87,MET:5.05 ± 0.65), triglyceride(TG, mmol/L)(HCQ:1.36 ± 0.51,MET:1.67 ± 0.72), low-density lipoprotein (LDL, mmol/L)(HCQ:2.66 ± 0.98,MET:0.47 ± 1.42),decreased in both groups post-treatment, with the HCQ group displaying clear advantages compared to the MET group. The improvement of sex hormone levels was not pronounced in either group, although there was an overall downward trend.

CONCLUSION

The potential benefits of HCQ in the management of in obese women with PCOS include significant improvements in body fat distribution, glucose and lipid metabolism levels, as well as correction of hormonal disorders.

CLINICAL TRIAL REGISTRATION

The study was officially registered as a clinical trial on April 17, 2022, with the registration number ChiCTR2200058816. https://www.chictr.org.cn/showproj.html?proj=160099 .

Breastfeeding initiation according to the severity of Class 3 obesity

Background: Class 3 obesity is composed of morbid (BMI 40-49 kg/m2) and extreme (BMI ≥ 50 kg/m2) subgroups. Adverse perinatal outcomes have been associated with obesity; however, data on breastfeeding (BF) initiation for women in either group remains limited.Objective: To compare BF initiation rates (exclusive or partial BF) and related comorbidities of 890 women with morbid and 890 with extreme obesity matched by race, parity, and year of delivery.Methods: Retrospective cohort study of women who delivered singletons at ≥ 34 weeks gestation (2013-2021). Those who had bariatric surgery or infants with major malformations were excluded.Results: Both groups were similar in: primiparity (38%), age (29y), white race (58%), African American (36%), current (10 vs 12%) and former (25 vs 27%) smokers, gestational hypertension (15 vs 16%), polycystic ovary syndrome (5 vs 7%), gastroesophageal reflux disease (10 vs 10%), and anemia (17 vs 17%). Women in the extreme group had a higher prevalence of gestational (17 vs 12%) and pregestational diabetes (12 vs 6%), chronic hypertension (41 vs 17%), severe preeclampsia (18 vs 12%), obstructive sleep apnea (12 vs 3%), asthma (22 vs 16%), and cesarean deliveries (62 vs 44%). Intention to BF (64 vs 71%), exclusive BF (23 vs 34%), and BF initiation (57 vs 64%) rates were lower in the extreme obesity group at discharge.Conclusion: Higher frequency of comorbidities in the extreme obesity group highlights the need for antenatal, intrapartum, and postpartum targeted interventions if the benefits of BF to mothers and infants are to be realized.

Polycystic ovary syndrome: Criteria, phenotypes, race and ethnicity

Background

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy, which leads to ovulation dysfunction and infertility, as well as metabolic and mental disorders. Women with PCOS exhibit several characteristic symptoms, with marked heterogeneity across different races and ethnicities.

Methods

In this review, the author outlines the phenotypic disparities of PCOS among various racial and ethnic populations. First, the prevalence of major symptoms in different racial and ethnic groups with PCOS is summarized. Next, the effects of four phenotypes, derived from the Rotterdam criteria for PCOS, on metabolic and reproductive features are recapitulated.

Main Findings

A growing body of evidence suggests that East Asian populations exhibit less hirsutism and adiposity compared with other groups. However, hirsutism is more prevalent in South Asian, Middle Eastern, and Hispanic populations. Hispanic and African American populations have more frequent obesity and insulin resistance. With regard to the association between mental disorders and racial and ethnic differences, limited studies exist; therefore, no conclusions can be drawn.

Conclusion

Race and ethnicity-specific factors related to PCOS must be considered in clinical practice. The diagnostic criteria of PCOS should be specific to race and ethnicity to avoid missing treatment opportunities.

Polycystic ovary syndrome: Recent research and therapeutic advancements

Polycystic ovary syndrome is often characterized by the appearance of several tiny cysts (fluid-filled sacs) in the ovaries. It is the most significant endocrinopathy affecting 8-13 % of women during their lifetime. Within the dynamic domain of women's health, this syndrome is a widespread issue that presents with an array of signs, including insulin resistance, hirsutism, androgen development, and menstrual flaws prompted by genetic, diet/lifestyle, gut microbiota dysbiosis, and environmental toxins. Impaired folliculogenesis, aberrant cortisol metabolism, and genes associated with steroidogenesis contribute to the pathophysiology of the disease. Moreover, it combines with various concurrent metabolic and idiopathic conditions specifically type 2 diabetes, heart disease, cancer, and infertility. On persuading the reproductive framework of women from ontogeny to menopause, the complexity of the syndrome hereditates generations due to maternal inheritance of hyperandrogenism. The advancement in diagnostic norms paved the way from the Rotterdam criteria to metabolomics, 3D ultrasound, and assisted reproductive technologies. The management and treatment of this hormonal disorder can be prevailed through lifestyle modifications and prompt medications. This review entails the aforementioned benchmarks of the syndrome's complexity and its ongoing research in alleviating its intricate behavioral changes in women from in-utero to menopause.

Elucidating the molecular interactions and immune modulation of bisphenols exposure in the pathogenesis of polycystic ovary syndrome

Bisphenols (BPs) are known endocrine disruptors potentially contributing to the pathogenesis of Polycystic Ovary Syndrome (PCOS). This study aims to elucidate the molecular interactions between BPs and PCOS-related genes and their combined effects on PCOS development. We identified common genes associated with BPs and PCOS using the CTD. Differential expression analysis was performed on three GEO datasets, leading to the identification of differentially expressed genes (DEGs). Protein-Protein Interaction (PPI) network construction, enrichment analysis, single-gene Gene Set Enrichment Analysis (GSEA), and immune cell infiltration analysis were carried out. A nomogram was developed for PCOS risk prediction, and molecular docking studies were performed using AutoDock Vina, with interaction visualizations via PyMOL. We identified 139 common genes between BPs exposure and PCOS, enrichment analysis highlighted pathways related to hormone metabolism, ovarian steroidogenesis, and p53 signaling. Four hub DEGs (PBK, CCNE2, LPCAT2, S100P) were identified, and a nomogram incorporating these genes demonstrated excellent predictive accuracy. GSEA revealed roles in cell adhesion, immune response, and metabolism. ssGSEA analysis showed significant differences in immune cell infiltration between PCOS and control groups, with notable correlations between hub DEGs and immune cells. Molecular docking indicated strong binding affinities between the hub DEGs and BPAF, suggesting potential disruptions induced by BPs. BPs exposure is associated with significant molecular and immunological changes in PCOS, impacting genes involved in hormone regulation, immune response, and metabolic pathways. The strong binding affinities between BPs and key PCOS-related genes reveal their potential role in exacerbating PCOS, providing insights for targeted therapeutic strategies.

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.

Relationship of adiponectin, leptin and reproductive endocrine hormones with insulin resistance in polycystic ovary syndrome patients with normal BMI

OBJECTIVE

This study aimed to analyze the correlation of adiponectin (APN) and leptin (LEP), reproductive endocrine hormones with insulin resistance (IR) in polycystic ovary syndrome (PCOS) patients with normal body mass index (BMI).

METHODS

Totally 160 PCOS patients were categorized into the Normal BMI (BMI: 18.5-25 kg/m2, n = 62) and High BMI (BMI > 25 kg/m2, n = 98) groups. Glucose indicators [fasting plasma glucose, fasting insulin and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR)], lipid indicators [total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)], adipokines [APN and LEP] and reproductive endocrine hormones [luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), total testosterone (TT), dehy-droepiandrosterone sulfate (DHEAS) and estradiol (E2)] were collected, and their correlations were analyzed. The relationship of HOMA-IR with APN, LEP and reproductive endocrine hormones was subjected to multiple linear regression analysis.

RESULTS

Correlation analysis revealed positive correlations of HOMA-IR with TC, TG, LDL-C, LEP, PRL, DHEAS and TT and negative correlations with HDL-C, APN, LH, FSH and E2 in PCOS patients with normal BMI. Multiple linear regression analysis showed that LH, FSH and E2 negatively affected HOMA-IR, while PRL positively affected HOMA-IR.

CONCLUSION

There were strong correlations of HOMA-IR in PCOS patients with normal BMI with APN, LEP, and reproductive endocrine hormones. Besides, LH, FSH, E2 and PRL expression had an important effect on IR in normal BMI PCOS patients, which provided a theoretical basis for the exploration of pathogenic mechanisms in normal BMI PCOS patients.

Protective effect of Yunkang oral liquid via regulating androgen receptor in polycystic ovary syndrome rats

Objectives: This study aimed to explore the effect and mechanism of Yunkang oral liquid (YK) on polycystic ovary syndrome (PCOS). Methods: PCOS model rats were prepared by injecting exogenous androgen dehydroepiandrosterone, and YK was administered simultaneously for 28 days during modeling. The morphology of ovaries and uterus was observed using H&E staining, and serum levels of testosterone (T), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were determined by radioimmunoassay. Additionally, serum lipids (TG, HDL-c), blood glucose (GLU), and aminotransferase (AST, ALT) levels were detected. The expression of androgen receptor (AR) protein was determined by Western blotting. Results: YK treatment resulted in reduced serum levels of T, LH and FSH, ameliorated ovarian polycystic-like pathological changes and uterine morphology in PCOS rats, and decreased serum TG, GLU, AST and ALT levels, elevated serum HDL-c levels, and improved abnormalities of glycolipid metabolism accompanying PCOS. Moreover, YK decreased the expression of ovarian AR in PCOS rats. Conclusions: This study indicates that YK may protect the ovaries by inhibiting the expression of AR, which could be a potential treatment for PCOS.

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

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder characterized by hormonal imbalances and insulin resistance (IR). Among the metabolic abnormalities associated with PCOS, obesity is often present concurrently. Nevertheless, the correlation between obesity, sex hormone levels, and blood lipid profiles in PCOS patients with IR remains uncertain.

METHODS

This is a cross-sectional study including a total of 206 Chinese women diagnosed with PCOS, enrolled between March 2016 and December 2021. The participants' anthropometric measurements, such as weight, height, waist circumference, and hip circumference, were recorded. Additionally, fasting blood samples were collected to measure various parameters, including fasting glucose, insulin levels, lipid profiles, and sex hormone levels.

RESULTS

Our findings highlight that obesity exhibited a significant correlation with lower levels of sex hormone binding globulin (SHBG) and elevated levels of free androgen index (FAI), fasting insulin, and HOMA-IR in PCOS patients diagnosed with IR. However, no significant association between obesity and blood lipid profiles was observed within this particular group of women.

CONCLUSION

This study suggests that among PCOS patients with IR, lower levels of SHBG and higher levels of FAI are associated with obesity. These findings indicate that SHBG and FAI may have the potential to serve as a biomarker for the initial identification and prognosis of IR in PCOS patients.

TRIAL REGISTRATION

Retrospectively registered on 25/04/2020 at ClinicalTrials.gov Identifer: NCT04264832.

Effectiveness and acceptability of different lifestyle interventions for women with polycystic ovary syndrome: protocol for a systematic review and network meta-analysis

INTRODUCTION

Women with polycystic ovary syndrome (PCOS) experience various metabolic, endocrine, reproductive and psychosocial manifestations. Lifestyle modification is crucial for the management of PCOS to reduce long-term complications. Nonetheless, the efficacy and acceptability of lifestyle interventions differs, and there are no uniform methods of clinical application. Hence, a systematic review and network meta-analysis (NMA) are needed to explore the efficacy and acceptability of lifestyle interventions to inform clinical practice.

METHODS AND ANALYSIS

Ten databases (Cochrane Gynaecology and Fertility Specialised Register, Cochrane Register of Studies Online, PubMed, EMBASE (Excerpta Medica Database), PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Chinese National Knowledge Infrastructure, WanFang, VIP, and Sinomed) and four clinical trial registry platforms will be searched to identify literature published in English or Chinese reporting results of randomised clinical trials conducted to evaluate the effects of lifestyle interventions for women with PCOS. The reference lists of the included studies will be manually searched. Primary outcomes will include biochemical and clinical hyperandrogenism, recruitment and retention rates. Secondary outcomes will encompass menstrual regularity, ovulation, anthropometry and quality of life. Literature selection and extraction of data will be performed independently by at least two researchers. An NMA random-effects model will be implemented for amalgamating evidence. All treatments will be ranked based on the value of p. OpenBUGS will be used for Bayesian modelling, with output verifications generated in Stata and R. The quality of evidence supporting network estimates of major outcomes will also be appraised using the Grading of Recommendations Assessment, Development, and Evaluation framework.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review as no data will be collected from human participants. Results will be presented in a peer-reviewed publication.

PROSPERO REGISTRATION NUMBER

CRD42024499819.

Characterizing clinical and hormonal profiles of acne in north African women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the leading endocrine disorder in young women of childbearing age. Dermatological issues, particularly acne, are a major reason for medical consultations. The aim of this study is to determine the prevalence of PCOS in patients presenting with acne as their main dermatological complaint and to compare the metabolic and hormonal clinical characteristics of acne patients with PCOS to those with isolated acne. This was a prospective study with analytical aims, carried out in the Endocrinology Department and the Dermatology Department of Farhat Hached University Hospital in Sousse. The study included patients seeking treatment for acne from January 2023 to January 2024, divided into two groups: those with confirmed PCOS (G1) and those with isolated acne (G2). All patients underwent hormonal assessment and ovarian ultrasound. We conducted a study involving 212 patients. We found that 65.6% of acne patients had been diagnosed with PCOS. Nodular lesions were significantly more frequent in 'PCOS' (p = 0.02). Acne was linked with hirsutism, which was more prevalent in 'PCOS' (94.2% 'PCOS' vs. 67.1% 'isolated acne'), as well as androgenic alopecia (51% 'PCOS' vs. 21.9% 'isolated acne') (p < 10- 3). 'PCOS' showed evidence of biological hyperandrogenism, with a mean testosterone level of 0.72 ± 0.27 ng/mL, significantly higher than in 'isolated acne'. The LH/FSH ratio was greater than 1 in 72.7% of cases in 'PCOS', demonstrating a significant difference compared to 'isolated acne', where it was greater than 1 in 24.7% of cases (p < 10- 3). In our study, acne in 'PCOS' appeared to be more severe and was associated with hypertestosteronemia (p = 0.041) and hyperprolactinemia (p = 0.008). According to our results, phenotype A was the most likely to cause severe acne (p = 0.043). Our work is unique in that it brings to light this hidden aspect of the dermatological impact of PCOS, prompting physicians to screen for this endocrine disorder in all adult women seeking acne treatment.

Integrated single-cell and spatial transcriptomics reveal microenvironment disruptions by androgen in mouse ovary

Elevated levels of androgen are risk factors for disrupted follicular maturation in the polycystic ovary syndrome (PCOS), a reproductive disease in women. As essential cell types for follicular maturation, granulosa and thecal cells respond to androgen, but their responses are unclear at the subpopulation level. Using single-cell RNA sequencing and spatial transcriptomics, we examined the subpopulation and function alterations in an androgen-induced PCOS-like mouse model. The results demonstrated that the granulosa cell subset 5 (GC5) was active in inflammation and the thecal cell subtype 2 (TC2) had an enhanced activity in lipid metabolism. The two subsets were expanded in population size and intercellular signaling pathways, such as Ptn-Ncl and Mdk-Ncl. The results reveal that androgen induced landscape and function shifts in the two cell types under the condition of impaired follicular maturation. The study characterizes the ovarian microenvironment in responses to androgen in PCOS mice.

Gut Microbiota and Oral Contraceptive Use in Women with Polycystic Ovary Syndrome: A Systematic Review

Background: Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine syndromes affecting women at reproductive age. With increasing knowledge of the role of the microbiota in the pathogenesis of PCOS, new management strategies began to emerge. However, data on the impact of established treatment regimens, such as metformin and oral contraceptive agents, on the gut microbiota composition are scarce. This study aimed to evaluate the specificity of the gut microbiota in women with PCOS before and after treatment with oral contraceptives. Methods: We have systematically searched the following databases: PubMed/MEDLINE, Scopus, Web of Science and Google Scholar. The last search was performed on 13 May 2024. We included only full-text original research articles written in English. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale. Results: The above described search strategy retrieved 46 articles. Additionally, 136 articles were identified and screened through Google Scholar. After removing duplicates, we screened the titles and abstracts, resulting in three eligible articles constituting the final pool. They were published between 2020 and 2022 and are based on three ethnically distinct study populations: Turkish, Spanish and American. The studies included a total of 37 women diagnosed with PCOS and using OCs. Conclusions: OC treatment does not seem to affect the gut microbiota in a significant way in patients with PCOS in short observation. Well-designed randomized controlled studies with adequate, unified sample size are lacking.

COVID-19 and persistent symptoms: implications for polycystic ovary syndrome and its management

The COVID-19 pandemic has left a profound mark on global health, leading to substantial morbidity and mortality worldwide. Beyond the immediate symptoms of infection, the emergence of "long COVID", the long-term effects of SARS-CoV-2, has become a significant public health concern. Long COVID is a multifaceted condition affecting various organs and systems, including the cardiovascular, digestive, nervous, and endocrine systems. Individuals diagnosed with polycystic ovary syndrome (PCOS) may face an increased risk of severe COVID-19 symptoms and infection. It is crucial to comprehend how long COVID affects PCOS patients to devise effective treatment and care strategies. Here, we review the detrimental effects of COVID-19 and its long-term effects on reproductive health, endocrine function, inflammation, metabolism, cardiovascular health, body composition, lifestyle, and mental health in patients with PCOS. We offer recommendations for the post-covid-19 management of PCOS, emphasizing the necessity of a comprehensive, multidisciplinary approach to patient care. Furthermore, we discuss prospective research directions, highlighting the significance of continued investigations and clinical trials to evaluate treatment approaches for long COVID and its ramifications in individuals with PCOS.

Jiawei Buzhong Yiqi Decoction attenuates polycystic ovary syndrome through regulating kisspeptin-GPR54-AKT-SHBG system

BACKGROUND

Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine disorders. Accumulated evidence has suggested the indispensable role of kisspeptin-G protein-coupled receptor (GPR54) system and SHBG in development of PCOS. However, potential mechanisms and their relationship are unclear. Jiawei Buzhong Yiqi Decoction (JWBZYQ) has been reported to ameliorate obese PCOS. Whereas, potential mechanisms remain elusive.

PURPOSE

To determine whether JWBZYQ attenuates PCOS by regulating the kisspeptin-GPR54 system and SHBG production. And to explore potential mechanisms.

METHODS

An overweight PCOS rat model was developed with testosterone propionate (TP) and high-fat diet (HFD). The efficacy of JWBZYQ was assessed by tracking changes in weight, estrous cycle, ovarian morphology, and serum sex hormone levels. Additionally, kisspeptin-GPR54 system expression in multiple organs and PI3K-AKT pathway activity in liver of different rats were detected. Modifications in SHBG production were also measured. Kisspeptin54 was administered to establish a cellular model. The levels of AKT phosphorylation and SHBG protein within HepG2 cells were analyzed. Finally, confirmatory studies were performed using AKT phosphorylation activator and inhibitor.

RESULTS

JWBZYQ effectively attenuated the overweight, disrupted estrous cycle, altered sex hormone levels, and aberrant ovarian morphology in PCOS rats. Meanwhile, PCOS rats exhibited elevated levels of kisspeptin and GPR54, along with reduced SHBG levels, which could be reversed by JWBZYQ. These alterations might be connected with the activation of AKT phosphorylation. In vitro experiment identified that JWBZYQ could rectify the hyperactivated AKT phosphorylation and deficient production of SHBG caused by kisspeptin54.

CONCLUSIONS

Overexpressed kisspeptin-GPR54 system inhibited SHBG synthesis in PCOS. JWBZYQ curtailed the exorbitant expression of kisspeptin and GPR54, which moderated the rise in AKT phosphorylation and subsequently promoted the production of SHBG.

Increased miscarriage rate is associated with at least four components of metabolic syndrome in women with polycystic ovary syndrome undergoing in vitro fertilization or intracytoplasmic sperm injection embryo transfer cycle

AIM

This study aimed to investigate the association between the components of metabolic syndrome (MetS) and reproductive outcomes in women with polycystic ovary syndrome (PCOS) undergoing their first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) embryo transfer cycle.

METHODS

This is a retrospective study that included 720 women with PCOS from January 2018 to December 2021. Anthropometric, biochemical, and reproductive data of the study subjects were collected from electronic medical record. Women with PCOS met <3, 3, and >3 criteria of MetS were classified in group 1, 2, and 3, respectively.

RESULTS

The miscarriage rate in women with MetS was significantly higher than that in non-MetS group (23.2% vs. 14.2%, p = 0.03). There was a significant increasing trend in miscarriage rate from group 1 to group 3 (p for trend <0.05). The miscarriage rate in group 3 was significantly higher than that in group 1 (29.3% vs. 14.2%, p < 0.05). Logistic regression analyses showed that women with at least four components of MetS (group 3) were independently associated with a high risk of miscarriage, with the odds ratios and 95% confidence intervals for group 2 and 3 versus group 1 were 1.38 (0.67-2.82) and 2.46 (1.06-5.74), respectively (p for trend = 0.04).

CONCLUSIONS

PCOS women accompanied with at least four diagnostic criteria of MetS is independently associated with increased miscarriage rate when undergoing their first IVF or ICSI cycle.

Transcription factor YY1 adversely governs ovarian granulosa cell growth in PCOS by transcription activation-mediated CDKN1C upregulation

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disease in women of childbearing age, making it imperative to explore more biomarkers for PCOS. Furthermore, previous studies have reported that cyclin dependent kinase inhibitor 1 C (CDKN1C) might be associated with PCOS progression. However, the molecular mechanism of CDKN1C involved in PCOS is poorly defined.

METHODS

CDKN1C and Yin-Yang-1 (YY1) expression levels were determined using real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot assay. Cell viability, proliferation, cell cycle progression, and cell apoptosis were analyzed using 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2-H-tetrazolium bromide (MTT), 5-ethynyl-2'-deoxyuridine (EdU), and flow cytometry assays. Caspase 3 activity was examined using a commercial kit. Binding between YY1 and CDKN1C promoter was predicted by JASPAR and verified using Chromatin immunoprecipitation (ChIP) and dual-luciferase reporter assays.

RESULTS

CDKN1C and YY1 were highly expressed in PCOS granulosa cells (GCs). Furthermore, CDKN1C silencing could promote cell proliferation and cell cycle process and repress cell apoptosis in human ovarian granulosa cell line KGN cells. For mechanistic analysis, YY1 is directly bound to the promoter of CDKN1C and transcriptional-regulated CDKN1C expression.

CONCLUSION

YY1-activated CDKN1C might block KGN cell proliferation and induce cell apoptosis, providing a possible therapeutic target for PCOS treatment.

Exploring the efficacy and mechanism of Bailing capsule to improve polycystic ovary syndrome in mice based on intestinal-derived LPS-TLR4 pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with reproductive dysfunction and metabolic abnormalities, particularly characterized by insulin resistance and chronic low-grade inflammation. Multiple clinical studies have clearly demonstrated the significant efficacy and safety of the combination of Bailing capsules (BL) in the treatment of PCOS, but its pharmacological effects and mechanisms still require further study.

AIM OF THE STUDY

To evaluate the effect of BL on improving PCOS in mice and explore the mechanism.

METHODS

In this study, Dehydroepiandrosterone (DHEA) injection was administered alone and in combination with a high-fat and high-sugar diet to induce PCOS-like mouse. They were randomly divided into five groups: normal group (N), PCOS group (P), Bailing capsule low-dose group (BL-L), Bailing capsule high-dose group (BL-H) and Metformin + Daine-35 group (M + D). Firstly, the effects of BL on ovarian lesions, serum hormone levels, HOMA-IR, intestinal barrier function, inflammation levels, along with the expression of IRS1, PI3K, AKT, TLR4, Myd88, NF-κB p65, TNF-α, IL-6, and Occludin of the ovary, liver and colon were investigated. Finally, the composition of the gut microbiome of fecal was tested.

RESULTS

The administration of BL significantly reduced body weight, improved hormone levels, improved IR, and attenuated pathological damage to ovarian tissues, up-regulated the expression of IRS1, PI3K, and AKT in liver. It also decreased serum LPS, TNF-α, and IL-6 levels, while downregulating the expression of Myd88, TLR4, and NF-κB p65. Additionally, BL improved intestinal barrier damage and upregulated the expression of Occludin. Interestingly, the abundance of norank_f__Muribaculacea and Lactobacillus was down-regulated, while the abundance of Akkermansia was significantly up-regulated.

CONCLUSION

The results of the study showed that BL exerts a treatment PCOS effect, which may be related to the modulation of the gut microbiota, the improvement of insulin resistance and the intestinal-derived LPS-TLR4 inflammatory pathway. Our research will provide a theoretical basis for the clinical treatment of PCOS.

The discriminatory capability of anthropometric measures in predicting reproductive outcomes in Chinese women with PCOS

OBJECTIVE

Obesity is a common feature in women with polycystic ovary syndrome (PCOS) and potentially significantly influences reproductive function. However, opinions are divided as to which factor is a more appropriate obesity predictor of reproductive outcomes. The aim of this study was to investigate the discriminatory capability of anthropometric measures in predicting reproductive outcomes in Chinese women with PCOS.

METHODS

A total of 998 women with PCOS from PCOSAct were included. Logistic regression models were used to compute the odds ratios (ORs) and 95% confidence interval (95% CIs) to assess the effect of anthropometric measures, including body mass index (BMI), waist circumference (WC), hip circumference (HC), the waist‒hip ratio (WHR) and the waist‒height ratio (WHtR), on reproductive outcomes. The discrimination abilities of the models were assessed and compared based on the area under the receiver operating characteristic curve (AUC), Akaike's information criterion (AIC) and integrated discrimination improvement (IDI).

RESULTS

Among PCOS women, there was a graded association between anthropometric measures and predicted reproductive outcomes across quintiles of anthropometric measures, including a linear association among WHR, BMI and reproductive outcomes and among waist circumference, WHtR and live birth, pregnancy, and ovulation. However, only a linear association was noted between the hip and ovulation. C-statistic comparisons and IDI analyses revealed a trend towards a significant superiority of BMI for ovulation and WHR for live birth, pregnancy and conception in the models. Combining obesity variables improved discrimination in the multivariable models for reproductive outcomes.

CONCLUSIONS

Our findings support that BMI is a better predictor of ovulation and that the WHR is a better predictor of live birth, pregnancy and conception, whereas the combination of obesity variables contributes to the discrimination of reproduction.