Polycystic Ovary Syndrome in Adolescence: Challenges in Diagnosis and Management

A cohort study on the association between metabolic/inflammatory status and pregnancy complications in PCOS patients after IVF/ICSI treatment

This study aims to explore the impact of insulin resistance and metabolic abnormalities on metabolic changes, inflammatory responses, and pregnancy complications during in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment in women with polycystic ovary syndrome (PCOS). A total of 100 PCOS patients who attended our hospital between February 2022 and February 2024, along with 100 control subjects with natural pregnancies, were included. Blood samples were analyzed for a range of parameters, including sex hormones (luteinizing hormone, follicle-stimulating hormone, estrogen, progesterone, testosterone, and prolactin), glycometabolism (fasting plasma glucose, fasting insulin, and homeostasis model assessment of insulin resistance), liver and kidney function (triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, creatinine, blood urea nitrogen, and uric acid), and inflammatory markers (C-reactive protein, interleukins [IL-2, IL-4, IL-6, IL-8, IL-12, and IL-18]). Changes in metabolic and inflammatory indicators were monitored throughout different pregnancy stages (early, mid, and late), and pregnancy outcomes, neonatal birth weight, and Apgar scores were recorded. The PCOS-IVF/ICSI group exhibited significantly higher levels of body mass index, systolic blood pressure, menstrual cycle irregularities, triglycerides, total cholesterol, low-density lipoprotein cholesterol, and hormones (luteinizing hormone, follicle-stimulating hormone, estrogen, progesterone, and testosterone) compared to the natural pregnancy group (P < .05). Pregnancy metabolic analysis showed significantly elevated fasting plasma glucose, fasting insulin, and homeostasis model assessment of insulin resistance indices across all pregnancy stages in the PCOS group (P < .01). Inflammatory markers, including C-reactive protein, IL-2, IL-4, IL-6, IL-8, IL-12, and IL-18, were also significantly higher in the PCOS-IVF/ICSI group (P < .05). Pregnancy outcome analysis revealed that the PCOS-IVF/ICSI group had higher rates of miscarriage and pregnancy complications (P < .05), with no significant difference in preterm birth rates (P = .12). Neonatal birth weight and Apgar scores were slightly lower in the PCOS-IVF/ICSI group compared to the natural pregnancy group (P < .05). Compared to women with natural pregnancies, the PCOS-IVF/ICSI group showed increased risks of metabolic disorders, inflammatory responses, and pregnancy complications, with slightly poorer neonatal outcomes, suggesting a higher risk during pregnancy for PCOS patients.

Presence of hyperandrogenemia in cases evaluated due to menstrual irregularity, the effect of clinical and/or biochemical hyperandrogenemia on polycystic ovary syndrome

OBJECTIVES

Polycystic ovary syndrome (PCOS) is known one of the most common causes of menstrual irregularities and hyperandrogenism in adolescents. We compared cases with increased risk for PCOS (presence of clinical hyperandrogenemia (CH) and/or biochemical hyperandrogenemia (BH) along with menstrual irregularity (MI)) and cases with only MI.

METHODS

Patients were divided into four subgroups. Those with only MI (n=130), CH+MI (n=68), BH+MI (n=25), and CH+BH+MI (n=31). Age, weight, height, and body mass index were recorded. The CH was assessed by the presence of persistent acne, hirsutism, or androgenic alopecia. Modified Ferriman Gallwey (mFG) score was used to evaluate hirsutism. Cases with total testosterone levels above 55 ng/dL were considered to have BH.

RESULTS

We observed that basal LH and LH/FSH ratio do not provide insight into CH. Unlike, DHEA-S (p=0.006), total testosterone (p=0.003), and free androgen index (FAI) (p=0.027) are relatively high in patients with CH. Polycystic ovarian morphology (PCOM) is lower in cases with only MI compared to cases with increased risk of PCOS (43.3 vs. 56.7 %, p=0.096). We predicted that 28.05 μg/L for Total testosterone, 75.9 for FAI, and 192.9 μg/dL for DHEA-S could be used as a cut-off value with a sensitivity and specificity over 60 %, ​​to distinguish MI from increased risk for PCOS.

CONCLUSIONS

After excluding other secondary endocrinological causes of MI in the first years, routine use of total testosterone, DHEA-S, and FAI is sufficient to distinguish cases presenting menstrual disorders due to anovulation from increased risk of PCOS.

Diagnosis and Treatment of Adolescent Polycystic Ovary syndrome:A Review

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age. Diagnosing adolescent PCOS is challenging due to the overlap between adult PCOS diagnostic criteria and normal physiological changes in adolescence. This review examines the diagnosis and treatment strategies for adolescent PCOS. The diagnosis of adolescent PCOS should meet two primary criteria-ovulatory dysfunction and biochemical or clinical hyperandrogenism-after excluding other causes. Defining these criteria accurately aids in early diagnosis and management of adolescent PCOS. However, due to limited research, age-specific diagnostic standards remain lacking. Once diagnosed, timely interventions-such as lifestyle, exercise, and dietary changes, along with targeted treatments like metformin and antiandrogens-should be initiated. In addition, the management of adolescent PCOS presents several challenges, including the absence of standardized medication guidelines, adolescent psychological factors that may impede adherence to dietary and exercise recommendations, and parental concerns about the long-term effects of medication on bone health and metabolism. Therefore, additional research is required to establish optimal management protocols to enhance patients' quality of life and prevent complications.

Development of machine learning models for diagnostic biomarker identification and immune cell infiltration analysis in PCOS

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. It is characterized by symptoms such as hyperandrogenemia, oligo or anovulation and polycystic ovarian, significantly impacting quality of life. However, the practical implementation of machine learning (ML) in PCOS diagnosis is hindered by the limitations related to data size and algorithmic models. To address this research gap, we have increased the sample size in our study and aim to utilize two ML algorithms to analyze and validate diagnostic biomarkers, as well as explore immune cell infiltration patterns in PCOS.

METHODS

We performed RNA-seq analysis on granulosa cell, including 13 samples from normal controls and 25 samples from women with PCOS. The data from our study were combined with publicly available databases. Batch effects were corrected using the 'sva' package in R software. Differential expression analysis was performed to identify genes that exhibited significant differences between the two groups. These differentially expressed genes (DEGs) were further analyzed for Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Hub genes were selected by intersecting the results of both methods after using LASSO and SVM-RFE for central gene selection for DEGs. Receiver Operating Characteristic (ROC) curves were employed to verify the accuracy of models by SVM and XGBoost. CIBERSORT analysis was performed to determine the relative abundances of immune cell populations. GSEA was analyzed to illustrate the expression patterns of genes within highly enriched functional pathways. RT-qPCR was used to validate the reliability of hub genes.

RESULTS

824 DEGs were found between the normal control and PCOS groups, including 376 upregulated and 448 downregulated genes. These DEGs were associated with endocytosis, salmonella infection and focal adhesion based on the KEGG enrichment analysis. Through overlapping LASSO and SVM-RFE algorithms, we identified four hub genes (CNTN2, CASR, CACNB3, MFAP2) that are significantly associated with the PCOS group. The diagnostic efficacy validation set using SVM and XGBoost yielded AUC values of 0.795 and 0.875, respectively, indicating their potential as diagnostic biomarkers. Consistent with the data analysis, the upregulation of CNTN2, CASR, CACNB3, and MFAP2 in PCOS was confirmed by RT-qPCR analysis on human granulosa cells. Furthermore, according to CIBERSORT analysis, a significant reduction in CD4 memory resting T cells was revealed in the PCOS group compared to the normal control group (P < 0.05).

CONCLUSIONS

This study identified CNTN2, CASR, CACNB3, and MFAP2 as potential diagnostic biomarkers for PCOS, which provides strong evidence for existing research on hub genes. Furthermore, the analysis of immune cell infiltration revealed the significant involvement of CD4 memory resting T cells in the onset and progression of PCOS. These findings shed light on potential mechanisms underlying PCOS pathogenesis and provide valuable insights for future research and therapeutic interventions.

Weight-neutral approach and later sleep midpoint in adolescents with "emerging polycystic ovary syndrome phenotype" as vehicles for sustainable weight loss

Objective

Incorporate sleep into a novel lifestyle intervention strategy in adolescents with Emerging symptoms of polycystic ovary syndrome (E-PCOS).

Design

A single-center cohort study.

Setting

University hospital-based clinic for adolescents with PCOS.

Patients

Forty-three girls at an age between 10 and 18 years presenting with E-PCOS between March 2015 and September 2017 with clinical signs of androgen excess and/or accelerated weight gain, acanthosis nigricans, irregular periods, or delayed menarche and followed every 6 months for a minimum of 4 visits, to October 2020.

Interventions

All patients received nutritional counseling, with a goal of "zero weight gain," daily moderate physical activity goals of 45 minutes per day, and education regarding age-appropriate sleep duration. Three treatment strategies for E-PCOS symptoms were applied depending on the chief clinical complaint: anti-insulin approach with metformin; antiandrogen approach with oral contraceptive and spironolactone; and surveillance.

Main Outcome Measures

Body mass index (BMI) Z-score over time. Alanine Transaminase (ALT) levels as a risk factor for nonalcoholic fatty liver.

Results

Average number of return visits was 4 with 58% having >4 return visits. Testosterone levels were correlated with ALT (r = 0.68). Weeknight sleep duration was less than age-appropriate recommendations for 63% of participants. Sleep midpoint correlated with ALT levels (r = 0.48). Despite the weight-neutral approach, regression models all demonstrated significant weight loss regardless of menarche status, metformin use, number of visits, and high vs. low ALT groups. Those with the latest sleep midpoint at baseline benefited the most, with BMI Z-score dropping significantly (interaction of time and baseline sleep midpoint from the first visit on school night).

Conclusion

A novel approach for adolescent girls with E-PCOS that focuses on metabolic endpoints and includes sleep duration and timing as specific targets, led to significant weight loss irrespective of treatment group.

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.

Polycystic Ovary Syndrome in Adolescents

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrinologic disorder that is characterized by oligomenorrhea or amenorrhea and signs of hyperandrogenism. The cause of PCOS remains unknown, but the syndrome is associated with insulin resistance that in turn leads to hyperandrogenism. An accurate and prompt diagnosis of PCOS is important to understanding an adolescent's risk. In adolescents, both oligoovulation and hyperandrogenism are needed for the diagnosis of PCOS and ultrasound is not recommended. Lifelong health consequences of PCOS are significant and include obesity, diabetes, metabolic syndrome, and anovulatory infertility. The symptoms of PCOS can be disturbing to an adolescent girl.

Identification and validation of core genes associated with polycystic ovary syndrome and metabolic syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder affecting women of reproductive age, affecting reproductive health, and increasing the incidence of diabetes mellitus and hypertension. Metabolic syndrome (MetS) is the most common metabolic disorder. Although clinical studies have shown a close association between PCOS and MetS, the molecular mechanisms are unknown. In this study, datasets of PCOS and MetS were obtained from the Gene Expression Omnibus database; differential expression analysis and weighted gene coexpression network analysis (WGCNA) were performed; and gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses also performed of differentially expressed genes (DEGs). The PCOS- and MetS-coexpressed DEGs were subsequently intersected with the coexpressed genes in the WGCNA module to obtain the core genes. By constructing receiver operating characteristic curves, we verified the predictive effects of the core genes. We also validated the expression of the core genes in the datasets. Finally, we verified the expression of the core genes by quantitative polymerase chain reaction in human follicular fluid granulosa cells. In addition, we used Cell-type Identification By Estimating Relative Subsets Of RNA Transcripts to analyze the immune infiltration of immune cells in PCOS and MetS. Finally, we obtained 52 coexpressed DEGs of PCOS and MetS and 3 coexpressed genes in the WGCNA module. By taking the intersection of coexpressed DEGs and coexpressed genes of the WGCNA module, we get ELOVL fatty acid elongase 7 (ELOVL7) as the core gene. Receiver operating characteristic curve analysis showed that ELOVL7 is a reliable biological marker for PCOS and MetS. The expression level of ELOVL7 in human follicular fluid granulosa cells from PCOS patients was significantly higher than that of controls, as verified by quantitative polymerase chain reaction. This study provides the first evidence of the role of ELOVL7 in developing PCOS and MetS. This gene may serve as a potential diagnostic marker and therapeutic target for both conditions.

Efficacy of optimal nutraceutical combination in treating PCOS characteristics: an in-silico assessment

BACKGROUND

Polycystic ovary syndrome (PCOS) is a serious health condition affecting women of reproductive age. High prevalence of PCOS and associated metabolic complications needs effective treatment and management. This study evaluated the efficacy of optimal nutraceutical combinations in improving PCOS characteristics using system biology-based mathematical modelling and simulation.

METHODS

A shortlisting of eight potent nutraceuticals was carried out with literature search. Menstrual cycle model was used to perform simulations on an in-silico population of 2000 individuals to test individual and combined effects of shortlisted nutraceuticals on five PCOS characteristics [oligomenorrhea, anovulation, hirsutism, infertility, and polycystic ovarian morphology (PCOM)] for a duration of 6 months. Efficacy was tested across lean and obese phenotypes and age groups.

RESULTS

Individual assessment of nutraceuticals revealed seven most potent compounds. Myo-inositol among them was observed to be the most effective in alleviating the PCOS characteristics. The in-silico population analysis showed that the combination of melatonin and ALA along with myo-inositol was efficacious in restoring the hormonal balance across age-groups and Body Mass Index (BMI) categories.

CONCLUSION

Supplementation with the combination of myo-inositol, melatonin, and ALA demonstrated potential in managing PCOS symptoms in our in-silico analysis of a heterogeneous population, including lean and obese phenotypes across various severities and age groups, over a 6-month period. Future clinical studies are recommended to validate these findings.

PCOS in Adolescents-Ongoing Riddles in Diagnosis and Treatment

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. A diagnosis of PCOS is established when a patient exhibits two of three Rotterdam criteria: oligoovulation or anovulation, excess androgen activity, and polycystic ovarian morphology. The pathogenesis of PCOS, as it affects adolescents, is often discussed in terms of a "two-hit" theory. This refers to a stepwise process in which the first "hit" is an inborn congenitally programmed predisposition, while the second "hit" arises from a provocative factor such as insulin resistance. The dynamic physiological and anatomical changes which occur in puberty make for a challenging diagnosis in this group of patients. It is important to be mindful of the physiological particularities in adolescence which often mimic the symptoms of PCOS. In their first-year post-menarche, approximately 75% of menstruating adolescents report their cycle to last between 21-45 days. Recent studies have shown that regular menstrual cyclicity is only achieved within 2-3 years post-menarche. Anovulation, as a crucial diagnostic element for PCOS, features in about half of early-post-menarchal adolescents. Hirsutism and acne are the most common clinical manifestations of hyperandrogenism, and mild features are developed by most adolescents as a result of elevated androgen levels. Distinguishing between a pathological sign and normal features of maturation is often difficult. A polycystic ovarian morphology (PCOM) through ultrasound has been found in up to 40%, 35%, and 33.3% of patients when assessed at 2, 3, and 4 years, respectively, after menarche. PCOM in adolescence is not associated with future abnormalities in ovulatory rate or menstrual cycle duration. For this reason, international guidelines recommend against the use of pelvic ultrasound until 8 years post-menarche. The primary aim of management is focused mainly on improving hormonal and metabolic status, the prevention of future comorbid complications, and generally improving the overall quality of life in young women with PCOS. Considerable controversy surrounds the choice of optimal pharmacological treatment to address PCOS in adolescents. Reliable studies, which include this sub-section of the population, are very limited. There is a lack of robust and reliable trials in the literature addressing the use of combined oral contraceptives. Further work needs to be undertaken in order to provide safe and effective care to the adolescent population in this regard.