The latest reports and treatment methods on polycystic ovary syndrome

Effect of letrozole doses on clinical pregnancy rates in polycystic ovary syndrome: a systematic review and network meta-analysis

Letrozole, an aromatase inhibitor, is commonly used for ovulation induction in patients with polycystic ovary syndrome (PCOS). However, the effect of different doses of letrozole on pregnancy outcomes remains controversial. This systematic review and network meta‑analysis aims to compare the effects of different doses of letrozole on pregnancy outcomes in PCOS patients. A systematic search was performed in databases such as PubMed, WOS, and Wanfang for randomized clinical trials (RCTs) assessing different doses of letrozole in PCOS patients. The primary outcome was pregnancy outcome. A network meta‑analysis was conducted using Stata 17's network package and the 'netmeta' and 'gemtc' packages in R software. A total of 30 RCTs involving 3663 patients were included, comparing 11 intervention strategies. Compared with 2.5 mg letrozole, 5 mg letrozole (OR = 1.99, 95% CI: 1.47-2.68; p > 0.05), 7.5 mg letrozole (OR = 1.89, 95% CI: 1.17-3.06; p > 0.05), and 7.5 mg letrozole combined with clomiphene (OR = 7.60, 95% CI: 1.33-43.35; p > 0.05) all significantly improved pregnancy outcomes. Additionally, compared with 2.5 mg letrozole combined with human gonadotropin (HMG), 5 mg (OR = 1.12), 7.5 mg (OR = 1.19), and 20 mg (OR = 1.72) letrozole combined with HMG showed improvements in pregnancy rates, though the differences were not statistically significant (p > 0.05). The lack of unpublished studies and non‑English publications may have introduced publication bias. Letrozole treatment significantly improves pregnancy outcomes in PCOS patients. Moderate‑dose letrozole is recommended as the most effective strategy for improving pregnancy outcomes. Further clinical studies are required to confirm these findings.

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.

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.

Integrating Artificial Intelligence in the Diagnosis and Management of Metabolic Syndrome: A Comprehensive Review

BACKGROUND

Metabolic syndrome (MetS) is a progressive chronic pathophysiological state characterised by abdominal obesity, hypertension, hyperglycaemia, and dyslipidaemia. It is recognised as one of the major clinical syndromes affecting human health, with approximately one-quarter of the global population impacted. MetS increases the risk of developing cardiovascular diseases (CVDs), stroke, type 2 diabetes mellitus (T2DM), and diverse metabolic diseases. Early diagnosis of MetS could potentially reduce the prevalence of these diseases. However, care for the MetS population faces significant challenges due to (i) a lack of comprehensive understanding of the full spectrum of associated diseases, stemming from unclear pathophysiological mechanisms and (ii) frequent underdiagnosis or misdiagnosis of MetS in clinical settings due to inconsistent screening guidelines, limited medical resources, time constraints in clinical practice, and insufficient awareness and training. The increasing availability of healthcare and medical data presents opportunities to apply and innovate with artificial intelligence (AI) in addressing these challenges. This review aims to (i) summarise the spectrum of diseases associated with MetS and (ii) review the diverse AI models applied to MetS and metabolic syndrome-related diseases (MetSRD), where MetSRD collectively refers to diseases and conditions directly associated with MetS.

METHODS

Our review consists of two phases. Initially, we conducted a literature review on MetS to narrow down the spectrum of MetSRD based on the strength of clinical evidence. We then used the terms 'Metabolic Syndrome' and 'Machine Learning' in combination with the identified MetSRD for further refinement. In total, we identified 52 related diseases in the first phase and 36 articles in the second phase.

RESULTS

We identified a total of 52 MetSRD after the first phase, with T2DM, CVDs, and cancer being the top three. Among the 36 articles obtained in the second phase, we observed the following: (i) The criteria for MetS were inconsistent across the studies. (ii) The primary purpose of AI applications was to identify risk factors for diseases, thereby improving predictions for MetS or MetSRD. Traditional machine learning models, such as Random Forest and Logistic Regression, were found to be the most effective. (iii) In addition to the MetS criteria, AI models explored other factors, including demographic and physiological variables, dietary influences, lipidomic and proteomic indicators, and more.

CONCLUSION

This review underscores the significant link between MetS and a spectrum of diseases, with a particular focus on underreported conditions such as non-alcoholic fatty liver disease and stroke. Through the analysis of data from diverse sources, AI models, and MetS diagnostic criteria, additional indicators beyond traditional measures have been identified, emphasising the importance of combining both traditional and non-traditional markers to enhance the diagnostic and predictive capabilities for MetS and MetSRD. AI shows great potential in MetS research, particularly through the integration of multi-source data, including clinical metrics, genetic information, and omics data. The amalgamation of traditional machine learning and modern machine learning models is particularly promising, offering a balanced approach to model performance and data complexity. While international definitions provide global applicability, they may not be suitable for all populations and scenarios, necessitating flexible diagnostic criteria and adaptive, explainable algorithms. Ultimately, these will enable personalised diagnostics and targeted interventions.

The Anti-Mullerian Hormone as a Biomarker of Effectiveness of Metformin Hydrochloride Therapy in Polycystic Ovarian Syndrome and Insulin Resistance

Background/Objectives: Among the therapeutic options available for managing PCOS, metformin improves insulin sensitivity, reduces androgen levels, and helps restore menstrual regularity and ovulation. While primarily used for its metabolic effects, metformin therapy may also influence reproductive parameters, including AMH levels, which are pivotal in improving ovarian function and predicting therapeutic outcomes in PCOS. The aim of this study was to search the scientific literature and analyze the correlation between AMH levels and metformin hydrochloride therapy in women with PCOS and IR. Methods: A systematic review of the scientific literature was conducted using the following keywords: polycystic ovarian syndrome, anti-Mullerian hormone, insulin resistance, metformin, treatment, biomarker, and metabolic syndrome. This review was aimed at investigating the potential of AMH as a biomarker of the effectiveness of metformin therapy in patients with PCOS and IR. Results: Metformin treatment in PCOS patients has shown significant reductions in serum AMH levels with prolonged therapy. As an insulin sensitizer, metformin improves insulin sensitivity, reduces hyperinsulinemia, and suppresses hyperandrogenism. This process inhibits the growth of antral follicles, which is reflected in decreased AMH levels. Conclusions: Reductions in AMH levels and improvements in insulin sensitivity can serve as indicators of treatment efficacy and enhancements in reproductive function for these patients. AMH could be considered a prognostic marker for evaluating the effectiveness of metformin therapy. A decrease in AMH levels following treatment may indicate improved ovarian function and a reduction in polycystic morphology. However, further research is necessary to confirm these findings and to determine the optimal dosages and duration of treatment.

Effects of Vitamin D3 Treatment on Polycystic Ovary Symptoms: A Prospective Double-Blind Two-Phase Randomized Controlled Clinical Trial

BACKGROUND/OBJECTIVES

Vitamin D deficiency is common in women with polycystic ovary syndrome (PCOS) and may be associated with metabolic and endocrine disorders as well as ovulatory dysfunction. Vitamin D supplementation may improve ovarian dysfunction and follicular development by effecting gene expression. The aim of the present study was to investigate the effects of vitamin D supplementation in women with PCOS through a prospective, randomized, two-phase, parallel design, placebo-controlled trial.

METHODS

We assessed the impact on ovarian morphology, cycle length, and ovulatory dysfunction. Transvaginal ultrasonography (TVUS) examinations and clinical laboratory assessments were conducted at the baseline, and again after 12 and 24 weeks. The participants received vitamin D (30,000 IU/week) or a placebo (without concurrent metformin use) for 12 weeks, supplemented with calcium, followed by an additional 12 weeks of vitamin D treatment.

RESULTS

The treatment resulted in improvements in ovarian morphology and regularity of menstrual cycles in more than half of the patients. Additionally, vitamin D3 was associated with a significant increase in the ovulation rate. A statistically significant reduction in mean testosterone levels was observed in the subgroup of patients with an LH/FSH ratio greater than 2.

CONCLUSIONS

Our results suggest that vitamin D3 treatment could function as either a standalone or an adjunctive therapy in the management of PCOS.

Treatment of Qin Gui Wan (QGW) in PCOS abnormal oocytes development via AMPK/PGC-1ɑ pathway

OBJECTIVES

To investigate the therapeutic effects of Qin Gui Wan (QGW) and its disassembled functional drug groups, Wenyang Zhuhuo (WYZH) and Xinwen Zhuyang (XWZY), on letrozole-induced PCOS rats.

METHODS

PCOS rat model was established by administering letrozole for 21 days. The rats were divided into control, PCOS, Diane-35, QGW, WYZH and XWZY groups. The changes of body weight, ovarian coefficient, estrous cycle and sex hormone levels were observed. The ovarian histological characteristics and ovulation were observed by HE staining. P450arom, SF-1, and AMPK/PGC-1ɑ pathway mRNA and protein expression were analyzed using qRT-PCR, WB, and IHC. The AMPK inhibitor Compound C (CC) was used to explore the treatment mechanism of QGW in granulosa cells. And UHPLC-MS/MS was used to performed chemical composition analysis.

RESULTS

QGW, WYZH, and XWZY can correct the disordered estrous cycle of PCOS rats and improve the serum hormone status of rats to varying degrees. HE results indicated that QGW, WYZH, and XWZY improved ovarian polycystic changes and normalized ovulation. qRT-PCR, WB, and IHC results demonstrated that QGW, WYZH, and XWZY increased PGC-1α, SF-1, and P450arom mRNA and protein expression in the ovaries of PCOS rats. The level of AMPK mRNA in the ovaries of QGW and its disassembled prescriptions increased, while only WYZH and XWZY rats showed increased ovarian AMPK levels. CC attenuated the activation of AMPK, PGC-1α, SF-1, and P450arom mRNA by QGW.

CONCLUSIONS

This study demonstrates that QGW alleviates abnormal oocyte development in PCOS rats, possibly by enhancing P450arom expression via the AMPK/PGC-1α pathway, thus restoring normal androgen-estrogen balance and follicular development.

The Role of Diet, Glycaemic Index and Glucose Control in Polycystic Ovary Syndrome (PCOS) Management and Mechanisms of Progression

PURPOSE OF REVIEW

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder with several causal pathways including impaired glucose tolerance, insulin resistance (IR), compensatory hyperinsulinemia and excess androgens (hyperandrogenism). This heterogeneous condition causes a range of reproductive, metabolic and psychological implications, the severity of which can differ between individuals depending on factors such as age, diet, ethnicity, genetics, medication, contraceptive use, adiposity, and Body Mass Index (BMI).

RECENT FINDINGS

Dietary interventions that focus on a low glycaemic index and glucose control are an efficient first-line dietary solution for the management of impaired glucose tolerance and IR, which subsequently improves weight management, quality of life and PCOS-related symptoms in individuals with this condition. This review aims to explore the relevance of nutrition and more specifically, the association of glycaemic index and glycaemic load with PCOS, as well as to assess the potential benefits of manipulating those indexes in the dietary approach for this syndrome.

Acupuncture and Drug Combination Therapy for Abnormal Glucose Metabolism: Exploring Synergistic Enhancement and Reduced Toxicity Mechanisms

This review examines the impact of combining acupuncture with drug therapy on abnormal glucose metabolism and investigates their underlying mechanisms. Conditions like diabetes pose significant health risks due to irregular glucose metabolism. Traditional drug treatments often encounter challenges related to side effects and drug resistance. Acupuncture, as a non-pharmacological intervention, is thought to enhance glucose metabolism and mitigate medication side effects. We selected the relevant studies of acupuncture or electroacupuncture combined with drugs in the treatment of abnormal glucose metabolism in the past five years, and the results indicate that the combination of acupuncture or electroacupuncture and drug therapy markedly enhances glucose metabolism and mitigates medication-related side effects such as gastrointestinal discomfort and hypoglycemia. Overall, this review underscores the synergistic benefits of acupuncture and drug therapy in improving treatment efficacy and reducing adverse effects, offering promising new approaches for managing abnormal glucose metabolism. Our review provides evidence for the potential benefits of combining acupuncture with drug therapy for abnormal glucose metabolism, which could lead to improved treatment outcomes and reduced side effects for patients with type 2 diabetes mellitus.

The association between dietary obesity-prevention score (DOS) and polycystic ovary syndrome: a case-control study

Polycystic ovary syndrome (PCOS) is one of the most prevalent obesity-related diseases in women of reproductive age. Linkage between diet and PCOS are still controversial. Dietary obesity prevention score (DOS) is one of the new indicators of diet evaluation which have been previously linked to obesity. To the best of our knowledge, this study was the first to investigate the relationship between DOS and PCOS. In this case-control study, 100 newly diagnosed women with PCOS and 100 age-matched women without PCOS were assayed from clinics affiliated to Kashan university of medical sciences, Kashan, Iran. A validated semi-quantitative food frequency questionnaire was used to evaluate food intakes. DOS was calculated based on previous published guideline. Anthropometric measurements were carefully measured by a trained nutritionist. A 10-houres fasting plasma blood sample was collected for all participants. Fasting blood sugar (FBS), triglyceride (TG), total cholesterol (CHOL), High density lipoprotein (HDL), Low density lipoprotein (LDL) and C - reactive protein (CRP) were measured based on laboratory methods. The mean age and BMI of study participants was 23.6 year and 24.9 kg/m2 respectively. After adjustment for potential confounders, adherence to DOS score was inversely associated with CRP levels. People in the top tertile of DOS had lower CRP level compared to people in the bottom tertile (3.71 compared to 4.48 mg/dl) (P = 0.04). In addition, participant in the top tertile of DOS had marginally significant higher level of FBS compared to participants in the bottom tertile (92.3 vs. 88.9 mg/dl, P = 0.051). After adjustment for all confounding factors people in the highest tertile of DOS had a 46% non-significant lower odds for PCOS compared to people in the lowest tertile (95% CI: 0.23-1.25; P-trend = 0.15). In the present study, an inverse significant association was seen between adherence to DOS and inflammation. However, no significant relationship was observed between DOS and odds of having PCOS. Further longitudinal studies are suggested to investigate the association between DOS and PCOS.

Quinoa ameliorates polycystic ovary syndrome via regulating gut microbiota through PI3K/AKT/mTOR pathway and autophagy

BACKGROUND

Polycystic ovary syndrome (PCOS) is a unity of endocrine and metabolic disorders, associated with PI3K/AKT/mTOR, autophagy, and gut microbiota. Quinoa is a valuable food source, which contains rich minerals, unsaturated fatty acids, and has a positive modulating effect on metabolic diseases. However, its effects and potential mechanisms on PCOS have not been reported yet. Therefore, the purpose of this study is to investigate the effect of quinoa on PCOS rats by regulating PI3K/AKT/mTOR, autophagy, and gut microbiota.

METHODS

Ten-week-old female Sprague-Dawley (SD) rats have received letrozole for 24 days for induction of PCOS and subsequently were treated with a quinoa diet for 8 weeks. Vaginal smears were used to analyze the estrous cycle of rats. Hormone and biochemical indexes were analyzed by kit assays and glucometer. The pathological changes of ovary, pancreas, duodenum and colon were observed by HE staining. PI3K, AKT, mTOR and autophagy-related proteins in the ovary and colon were measured by western blot and immunohistochemistry staining. Tight junction proteins in colon were measured by immunohistochemistry staining. 16 s rDNA sequencing was used to detect the changes of intestinal microbiota in rats. Network pharmacology and molecular docking were used to study the possible targets and mechanisms of quinoa on PCOS. Spearman correlation analysis was used to study the relationship between intestinal microbial abundance and hormone levels of PCOS rats at the phylum and genus level.

RESULTS

Quinoa significantly improved estrous cycle and biochemical parameters of PCOS-like rats, and the pathological state of ovary, pancreas, duodenum and colon tissues. Especially, quinoa significantly regulated the expression of PI3K, AKT, mTOR and autophagy-related proteins in the ovary. Quinoa may repair the intestinal barrier by upregulating the expression of tight junction proteins in the colon, and regulate autophagy-related factors in colon. Additionally, quinoa increased the abundance of Lactobacillu, Bacteroides and Oscillospira, and decreased the Firmicutes/Bacteroidetes ratio and the Blautia, and Prevotella, reversing the dysregulation of the gut microbiota. Correlation analysis showed that there is a strong correlation between gut microbiota with significant changes in abundance and hormone related to PCOS.

CONCLUSION

Our result indicated that effect of quinoa on PCOS maybe associated with activation of the PI3K/AKT/mTOR signaling pathway, inhibition of autophagy, and regulation of intestinal flora.