Endometrial function in women with polycystic ovary syndrome: a comprehensive review

Correlation between serum uric acid to serum creatinine ratio and infertility in reproductive-age female of American: data from national health and nutrition examination survey (NHANES), 2013-2016

BACKGROUND

The elevated levels of serum uric acid (SUA) may be closely associated with female infertility. Serum uric acid to serum creatinine ratio (SUA/SCr) is a standardized indicator for assessing kidney function, providing a more accurate reflection of endogenous SUA levels within the body. Up to now, there have been no reports on the relationship between SUA/SCr and infertility. Therefore, we conducted a study on the relationship between SUA/SCr and infertility.

METHODS

The analysis was based on data from the 2013-2016 National Health and Nutrition Examination Survey (NHANES), a cross-sectional study of 1918 female participants between the ages of 20 and 45. The levels of SUA (mg/dL) and serum creatinine (mg/dL) were measured, and the reproductive status of each subject was evaluated with reproductive health questionnaire. In the analysis of the whole sample and each group, the Logistic regression model was used to evaluate the relationship between SUA/SCr and infertility. The level of SUA/SCr was analyzed by stratified multivariate Logistic regression model.

RESULTS

Infertility was found in 277 (14.4 %) of the 1,918 female adults in this study, with greater mean SUA/SCr (6.79 ± 1.85 vs. 6.99 ± 1.90). SUA/SCr were associated with infertility in both the initial and adjusted models. According to multivariate logistic regression, the odds of female infertility were found to be significantly higher with rising SUA levels (Q4 [SUA/SCr ≥ 7.78] vs. Q1 [SUA/SCr ≤ 5.37]), fully adjusted odds ratio [OR] = 1.80 p = 0.004]. The data suggests that there is a dose-response relationship between the two.

CONCLUSIONS

The results from this nationally representative sample from the United States indicates that the increase of SUA/SCr promotes the occurrence of female infertility events. Infertile women may benefit from improving their lifestyle and modifying dietary habits to reduce the SUA/SCr, which could potentially be advantageous for increasing the probability of pregnancy.

The emerging roles of N6-methyladenosine (m6A) deregulation in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is an endocrine metabolic syndrome characterized by ovulation disorders, hyperandrogenemia, and polycystic ovaries, which seriously affect the psychological and physical health of childbearing women. N6-methyladenosine (m6A), as the most common mRNA epigenetic modification in eukaryotes, is vital for developing the female reproductive system and reproductive diseases. In recent years, an increasing number of studies have revealed the mechanisms by which m6A modifications and their related proteins are promoting the development of PCOS, including writers, erasers and readers. In this work, we reviewed the research progress of m6A in the pathophysiological development of PCOS from the starting point of PCOS clinical features, included the recent studies or those with significant findings related to m6A and PCOS, summarized the current commonly used therapeutic methods in PCOS and the possible targeted therapies against the m6A mechanism, and looked forward to future research directions of m6A in PCOS. With the gradual revelation of the m6A mechanism, m6A and its related proteins are expected to become a great field for PCOS treatment.

Metformin alleviates inflammatory responses in acute allergic asthma by inhibiting ILC2s function

Allergic asthma was a type 2 immunity-mediated airway inflammatory disorder, in which type 2 innate lymphoid cells (ILC2s) play a pivotal role in response to allergen sensitization eosinophil infiltration, mucus hypersecretion, and bronchial hyperresponsiveness were its hallmark features. Despite the widespread use of glucocorticoids in allergic asthma management, drugs targeting ILC2s remain underdeveloped. Recently, emerging evidences have suggested that metformin displays anti-inflammatory properties during the challenge phase of allergic asthma. In order to further investigate the role and cellular mechanisms of metformin in the sensitization phase of allergic asthma, this study employed IL-33 alone or ovalbumin combined with papain to induce acute allergic asthma models in mice. During the sensitization process, metformin was administered via intraperitoneal injection. Histopathological and flow cytometric analyses revealed that metformin significantly attenuated airway inflammation, as evidenced by alleviated pathological damage, reduced mucus hypersecretion, decreased eosinophil infiltration, and diminished levels of IL-5 and IL-13 in bronchoalveolar lavage fluid. Additionally, the number and proportion of pulmonary ILC2s were notably decreased in metformin-treated mice. Furthermore, pulmonary ILC2s in metformin-treated mice displayed compromised cytokine production, diminished proliferation, and augmented death. These results indicate that metformin effectively alleviates airway inflammation in acute allergic asthma and its protective role may be mediated through the suppression of ILC2s. This study not only elucidates mechanistically the previously uncharacterized role of metformin in preventing allergen sensitization through inhibiting ILC2s, but also suggests that translationally metformin emerges as a potential prophylactic candidate for preventing the transition from subclinical inflammation to overt allergic asthma.

An endocrinological perspective on polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is a complex endocrinological disorder that involves dysfunctions across multiple endocrine axes, including the hypothalamic-pituitary-gonadal (HPG), hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes. Our review focuses on understanding the pathophysiology of PCOS through an endocrinological perspective, emphasizing the complex interactions between multiple endocrine axes. We have discussed the roles of the HPG, HPA, and HPT axes in PCOS. Dysregulation of the HPG axis, particularly the altered gonadotropin-releasing hormone pulse frequency resulting in elevated ratio of luteinizing hormone to follicle stimulating hormone, is central to the hyperandrogenism and anovulation, observed in PCOS. We have further highlighted the contributions of the HPA and HPT axes, where elevated adrenal androgen levels and hypothyroidism intensifies the phenotypes of PCOS. Additionally, insulin resistance and hyperinsulinemia, commonly associated with PCOS, aggravates hormonal disturbances and heighten the risk of metabolic complications such as type 2 diabetes and cardiovascular diseases. Elevated levels of anti-Müllerian hormone have also been emphasized as a key factor in inhibiting follicular growth, leading to impaired ovarian function and hyperandrogenism. This review further supports that PCOS is a multifactorial condition involving complex feedback mechanisms between the endocrine, metabolic, and reproductive systems. Furthermore, there remains a huge scope for deciphering the precise molecular interactions between the HPG, HPA, and HPT axes in PCOS, which could pave the way for targeted therapies for better management of both the endocrine and metabolic aspects of this disorder. This review will benefit researchers to get an endocrine perspective on PCOS.

Prenatally androgenized PCOS mice have ovary-independent uterine dysfunction and placental inflammation aggravated by high-fat diet

Polycystic ovary syndrome (PCOS) is a common hyperandrogenic and metabolic condition in women. The syndrome is linked to subfertility and pregnancy complications, yet the independent effects of exposure to hyperandrogenism and obesity on endometrial function remain unclear. Here, PCOS-like mice were generated using prenatal androgenization (PNA) with dihydrotestosterone, followed by a prepubertal high-fat (HF) or standard diet. In ovariectomized mice, PNA impaired uterine closure during the implantation window, disrupted decidualization, and altered extracellular matrix- and inflammation-related gene expression. The effects were aggravated by the HF diet. In naturally mated, ovary-intact mice, PNA and HF diet affected decidual and placental gene expression, suggestive of placental dysfunction and inflammation, and induced fetal growth restriction. This study underlines the role of the uterus in adverse pregnancy outcomes in PCOS and identifies possible underlying mechanisms for future studies. Prepregnancy interventions targeting metabolic health and hyperandrogenism should be the next steps to optimize PCOS pregnancy outcomes.

Polycystic ovary syndrome and morphokinetic embryonic development: a case-control study evaluating 791 embryos

OBJECTIVE

To investigate the association between polycystic ovary syndrome (PCOS) and the rate of embryo development, using time-lapse monitoring systems, compared with a control group of women with mechanical (tubal) factor infertility.

DESIGN

A retrospective case-control study conducted in a university-affiliated in vitro fertilization (IVF) unit.

SUBJECTS

Women with PCOS undergoing IVF treatments and those with non-PCOS controls with tubal factor infertility only. Development morphokinetic milestones were compared and analysis of covariance for time to distinct cell number as well as logistic mixed models to determine predictors for embryos over the 75th percentile was performed.

EXPOSURE

Not applicable.

MAIN OUTCOME MEASURES

Embryo development morphokinetic parameters in women with and without PCOS undergoing IVF treatments.

RESULTS

The study included 791 embryos from 115 women, 364 embryos from 52 women with PCOS and 427 embryos from 63 women with non-PCOS controls with tubal factor infertility. The PCOS group was 4 years younger (30.07 ± 6.03 vs. 34.08 ± 4.84 years) and had higher number of oocytes retrieved (16.00 vs. 11.00), mature oocytes (11.00 vs. 7.00) and fertilized oocytes (8.00 vs. 5.00). The PCOS and control groups demonstrated comparable clinical pregnancy rates (55.8% vs. 32.1%), miscarriage rate (12.5% vs. 11.8%), and live birth rate (48.8% vs. 31.2%). Morphokinetic parameters were comparable between the groups. Although age was associated with later time to 5 and 8 discrete cells and start of blastulation (tSB), PCOS was only associated with later tSB, including tSB >75th percentile.

CONCLUSION

This study demonstrated comparable IVF outcomes in women with PCOS and non-PCOS controls. An analysis of time-lapse monitoring data from these patients showed no evidence that PCOS negatively affects embryonic development rate in women undergoing IVF cycles.

Adipokines level in plasma, hypothalamus, ovaries and adipose tissue of rats with polycystic ovary syndrome

RESEARCH QUESTION

Do the levels of adipokines (adiponectin, apelin, chemerin and vaspin) in plasma, hypothalamus, ovaries and periovarian adipose tissue differ during polycystic ovarian syndrome (PCOS)?

DESIGN

The PCOS was induced in rats by oral administration of non-steroidal aromatase inhibitor letrozole. To determine the plasma levels of adiponectin, apelin, chemerin and vaspin enzyme-linked immunosorbent assays were carried out. To assess the expression (gene and protein) and immunolocalization of these adipokines and their receptors, namely Adipor1 and Adipor2 for adiponectin, Aplnr for apelin, Ccrl2, Cmklr1 and Gpr1 for chemerin and Grp78 for vaspin in the hypothalamus, real-time polymerase chain reaction, and Western blot and immunohistochemistry were used to analyse ovaries and periovarian adipose tissue respectively.

RESULTS

In PCOS, the plasma level of adiponectin decreased (P = 0.0003), whereas apelin, chemerin and vaspin increased (P ≤ 0.0479). Moreover, PCOS modulates the expression of adipokines and their receptors in the hypothalamus, ovaries and periovarian adipose tissue compared with healthy rats (P ≤ 0.487).

CONCLUSIONS

A strong relationship was found between PCOS and adipokines, which suggests that adipokines may be a biomarker of PCOS.

Age and BMI-related changes in hormonal profile in women with polycystic ovary syndrome (PCOS): Association with infertility

OBJECTIVE

The aim of the study was to evaluate age- and body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters)-related changes in hormonal profile in women with PCOS and to compare hormonal changes among women with polycystic ovary syndrome (PCOS) with and without infertility.

METHODS

In this case-control study, conducted from March 2018 to January 2024, we enrolled women with PCOS with infertility (n = 265) and controls (n = 265) matched for age and BMI at the Department of Endocrinological Gynecology in University Hospital, Krakow, Poland. The assessment of anti-Müllerian hormone (AMH) along with hormonal profile including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), androgens (testosterone, 17-hydroxyprogesterone [17-OHP], dehydroepiandrosterone sulfate [DHEA-S]) as well as sex-hormone binding globulin was performed among these women, after assignment to different age BMI groups.

RESULTS

Women with POCS and infertility showed higher AMH (+42.9%), E2 (+15.9%) and LH (+41.9%) along with increased androgen levels reflected by increased testosterone (+20%), DHEA-S (+28.7%) and lower FSH (-10.3%) in contrary to women without infertility. Younger women (≤25 years) showed higher AMH, LH and androgens levels (total testosterone and DHEA-S) with lower FSH concentration. Women with higher BMI (≥30) had lower AMH together with increased free androgen index (FAI) and decreased sex hormone binding globulin (SHBG).

CONCLUSION

Infertile women with PCOS represent higher AMH together with elevated total testosterone, DHEA-S and FAI levels in contrary to fertile ones. Higher BMI together with older age have a negative impact on AMH in women with PCOS.

Elevated log uric acid-to-high-density lipoprotein cholesterol ratio (UHR) as a predictor of increased female infertility risk: insights from the NHANES 2013-2020

BACKGROUND

Infertility is a multifaceted condition influenced by metabolic and biochemical factors. Uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) may individually affect reproductive health. The UA-to-HDL-C ratio (UHR), an emerging indicator of chronic inflammation and metabolic status, may be associated with infertility because of its connections to metabolic disorders, disrupted reproductive processes, and other related factors. Nevertheless, evidence of the relationship between the UHR and infertility remains limited and controversial. Therefore, potential associations were analyzed in this study.

METHODS

In this cross-sectional study, data from the 2013-2020 National Health and Nutrition Examination Survey (NHANES) were utilized, a nationally representative survey assessing the health and nutritional status of the U.S.

POPULATION

Female participants aged 18-45 years (n = 6502) whose infertility status was determined through self-reported responses to reproductive health questions were included. The primary outcome was infertility, defined on the basis of responses indicating difficulty in conceiving over the past year. Between-group differences were analyzed via Student's t test or the Mann‒Whitney U test for continuous variables or the chi-square test for categorical data. The independent association between infertility status and the log UHR was assessed by log computes logarithms by default natural logarithms. Subgroup analyses were performed to assess the strength of the results.

RESULTS

The mean log UHR of the women in the infertility group was significantly greater than that of the women in the noninfertility group (5.34 vs. 5.22, P < 0.001). Adjusted analyses revealed that an increase in the log UHR was associated with greater odds of infertility (odds ratio (OR) = 1.830, 95% confidence interval (CI) 1.396-2.401). Subgroup analysis revealed that women younger than 35 years with an elevated log UHR faced an even greater risk of infertility (OR = 2.716, 95% CI 1.784-4.162; P < 0.001).

CONCLUSIONS

An elevated UHR is associated with a higher risk of infertility, and this knowledge may be beneficial for developing a nonpharmacological intervention for improving fertility outcomes. Further research is needed to clarify the direct impact of the UHR on female infertility, which could inform future strategies for prevention and treatment.

Molecular and biological markers for assessing endometrial receptivity in infertile women: A narrative review

Successful embryo implantation relies on embryo quality, endometrial receptivity, and the synchronized development of both. In recent years, methods for assessing endometrial receptivity have considerably advanced, shifting from traditional imaging techniques to modern molecular biology approaches. The evaluation of endometrial thickness, morphology, subendometrial blood flow, and peristalsis before implantation has become less prominent, whereas molecular markers such as pinopodes, integrin αvβ3, its ligand osteopontin, and homologous box gene A10 are widely used in clinical practice for assessing endometrial receptivity. To provide a comprehensive overview, this narrative review systematically searched PubMed and Web of Science for studies on endometrial receptivity assessment in infertile women over the past two decades, with a focus on both clinical and experimental research. This narrative review has examined recent advancements in morphological markers, endometrial receptivity-related genes, endometrial microbiota, and other emerging indicators, emphasizing their potential in optimizing embryo implantation and improving the success rates of assisted reproductive technologies. Notably, endometrial receptivity array testing and uterine microbiome analysis have gained substantial attention for their potential in personalized diagnosis and treatment. This review aims to provide scientific insights for precise infertility diagnostics and individualized treatment strategies while offering recommendations for future research development.

Establishing a predictive model for ectopic pregnancy risk following assisted reproductive technology

BACKGROUND

The risk of ectopic pregnancy (EP) is known to increase with assisted reproductive technology (ART), but the specific risk factors are unclear.

METHODS

We screened 6872 cycles for clinical data that met our study's inclusion criteria and conducted univariate and multivariate analyses to identify factors associated with EP and develop a nomogram prediction model for its incidence.

RESULTS

The multivariate analysis demonstrated that women with polycystic ovary syndrome (PCOS) have an over two-fold increased risk of EP (aOR = 2.07, 95% CI: 1.27-3.36, P = 0.004). Frozen embryo transfer can significantly reduce the risk of EP compared to fresh embryo transfer (aOR = 2.17, 95% CI: 1.62-2.91, P < 0.001). Male infertility factor was associated with a 1.4-fold increased risk of EP (aOR = 1.39, 95% CI: 1.05-1.85,P = 0.021). Each 1 mm increase in endometrial thickness (EMT) is associated with a 15% reduction in the odds of EP(aOR = 0.86, 95% CI: 0.77-0.93, P < 0.001). Women with EP history was associated with 1.4-fold increased risk of EP (aOR = 1.41, 95% CI: 1.01-1.97, P = 0.046). A nomographic prediction model was established based on the results above. The area under the curve (AUC) for the model predicting EP following ART is 0.624, whereas in the external validation set, it is 0.618.

CONCLUSIONS

Our findings indicate that PCOS increases the risk of EP after ART, and fresh embryo transfer is also linked to higher EP rates. We developed a nomogram to predict and mitigate the incidence of EP.

TRIAL REGISTRATION

Retrospectively registered.

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.

Impact of CYP19A1 genetic variations on polycystic ovary syndrome: findings from a case-control study

OBJECTIVE

To study the association between CYP19A1 genetic variants and the risk of developing polycystic ovary syndrome (PCOS). The study explored the relationship between the candidate gene CYP19A1 and hyperandrogenism, as well as its interplay with obesity, in PCOS patients compared with healthy controls.

DESIGN

A case-control study with genetic association analysis by tetra-primer amplification refractory mutation system polymerase chain reaction and biochemical analysis.

SUBJECTS

204 women (113 PCOS patients and 91 healthy controls) were included in the present study.

EXPOSURE

CYP19A1 variants (rs700519 and rs2236722) in PCOS women.

MAIN OUTCOME MEASURES

Genotypic and allelic frequencies of CYP19A1 variants (rs2236722 and rs700519) and their impact on androgen metabolism and obesity markers.

RESULTS

The genotypic and allelic frequency of rs2236722 showed statistically significant differences between PCOS cases and controls. A significant association was observed under the dominant model, with an odds ratio of 0.34 (95% confidence interval, 0.16-0.66), as well as under the heterozygous model, where the odds ratio was 2.58 (95% confidence interval, 1.34-4.97). However, rs700519 did not reveal any significant association between the groups. A noticeable statistical difference was observed in the levels of total testosterone, dehydroepiandrosterone sulfate , prolactin, luteinizing hormone/follicle-stimulating hormone , Estradiol/total testosterone ratio, body mass index, and waist-to-hip ratio between the case and control groups . However, no variations in clinical variables were observed among genotypes within the PCOS group.

CONCLUSION

Our study demonstrates that the CYP19A1 rs2236722 polymorphism significantly correlates with PCOS risk, although rs700519 showed no significant association. The findings suggest that altered aromatase activity linked to rs2236722 may contribute to the hyperandrogenic phenotype observed in PCOS patients. These results enhance our understanding of the genetic basis of PCOS and may have implications for personalized treatment approaches.

The role of ethnicity and polycystic ovary syndrome on pregnancy complications: an analysis of a population database

OBJECTIVE

To determine the independent effect of ethnicity on obstetric outcomes in women with polycystic ovary syndrome (PCOS).

DESIGN

This was a retrospective, population-based cohort study using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2004 to 2014. Women with PCOS were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Pregnancy, delivery, and neonatal outcomes were compared across ethnic groups. The chi-square tests assessed baseline characteristics, and logistic regression was used to evaluate associations between ethnicity and outcomes, estimating odds ratios (ORs) and 95% confidence intervals (CIs).

SUBJECTS

A total of 12,782 pregnant women with PCOS were identified between 2004 and 2014, categorized by ethnicity: White (n = 9,107); African American (n = 1,098); Hispanic (n = 1,288); and Asian (n = 741).

EXPOSURE

The exposure of interest was maternal ethnicity and its association with pregnancy, delivery, and neonatal outcomes among women with PCOS.

MAIN OUTCOME MEASURES

Pregnancy, delivery, and neonatal complications were assessed across ethnic groups.

RESULTS

Asian women had a higher odds of having gestational diabetes (adjusted OR [aOR], 1.96; 95% CI, 1.49-2.58), chorioamnionitis (aOR, 3.41; 95% CI, 2.12-5.47), operative vaginal delivery (aOR, 2.42; 95% CI, 1.65-3.56), postpartum hemorrhage (PPH) (aOR, 2.07; 95% CI, 1.25-3.43), and maternal infection (aOR, 2.84; 95% CI, 1.80-4.49). African Americans had a higher risk of pregnancy-induced hypertension (aOR, 1.38; 95% CI, 1.06-1.80), preeclampsia (aOR, 1.68; 95% CI, 1.15-2.45), preterm premature rupture of membrane (aOR, 2.75; 95% CI, 1.58-4.78), chorioamnionitis (aOR, 1.83; 95% CI, 1.12-2.98), and cesarean sections (aOR, 1.69; 95% CI, 1.32-2.15) and lower risk of operative vaginal delivery (aOR, 0.53; 95% CI, 0.31-0.93), spontaneous vaginal delivery (aOR, 0.67; 95% CI, 0.52-0.85), and maternal infection (aOR, 1.91; 95% CI, 1.21-3.00). The risk of gestational diabetes (aOR, 1.36; 95% CI, 1.06-1.73) and PPH (aOR, 1.58; 95% CI, 1.01-2.47) increased among Hispanic patients. Caucasian patients were at lower risk of gestational diabetes (aOR, 0.67; 95% CI, 0.57-0.79), chorioamnionitis (aOR, 0.39; 95% CI, 0.28-0.55), cesarean section (aOR, 0.83; 95% CI, 0.73-0.95), PPH (aOR, 0.70; 95% CI, 0.50-0.98), blood transfusion (aOR, 0.49; 95% CI, 0.29-0.83), maternal infection (aOR, 0.34; 95% CI, 0.27-0.51), and small-for-gestational-age infants (aOR, 0.64; 95% CI, 0.44-0.93) and had higher odds of having a spontaneous vaginal delivery (aOR, 1.25; 95% CI, 1.10-1.43).

CONCLUSION

Among women with PCOS, African Americans have the highest number of increased pregnancy complications, followed by Asians and Hispanics. Caucasians with PCOS have the lowest risk of pregnancy complications.

Impact of maternal body mass index on pregnancy outcomes following frozen embryo transfer: A systematic review and meta-analysis

OBJECTIVE

There is still a significant gap in understanding how maternal body mass index (BMI) impacts outcomes of pregnancy after frozen embryo transfer (FET). This review aims to evaluate the effects of various BMI categories on clinical pregnancy and live birth rates in women undergoing FET.

METHODS

PubMed, Scopus, Embase, and Web of Science databases were searched for studies, published up to March, 2024, using the keywords "obesity", "overweight", "obese", "maternal body mass index," "pregnancy outcomes," "frozen embryo transfer,". Eligible studies were selected based on predefined inclusion criteria, statistical analysis was performed using a random-effects model, and ther results were presented as odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

A total of 17 studies were included in the meta-analysis. Pooled findings indicate significantly reduced live birth rate in underweight (OR 0.93; 95% CI: 0.89, 0.98) and obese (OR 0.85; 95% CI: 0.77, 0.93) women but not in those who were overweight (OR 0.96; 95% CI: 0.92, 1.00), compared to those with normal BMI. Further, only those women who were underweight (OR 0.91; 95% CI: 0.85, 0.97) had reduced odds of clinical pregnancy rate but not those who were overweight (OR 0.99; 95% CI: 0.94, 1.05) or obese (OR 0.92; 95% CI: 0.82, 1.03).

CONCLUSION

Maternal BMI impacts pregnancy outcomes after frozen embryo transfer, with underweight and obese women having lower live birth rates and only underweight women showing reduced clinical pregnancy rates compared to those with normal BMI. These findings underscore the importance of addressing BMI in women undergoing FET to improve pregnancy outcomes.

Single-cell profiling of the human endometrium in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) has a negative effect on the receptivity of the endometrium to embryo implantation and increases the risk of miscarriage and endometrial cancer. The cellular and molecular heterogeneity of the endometrium in women with PCOS has not been well studied. Our study presents a comprehensive cellular atlas of the endometrium during the proliferative phase in women with PCOS characterized by overweight and obesity, hyperandrogenism and insulin resistance compared with controls of similar age, weight and body mass index. Analysis of 247,791 isolated endometrial nuclei from 27 biopsies (5 controls and 12 PCOS cases at baseline and 7 after 16 weeks of metformin and 3 after lifestyle intervention) revealed cell-type-specific disease signatures and variations in cellular composition and localization. Samples taken after 16 weeks of metformin treatment and lifestyle management showed extensive recovery of disease-specific endometrial signatures. We linked the specific role of each cell type to clinical features such as hyperandrogenism and insulin resistance, and specific cell types to risk of endometrial and metabolic disease. In addition, potential therapeutic targets such as integrin inhibitors were identified and the role of metformin in restoring endometrial health in patients with PCOS was highlighted. Our findings lay the groundwork to significantly advance the understanding of PCOS-specific endometrial dysfunction for future targeted therapies.

The correlation between serum fructose levels and pregnancy outcomes in IVF patients with and without PCOS: a case-control study

BACKGROUND

Excessive fructose intake can impact pregnancy health. Additionally, Polycystic ovary syndrome (PCOS) is associated with both elevated fructose levels and adverse pregnancy outcomes. Therefore, it is significant to investigate whether serum fructose levels influence pregnancy outcomes in patients with or without PCOS.

METHODS

This case-control study included 270 participants (PCOS, n = 135; non-PCOS, n = 135). The serum fructose levels of consecutively treated women undergoing in vitro fertilization - embryo transfer treatment at the Center of reproductive medicine in Shengjing hospital of China Medical University, from June 2020 to June 2021, were measured. Pregnancies were monitored until the ultimate outcome was determined. The antenatal, delivery, and neonatal outcomes were extracted from hospital records.

RESULTS

In patients with PCOS, those who experienced miscarriage had significantly higher serum fructose levels (P = 0.011). The incidence of miscarriage increased as the serum fructose quartiles increased in patients with PCOS (P = 0.010). There was a significant correlation between serum fructose levels and miscarriage (r = 0.258, P = 0.002). The results of multivariate logistic regression analysis remain consistent (odd ratio [OR] = 10.138, P = 0.005). Conversely, in women without PCOS, those who prematurely delivered had significantly higher serum fructose levels (P = 0.001). The incidence of preterm delivery increased as the serum fructose quartiles increased in patients without PCOS (P < 0.001). There was a significant correlation between serum fructose levels and preterm delivery (r = 0.311, P < 0.001) in non-PCOS group. The multivariate logistic regression analysis indicated the identical results (OR = 18.359, P = 0.008). The area under the curve for fructose-mediated prediction of miscarriage in PCOS was 0.686, while for prediction of preterm birth in non-PCOS individuals, the area under the curve was 0.731.

CONCLUSIONS

Serum fructose levels are positively associated with miscarriage risk in patients with PCOS. Within the non-PCOS cohort, fructose levels are linked to preterm birth. Further investigation is warranted to comprehensively elucidate the underlying mechanisms, thus enhancing our profound understanding.

Enhancing understanding of endometrial function in patients with PCOS: clinical and immunological insights

OBJECTIVE

To evaluate the pregnancy and perinatal outcomes of different phenotypes of polycystic ovary syndrome (PCOS) patients during the frozen embryo transfer (FET) cycles. Additionally, to analyze the T cell balance in the endometrium of PCOS patients and explore its relationship with various PCOS phenotypes.

DESIGN

Retrospective cohort study.

SETTING

A single academically affiliated reproductive medicine center.

PATIENTS

21,074 FET cycles were included and divided into two groups based on the diagnosis of PCOS. Patients with PCOS were further categorized into four phenotypic groups: PCOM + HA + OA, PCOM + HA, PCOM + OA, and HA + OA. Endometrial biopsies from 21 PCOS patients and 26 controls were obtained to analyze T cell subsets.

METHODS

Pregnancy and perinatal outcomes, as well as T cell subset abundance were compared between women with and without PCOS. Multiple logistic regression models were employed to adjust for confounding factors impacting pregnancy-related outcomes. Flow cytometry was utilized to analyze the abundance of T cell subsets.

MAIN OUTCOME MEASURES

Pregnancy and perinatal outcomes were assessed. T cell subsets including CD4+CD8-T cells, CD4-CD8+T cells, Th1, Th2, Th17 and Treg cells in the endometrium were determined by flow cytometry.

RESULTS

There was a significantly increased incidence of miscarriage, hypertensive disorders of pregnancy (HDP), preterm birth (PTB), and even fetal malformations across different phenotypes of PCOS women, especially those with the hyperandrogenic phenotype. Th1 cells decreased while Th2 cells increased significantly in the PCOS endometrium.

CONCLUSIONS

The unfavorable pregnancy and perinatal outcomes in FET cycles and T cell imbalance both suggest the endometrial dysfunction of PCOS patients, especially those with the hyperandrogenic phenotype.

Diagnosis and management of infertility in patients with polycystic ovary syndrome (PCOS): guidelines from the Italian Society of Human Reproduction (SIRU) and the Italian Centers for the Study and Conservation of Eggs and Sperm (CECOS Italy)

The polycystic ovary syndrome (PCOS) is a multifaced disease of the reproductive age associated with several comorbidities including infertility. Very few documents regarding the management of the infertility in women with PCOS, including guidelines, position papers and consensus conferences, are available in the literature. The Italian Law indicates that health professionals must comply with the recommendations set out in the guidelines developed by public and private bodies and institutions, as well as scientific societies and technical-scientific associations of the health professions, except for specific cases. Unfortunately, no guideline for the diagnosis and the management of infertility in women with PCOS is currently available in Italy. In 2024, the Italian Society of Human Reproduction (SIRU) and the Italian Centers for the Study and Conservation of Eggs and Sperm (CECOS Italy) pointed out the need to produce Italian guidelines on this topic and established a specific working group to develop those guidelines. The working group chose to adapt the guideline with highest quality to the Italian context rather than developing a de novo document. The International Evidence-Based Guideline for the Assessment and Management of PCOS guidelines were selected. All recommendations regarding the diagnosis and the management of women with PCOS and infertility extracted, adapted to the Italian context and improved incorporating new recommendations or practical comments and suggestions where needed.

Endoplasmic Reticulum Stress in Myometrial Smooth Muscle Cells and Spontaneous Contraction Changes in the Uterus of Dehydroepiandrosterone-induced Polycystic Ovary Syndrome Rats

Myometrial changes in polycystic ovary syndrome (PCOS) are poorly investigated. Thus, we aimed to investigate endoplasmic reticulum (ER) stress in myometrial smooth muscle cells and changes in spontaneous uterine contraction in PCOS. Twenty-one female Sprague-Dawley rats (21 days old) were divided into control (n = 7), vehicle (n = 7) and PCOS (n = 7) groups. While the control group was not injected subcutaneously, the vehicle group was injected subcutaneously with sesame oil (0.2 ml/day) for 20 consecutive days. The PCOS group was injected subcutaneously with dehydroepiandrosterone (6 mg/100 g/day dissolved in 0.2 ml sesame oil) for 20 consecutive days. Blood samples were collected for the measurement of follicle stimulating-hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2) and glucose-regulated protein 78 (GRP78). The mRNA expression of GRP78 in the uterine tissue samples was analysed by quantitative real-time polymerase chain reaction. GRP78 protein expression was assessed by immunohistochemistry. Myometrial smooth muscle cells were examined by transmission electron microscopy. Uterine contractions were evaluated with isolated organ bath experiments. In the PCOS group, T and LH levels increased significantly, although FSH and E2 levels decreased, but this decrease was not statistically significant. Additionally, GRP78 levels increased significantly in the PCOS group. In the PCOS group, the mRNA level, immunostaining intensity of GRP78, and ER damage grade increased, but the uterine tissue calcium levels, and the frequency and amplitude of spontaneous uterine contractions decreased. The results indicated that increased ER stress in myometrial smooth muscle cells may play a causative role in the decreased spontaneous uterine contractions in PCOS.

Hyperandrogenism increases late spontaneous miscarriage in polycystic ovary syndrome women due to cervical insufficiency? A propensity-score matching study

BACKGROUND

The potential effects of hyperandrogenism (HA) on pregnancy outcomes among polycystic ovary syndrome (PCOS) patients are still unknown. The aim of this study was to explore the impact of HA on miscarriage rate after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment in PCOS patients.

METHODS

Women diagnosed with PCOS who underwent the first autologous IVF/ICSI cycles using gonadotropin-releasing hormone agonist (GnRH-a) protocols for ovarian stimulation during the period from January 2016 to December 2022 were included. Women were divided into the HA and non-HA group according to Hyperandrogenemia (serum testosterone level > 0.48 ng/mL), and/or the presence of hirsutism. Pregnancy outcomes were compared before and after propensity-score matching (PSM). Multiple logistic regression models were performed to demonstrate the independent impact of HA on pregnancy outcomes.

RESULTS

A total of 3066 patients were included. PCOS women with HA experienced a notably higher rates of late spontaneous miscarriage (LSM) as compared to those without HA before and after PSM (8.8% versus 3.5%, P < 0.001; 8.9% versus 3.9%, P = 0.001, respectively), but comparable rates of clinical pregnancy, early spontaneous miscarriage, and live birth. After adjusting for possible confounding factors, the logistic regression confirmed that HA was independently associated with the increased risk of LSM (adjusted OR: 2.540, 95% confidence interval: 1.326-4.672, P = 0.003). For the specific reasons for LSM, cervical insufficiency accounted for a larger proportion in women with HA than their counterparts without HA (15/32 versus 7/33, P = 0.029).

CONCLUSIONS

Androgen excess is postulated to play a role in late miscarriage via increased likelihood of cervical insufficiency.

TRIAL REGISTRATION

N/A.

A survey on the frequency of polycystic ovary morphology (PCOM) in infertile patients with septate and arcuate uterine anomalies: a cross-sectional study

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. Previous research has highlighted a potential link between PCOS and Müllerian anomalies. The present cross-sectional study aimed to evaluate the prevalence of polycystic ovary morphology (PCOM) in infertile patients with uterine anomalies (septate and arcuate uterine), attending the Royan Research Institute in Tehran, Iran, between January 2021 and December 2022. A total of 884 infertile women who underwent 3D-hysterosonography at the Institute were included in the study. The participants were divided into two groups: 127 women with uterine anomalies and 757 women without. Data was collected from the participants' medical records. The results showed that the frequency of PCOM was significantly higher in women with uterine anomalies (40.9%, 52 women) compared to those without such anomalies (14.7%, 111 women) (p = 0.0001). A higher prevalence of PCOM in women with uterine anomalies highlights the need for targeted screening within this population and underscores the importance of integrated diagnostic approaches.

Dyslipidemia and female reproductive failures: perspectives on lipid metabolism and endometrial immune dysregulation

Dyslipidemia is a common metabolic disorder around the world, with a higher incidence in the population of childbearing age and those experiencing infertility. Increasing research has been focused on the impact of dyslipidemia on female reproduction. This article reviews relevant clinical and basic science research on the effects of dyslipidemia on female reproduction, particularly paying attention to immune inflammatory changes in the endometrium. A comprehensive overview of the physiological effects of lipid metabolism on innate and adaptive immunity is provided, specifically examining the relationship between lipid metabolism and endometrial immune homeostasis, as well as the changes observed in women with reproductive failures. Moreover, the alterations in endometrial gene expressions and immune effectors in women with dyslipidemia and reproductive disorders are discussed, offering a new perspective on the reproductive disorders in women with dyslipidemia. Considering the significant involvement of lipid metabolism in human reproduction, gaining a deeper insight into dyslipidemia and female reproduction could have important clinical implications for the diagnosis and management of female reproductive disorders.

Role of SAA1 in Endometrial Extracellular Matrix Remodeling in Polycystic Ovary Syndrome: Implication for Pregnancy Loss

CONTEXT

Abnormal endometrial extracellular matrix (ECM) remodeling compromises endometrial receptivity and diminishes the probability of a successful live birth. Serum amyloid A1 (SAA1), a modulator of inflammation, is elevated in the circulation of polycystic ovary syndrome (PCOS) patients and involved in ECM remodeling during tissue repair. However, the specific role of SAA1 in endometrial ECM remodeling and subsequent risk of pregnancy loss in PCOS patients remains unclear.

OBJECTIVE

To examine the role and underlying mechanism of SAA1 in ECM remodeling in the endometrium of PCOS patients.

DESIGN

Serum samples from PCOS and control patients were utilized to investigate the relationship between the abundance of SAA1 and pregnancy loss. Human endometrial tissues and primary human endometrial stromal cells were used to examine the role and underlying mechanism of SAA1 in ECM remodeling.

RESULTS

Serum SAA1 concentration was elevated and could serve as an independent risk of pregnancy loss in PCOS patients. Increased SAA1 abundance was also observed in endometrium obtained from these patients. Further mechanistic studies showed that SAA1 stimulated collagen I chains synthesis (COL1A1 and COL1A2) in endometrial stromal cells, suggesting excessive SAA1 may contribute to endometrial ECM remodeling, resulting in a nonsupportive environment for ongoing pregnancy. This effect was abolished by either a toll-like receptor 2/4 antagonist or a nuclear factor κB inhibitor.

CONCLUSION

The locally elevated levels of SAA1 in endometrium contribute to ECM overdeposition by inducing collagen I synthesis in PCOS patients, which may hamper embryo implantation and increase the risk of pregnancy loss. These observations highlight the crucial role of heightened SAA1 in orchestrating endometrial dysfunction and shed light on potential therapeutic avenues for improving reproductive outcomes in PCOS patients.

The impact of long-acting Gonadotropin-releasing hormone agonist pretreatment on the clinical pregnancy outcomes of hormone replacement therapy-frozen embryo transfer in recurrent implantation failure patients with and without polycystic ovary syndrome: a retrospective clinical study

BACKGROUND

Several studies have demonstrated that pre-treatment with long-acting Gonadotropin-Releasing Hormone agonists (GnRHa) can significantly enhance the clinical pregnancy rate among recurrent implantation failure (RIF) patients. Investigations have also suggested that GnRHa pre-treatment could ameliorate the clinical pregnancy and live birth rates in polycystic ovary syndrome (PCOS) patients. But there is a dearth of research on whether long-acting GnRHa pre-treatment yields superior clinical outcomes for RIF patients with PCOS.

METHODS

The retrospective study enrolled 1602 patients under the age of 40 meeting the criteria for RIF at the Reproductive Medicine Center of Nanjing Drum Tower Hospital, who underwent frozen-thawed embryo transfer (FET) between January 2017 and December 2021. All cycles were categorized into hormone replacement therapy (HRT) Group (n = 1283) and GnRHa-HRT Group (n = 319), contingent on the usage of long-acting GnRHa pretreatment. Primary outcomes investigated in this study was clinical pregnancy rate, while live birth rate and early miscarriage rate were deemed as secondary outcomes. Univariate analysis and a multivariate logistic regression model were employed to assess the impact of GnRHa pretreatment on the clinical pregnancy rate in RIF patients. The influence of long-acting GnRHa pretreatment on clinical pregnancy outcomes was re-examined in PCOS and non-PCOS subgroups. Additionally, an interaction analysis was performed to evaluate the effect of PCOS on the relationship between long-acting GnRHa pretreatment and the clinical pregnancy rate.

RESULTS

Multiple regression analysis showed that long-acting GnRHa pretreatment had a positive impact on the clinical pregnancy rate (aOR = 1.51, 95%CI: 1.15-1.99, P = 0.003). We divided the RIF population into two subgroups, for PCOS patients, although the clinical pregnancy rate was higher in women who received GnRHa pretreatment compared to those who did not, it was not statistically significant (aOR = 1.51, 95%CI: 0.81-2.82, P = 0.195). Interaction analysis suggested that for PCOS patients, there was no significant difference in the clinical pregnancy rate between women who received GnRHa pretreatment and those who did not (P interaction = 0.818), indicating that the effect of GnRHa pretreatment on the clinical pregnancy rate was not influenced by PCOS.

CONCLUSIONS

Our study demonstrates that long-acting GnRHa pretreatment can enhance clinical pregnancy outcomes in patients with RIF. Among RIF patients without PCOS, the clinical pregnancy rate exhibited a significant increase following GnRHa pretreatment compared to the control group. However, in RIF patients with concurrent PCOS, there was no significant elevation in the clinical pregnancy rate post-GnRHa pretreatment. Therefore, GnRHa pretreatment is effective in improving pregnancy outcomes for RIF patients. However, whether GnRHa pretreatment is suitable for RIF patients with PCOS requires more cautious clinical discussion.

Exploring the benefits of astaxanthin as a functional food ingredient: Its effects on oxidative stress and reproductive outcomes in women with PCOS - A systematic review and single-arm meta-analysis of randomized clinical trials

Polycystic ovary syndrome (PCOS) is a prevalent gynecological-endocrinological disorder characterized by hyperandrogenism, menstrual irregularities, and metabolic disturbances. Recent research has highlighted the role of oxidative stress and chronic inflammation in exacerbating PCOS symptoms and impeding reproductive outcomes. Astaxanthin, a potent antioxidant found in marine organisms, has been suggested as a potential therapeutic intervention due to its ability to reduce oxidative stress and inflammation. This meta-analysis systematically reviews randomized controlled trials assessing the impact of astaxanthin supplementation on oxidative stress and reproductive outcomes in women with PCOS. Data from four trials were analyzed, focusing on markers of oxidative stress and reproductive health metrics. The meta-analysis utilized fixed and random-effects models to synthesize results, with heterogeneity assessed using Chi-square and I2 statistics. The findings indicate that while astaxanthin significantly improves markers of total antioxidant capacity (TAC) in follicular fluid, it does not show a consistent effect on other oxidative stress biomarkers such as malondialdehyde (MDA), catalase (CAT), or superoxide dismutase (SOD). Reproductive outcomes, including oocyte quality and the number of high-quality embryos, showed moderate improvements, although effects on fertilization rates and pregnancy outcomes were insignificant. The analysis highlights variability in study designs and dosing, suggesting a need for further research with standardized protocols and larger sample sizes. Future studies should focus on determining optimal dosing, exploring mechanistic pathways, and investigating the combined effects of astaxanthin with other interventions. Longitudinal studies are needed to assess long-term benefits and safety, and personalized approaches could enhance treatment efficacy for individuals with PCOS.

Mechanisms and effects of AdipoRon, an adiponectin receptor agonist, on ovarian granulosa cells-a systematic review

Granulosa cells, crucial components of ovarian follicles, play a fundamental role in follicle development, hormone production, and overall reproductive health. These cells are integral to steroidogenesis, including the synthesis and secretion of key hormones such as estrogen and progesterone. Dysregulation of granulosa cells can lead to reproductive disorders, including polycystic ovary syndrome and infertility. This systematic review provides a comprehensive evaluation of AdipoRon, a synthetic agonist of adiponectin receptors AdipoR1 and AdipoR2, and its effects on ovarian function, with a particular focus on granulosa cells. Due to the absence of clinical trials, the review centers on preclinical studies to explore AdipoRon's potential therapeutic benefits and to suggest future research directions. A detailed literature search across databases such as PubMed, Scopus, Web of Science, Embase, and Google Scholar was conducted using terms related to AdipoRon and ovarian function. The review encompasses four preclinical studies involving various models: primary granulosa cells from rats, laying hens' granulosa cells, human luteinized granulosa cells, and chicken ovary follicles. Findings indicate that AdipoRon enhances glucose absorption in rat granulosa cells by stimulating glucose transporter 1 expression, modulates steroid hormone secretion in laying hens' granulosa cells, and affects cell proliferation and steroidogenesis in human luteinized granulosa cells. Additionally, AdipoRon, in conjunction with recombinant chicken adiponectin, influences ovarian follicular cell proliferation and steroidogenesis in chicken ovary follicles. This review highlights the need for further investigation into AdipoRon's long-term effects and its potential applications in reproductive health and therapy.

High anti-Müllerian hormone level as a predictor of poor pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization/intracytoplasmic sperm injection: a retrospective cohort study

OBJECTIVE

To study the correlation between anti-Müllerian hormone levels and pregnancy outcomes after in vitro fertilization/intracytoplasmic sperm injection in women with polycystic ovary syndrome, which remains controversial.

METHODS

This retrospective cohort study recruited 4,719 women with infertility and polycystic ovary syndrome aged 20-40 years who underwent treatment at the Reproductive Center of Peking University Third Hospital between February 2017 and June 2023. We divided the participants into three groups according to the 25th and 75th percentile cutoffs of serum anti-Müllerian hormone: low (≤ 4.98 ng/mL, n = 1,198), average (4.98 - 10.65 ng/mL, n = 2,346), and high (≥ 10.65 ng/mL, n = 1,175). Pregnancy outcomes included live birth rate, miscarriage rate, clinical pregnancy rate, and cumulative live birth rate.

RESULTS

The live birth rate for fresh embryo transfer was 39.8%, 35.9%, and 30.4% in the low, average, and high anti-Müllerian hormone groups, respectively. The miscarriage rate was 11.3%, 17.1%, and 21.8% in the low, average, and high anti-Müllerian hormone groups, respectively. Significant intergroup differences were observed in the live birth rate (P = 0.017) and miscarriage rate (P = 0.018). No significant intergroup difference was observed in the clinical pregnancy rate (P = 0.204) or cumulative live birth rate (P = 0.423). After adjusting the confounders by multivariable logistic regression analysis, anti-Müllerian hormone was associated with decreased live birth rate in the high anti-Müllerian hormone group compared with that in the low anti-Müllerian hormone group (odds ratio: 0.629, 95% confidence interval: 0.460-0.860). Anti-Müllerian hormone was associated with increased miscarriage rate in the average and high anti-Müllerian hormone groups compared with that in the low anti-Müllerian hormone group (average vs. low: odds ratio: 1.592, 95% confidence interval: 1.017-2.490); high vs. low: odds ratio: 2.045, 95% confidence interval: 1.152-3.633).

CONCLUSION

High anti-Müllerian hormone is a prognostic factor for reduced live birth rate after fresh embryo transfer in women with polycystic ovary syndrome aged 20-40 years undergoing in vitro fertilization/intracytoplasmic sperm injection, and is associated with increased miscarriage rate in these patients.

Dysregulation of Leukaemia Inhibitory Factor (LIF) Signalling Pathway by Supraphysiological Dose of Testosterone in Female Sprague Dawley Rats During Development of Endometrial Receptivity

OBJECTIVE

This study investigated the effects of a supraphysiological dose of testosterone on uterine morphology and the regulation of the leukaemia inhibitory factor (LIF) signalling pathway during endometrial receptivity.

METHODS

In this study, 30 adult female Sprague-Dawley rats were divided into treatment and control groups. The treatment groups received subcutaneous injections of 1 mg/kg/day of testosterone from gestational day 1 to day 3, either testosterone alone or in combination with inhibitors (anastrozole, finasteride, or both). A control group of six untreated rats was maintained for comparison. Rats were euthanised on the evening of gestational day 4 to examine uterine morphological changes, gene expression and the distribution of proteins associated with the LIF signalling pathway (LIF, LIFR, JAK1 and STAT3) and MUC1 by quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC), respectively.

RESULTS

The results of this study showed that the thickness of the endometrium and myometrium, as well as the number of glands, markedly decreased in all testosterone-treated rats. In addition, the mRNA levels of LIF, LIFR, JAK1 and STAT3 were significantly downregulated in response to supraphysiological testosterone treatment, while the mRNA of MUC1 was significantly upregulated. The IHC results were consistent with the mRNA data and confirmed the changes in protein distribution in all treatment groups.

CONCLUSIONS

A supraphysiological dose of testosterone may impair endometrial receptivity through dysregulation of the LIF signalling pathway, potentially affecting fertility.

Changing trends in the global burden of polycystic ovarian syndrome-related infertility over the past 30 years: retrospective data analysis of the global burden of disease study 2019

OBJECTIVES

Polycystic ovary syndrome (PCOS) represents a significant and persistent metabolic disorder, emerging as a leading factor contributing to infertility. Despite its profound impact, there remains an inadequate understanding of the global burden of PCOS-related infertility across diverse regions and countries. The aim of this study was to evaluate the global, regional, and national burden of PCOS-related infertility from 1990 to 2019.

METHODS

The data utilized in this study were derived from the Global Burden of Disease Study 2019. The global burden of PCOS-related infertility was collected and subsequently categorized based on age and sociodemographic index (SDI) spanning the period from 1990 to 2019. Temporal trends in PCOS-related infertility over the past three decades were scrutinized employing joinpoint regression analysis, enabling the determination of annual percentage change (APC) and average annual percentage changes (AAPCs). The association between the age-standardized prevalence rate (ASPR), age-standardized YLD rate (ASYR), and the AAPCs in ASPR and ASYR and the SDI was performed using linear regression analysis. Additionally, the Slope Index of Inequality (SII) and the Relative Concentration Index were employed to assess the inequalities in the distribution of infertility burdens related to PCOS.

RESULTS

Globally, the number of prevalent cases and YLDs due to PCOS-related infertility increased from 5,997,589 (95% UI: 3,772,636-8,764,813), and 35,201 (95% UI: 13,282 - 80,010) in 1990 to 12,131,849 (95% UI: 7,625,027 - 17,945,905), and 69,694 (95% UI: 26,756 - 160,420) in 2019, respectively. The age-standardized rates of prevalence and YLDs consistently increased over the same period, with respective AAPCs of 2.45 (95% CI: 2.4-2.5) and 2.37 (95% CI: 2.32-2.43), respectively. The number of prevalent cases and rate of PCOS peaked in the 25-29 years. Populations with high SDI had the highest ASPRs and ASYRs of PCOS-related infertility, while populations with low SDI exhibited more pronounced upward trends. Additionally, linear regression analysis revealed that ASPRs and ASYRs were positively correlated with SDI (R = 0.419 and 0.433, respectively, all P < 0.0001), and the AAPCs in ASPRs and ASYRs were negatively correlated with SDI (R= - 0.570 and - 0.571, respectively, all P < 0.0001). The SII for prevalent cases and YLDs were 121.94 (95% CI: 94.66-149.23) and 0.75 (95% CI: 0.55-0.85) to 146.56 (95% CI: 110.27-182.86) and 0.91 (95% CI: 0.71-1.03), respectively.

CONCLUSION

The prevalent cases and YLDs, along with the ASPRs and ASYRs attributable to PCOS-related infertility, exhibited a consistent upward trajectory over the past 30 years. This escalation was closely associated with factors such as age, socioeconomic status, and geographic location. It is crucial to bolster healthcare management, devise timely and efficacious prevention and control strategies, and provide epidemiological theoretical evidence to alleviate the burden of PCOS-related infertility.

Factors influencing endometrial receptivity in women with recurrent implantation failure

BACKGROUND

Embryo implantation involves two key elements: a good quality embryo and receptive endometrium. Endometrial receptivity abnormalities are known as one of the possible causes of recurrent implantation failure (RIF), especially when the embryo is euploid. This study was aimed to evaluate the impact of age and other clinical factors on endometrial receptivity in women with RIF.

METHODS

68 women with RIF (defined as at least three unsuccessful transfers of good quality embryo of at least 1BB category of blastocysts) and 49 controls (women undergoing IVF treatment because of idiopathic infertility or male factor) were included to the study. After preparation of the endometrium by the hormone replacement therapy endometrial biopsies were taken from each patient and sequenced with beREADY test TAC targeting 67 biomarker genes for endometrial receptivity. Depending on the test result patients were classified into one of four different groups: pre-receptive (n = 16), early-receptive (n = 54), receptive (n = 44) and late-receptive (n = 3).

RESULTS

In women with RIF pre-receptive endometrium has been detected substantially more often than in controls - 13 (19,1%) vs. 3 (6,1%) patients (p = 0,043). Early-receptive endometrium was diagnosed in the majority of patients with idiopathic infertility - 12 (66.7%) vs. 6 (33.3%) women (p = 0.042) and with polycystic ovary syndrome (PCOS) - 12 (70,6%) vs. 3 (17.7%) women (p = 0,0447). We found significant association between abnormal endometrial receptivity and patient's age and duration of infertility. Young women were diagnosed significantly more often as normal or late-receptive, whereas older women with longer history of infertility as early-receptive and pre-receptive.

CONCLUSIONS

In patients with RIF in comparison to other women undergoing IVF procedures, patient's age and infertility duration are the most important factors related to endometrial receptivity abnormalities, indicating that older women with a longer history of infertility may benefit the most from endometrial receptivity testing.

TRIAL REGISTRATION

Not applicable.

Increased Oxidative and Nitrative Stress and Decreased Sex Steroid Relaxation in a Vitamin D-Deficient Hyperandrogenic Rodent Model-And a Validation of the Polycystic Ovary Syndrome Model

BACKGROUND/OBJECTIVES

Both hyperandrogenism (HA) and vitamin D deficiency (VDD) can separately lead to impaired vascular reactivity and ovulatory dysfunction in fertile females. The aim was to examine the early interactions of these states in a rat model of PCOS.

METHODS

Four-week-old adolescent female rats were divided into four groups: vitamin D (VD)-supplemented (n = 12); VD-supplemented and testosterone-treated (n = 12); VDD- (n = 11) and VDD-and-testosterone-treated (n = 11). Animals underwent transdermal testosterone treatment for 8 weeks. Target VD levels were achieved with oral VD supplementation and a VD-free diet. Estrous cycles were followed by vaginal smear, and quantitative histomorphometric measurements of the ovaries were also taken. In the 8th week, testosterone- and estrogen-induced relaxation of coronary arterioles was examined with pressure angiography. Estrogen receptor (ER) density and oxidative and nitrative stress parameters (Poly-(ADP-Ribose)-Polymerase and 3-nitrotyrosine) in the vessel wall were investigated with immunohistochemistry.

RESULTS

VDD caused impaired estrous cycles, and testosterone caused anovulatory cycles (the cycles were stopped at the diestrous phase). VDD combined with testosterone treatment resulted in reduced testosterone and estrogen vasorelaxation, lower ER density, and higher oxidative and nitrative stress in the vessel wall.

CONCLUSIONS

PCOS with vitamin D deficiency may be associated with increased oxidative-nitrative stress in coronary arterioles. This oxidative and nitrative stress, potentially caused by hyperandrogenism and/or vitamin D deficiency, could impair estrogen-induced relaxation of the coronary arterioles, possibly by decreasing NO bioavailability and disrupting the estrogen-induced relaxation pathway.

Efficacy and Safety of Human Umbilical Cord Mesenchymal Stem Cells in Improving Fertility in Polycystic Ovary Syndrome Mice

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most prevalent reproductive endocrine illness in women of reproductive age and is one of the most important causes of female infertility. The pathogenesis of PCOS is complex. Although mesenchymal stem cell therapy is anticipated to be a successful treatment for PCOS, its long-term safety, including tumorigenesis in patients, remains unknown.

OBJECTIVE

This study aimed to confirm the efficacy and safety of human umbilical cord mesenchymal stem cells in improving fertility in PCOS mice.

METHODS

In this study, dehydroepiandrosterone (DHEA) was used to construct a C56BL/6 mouse PCOS model, human umbilical cord mesenchymal stem cells (hUC-MSCs) were used as a treatment, and the reproductive phenotype was observed in parallel breeding experiments to confirm the efficacy of the treatment. A 4-month follow-up period, final blood tests, and organ histology were carried out to confirm the long-term safety of the treatment.

RESULTS

After hUC-MSCs treatment, the sex hormone disorder of mice was corrected, the morphology and function of the ovary were improved, the number of offspring was significantly increased compared to the control group, and no adverse reactions related to stem cell transplantation such as tumor formation were found within 4 months.

CONCLUSION

The treatment of hUC-MSCs is safe and effective in treating PCOS over the long term.

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.

Update on the therapeutic role of metformin in the management of polycystic ovary syndrome: Effects on pathophysiologic process and fertility outcomes

Influential guidelines have supported the role of metformin in the management of polycystic ovary syndrome (PCOS) for a number of years. However, regulatory approvals for this therapeutic indication are still exceptional and exist only in a few countries, including for the originator, Glucophage®. PCOS is an insulin-resistant state, which drives hyperandrogenism and anovulatory infertility. The metabolic action of metformin involves amelioration of insulin resistance, which helps to resolve hormonal and metabolic disturbances and increases ovulation, pregnancy, and live birth rates relative to placebo. A combination of metformin with clomifene citrate (another widely used treatment for PCOS) is more effective than either alone and is a useful option in women with clomifene-resistant PCOS. Combining metformin with letrozole (1st-line agent for ovulation induction in women with PCOS and no other infertility risk factors) is not more effective than letrozole alone. Continuing metformin to the end of the 1st trimester at an effective dose (e.g. 1000-2000 mg/day) may help to reduce the rate of miscarriages. Metformin also has an adjunctive role in women with PCOS receiving assisted reproduction technology (ART) using the long gonadotrophin-releasing hormone agonist protocol, where it appears to increase the pregnancy rate and to reduce the risk of ovarian hyperstimulation syndrome. There is no role for metformin in women receiving short ART protocols. Where a successful pregnancy is achieved, metformin is generally safe for the mother and neonate. Further research is needed to define with greater precision the optimal dosage and times to initiate and discontinue metformin in women with PCOS who achieve pregnancy.

Comparative efficacy and safety of metformin, anti-obesity agents, and myoinositol in improving IVF/ICSI outcomes and reducing ovarian hyperstimulation syndrome in women with polycystic ovary syndrome: a systematic review and network meta-analysis

PURPOSE

To compare the efficacy and safety of metformin, anti-obesity agents, and inositol with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

METHODS

A comprehensive search was conducted in PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov for studies published in English up to October 26, 2024. Randomized controlled trials (RCTs) evaluating metformin, anti-obesity agents, and inositol were included. A network meta-analysis was performed using frequency statistical methods. Subgroup analyses were conducted based on controlled ovarian stimulation (COS) protocols and body mass index(BMI). The research protocol was registered with PROSPERO (registration code CRD42024502823).

RESULTS

20 RCTs were included with 1,827 patients assessed six different agents. Nineteen trials were rated low risk, with one rated moderate risk. Pairwise meta-analysis showed that metformin did not improve pregnancy outcomes but was associated with a reduced ovarian hyperstimulation syndrome (OHSS) risk (OR = 0.52, 95% CI 0.33-0.83), particularly in agonist protocols, along with lower E2 levels on the trigger day (SMD = -0.56, 95% CI -0.90 to -0.21) and increased side effects (OR = 6.85, 95% CI 4.32-10.86). Network meta-analysis confirmed no significant differences in pregnancy outcomes for these agents compared to controls, though both myoinositol and metformin reduced OHSS risk. Myoinositol was linked to a shorter gonadotropin duration (SMD = -1.21, 95% CI -2.03 to -0.38) and fewer side effects (OR = 0.23, 95% CI 0.06-0.83) compared to controls. Metformin led to lower E2 levels, a higher number of mature oocytes, and increased side effects (SMD = -376.52, 95% CI -610.83 to -142.22; SMD = 2.23, 95% CI 0.36-4.10; OR = 6.85, 95% CI 4.32-10.86) than controls. No studies reported an increased risk of fetal abnormalities.

CONCLUSION

Metformin and myoinositol may reduce OHSS risk in PCOS patients but did not significantly improve pregnancy outcomes. Metformin may lower OHSS risk in agonist protocol, reduce E2 levels on trigger day and increase mature oocytes but cause more side effects, while myoinositol may shorten gonadotropin duration with fewer side effects. Further robust RCTs are needed to confirm these findings.

Metabolism-related proteins as biomarkers for predicting prognosis in polycystic ovary syndrome

OBJECTIVE

The study aimed to explore the role of metabolism-related proteins and their correlation with clinical data in predicting the prognosis of polycystic ovary syndrome (PCOS).

METHODS

This research involves a secondary analysis of proteomic data derived from endometrial samples collected from our study group, which includes 33 PCOS patients and 7 control subjects. A comprehensive identification and analysis of 4425 proteins were conducted to screened differentially expressed proteins (DEPs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were subsequently performed on the DEPs. To identify independent prognostic metabolism-related proteins, univariate Cox regression and LASSO regression were applied. The expression levels of these proteins were then used to develop a prognostic model, with their predictive accuracy evaluated through receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves. Furthermore, we also investigate the correlation between clinical data and prognostic proteins.

RESULTS

The study identified 285 DEPs between the PCOS and control groups. GO enrichment analysis revealed significant involvement in metabolic processes, while KEGG pathway analysis highlighted pathways such as glycolysis/gluconeogenesis and glucagon signaling. Ten key metabolism-related proteins (ACSL5, ANPEP, CYB5R3, ENOPH1, GLS, GLUD1, LDHB, PLCD1, PYCR2, and PYCR3) were identified as significant predictors of PCOS prognosis. Patients were separated into high and low-risk groups according to the risk score. The ROC curves for predicting outcomes at 6, 28, and 37 weeks demonstrated excellent predictive performance, with AUC values of 0.98, 1.0, and 1.0, respectively. The nomogram constructed from these proteins provided a reliable tool for predicting pregnancy outcomes. DCA indicated a net benefit of the model across various risk thresholds, and the calibration curve confirmed the model's accuracy. Additionally, we also found BMI exhibited a significant negative correlation with the expression of GLS (r =-0.44, p = 0.01) and CHO showed a significant positive correlation with the expression of LDHB (r = 0.35, p = 0.04).

CONCLUSION

The identified metabolism-related proteins provide valuable insights into the prognosis of PCOS. The protein based prognostic model offers a robust and reliable tool for risk stratification and personalized management of PCOS patients.

The relationship between serum CTRP-5, C3a/desArg, and complement-C3 levels and hypothyroidism in women with polycystic ovary syndrome

INTRODUCTION

Many patients with polycystic ovary syndrome (PCOS) also experience thyroid disorders. There is a notable similarity in energy metabolism among PCOS, C1q/tumor necrosis factor (TNF)-related proteins (CTRP-5)deficiency, C3a/desArg (also known as acylation-stimulating protein (ASP)) deficiency, and hypothyroidism. This study aimed to investigate the relationship between serum levels of these factors and hypothyroidism in patients with PCOS. Improved clarity and vocabulary, corrected minor grammatical issues, and enhanced readability.

METHODS

This case-control study involved three groups: healthy women (control group), women with PCOS and hypothyroidism, and women with PCOS without hypothyroidism. Serum levels of FBS, total cholesterol, triglycerides, and HDL-C were measured using enzymatic and colorimetric methods. TSH, T4, T3, and anti-thyroid peroxidase (Anti-TPO) levels were determined by ELISA to screen for hypothyroidism in women with PCOS. Additionally, serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), CTRP-5, ASP, and complement C3 were assessed using the ELISA method.

RESULTS

The results indicated that reduced blood levels of CTRP-5, along with elevated levels of ASP (C3a/desArg) and complement C3 in patients with PCOS, may be linked to dysregulation of the thyroid gland. Furthermore, the study observed that changes in these parameters, in conjunction with thyroid dysfunction, are associated with pathological alterations in lipid profiles and blood glucose levels.

CONCLUSION

While changes in CTRP-5, ASP, and complement C3 can influence energy expenditure and storage in PCOS and thyroid function, the complex nature of PCOS requires further research to investigate the prevalence of hypothyroidism in individuals with PCOS.

CLINICAL TRIAL NUMBER

Not applicable.

Chemerin and Polycystic Ovary Syndrome: A Comprehensive Review of Its Role as a Biomarker and Therapeutic Target

Background: Chemerin, an adipokine implicated in inflammatory, metabolic, and adipogenic processes, has been detected in high serum concentration in women with polycystic ovary syndrome (PCOS) and seems to play a role in PCOS pathogenesis. Moreover, at present, no comprehensive and critical document is available in the literature on this topic. The aim of the current study was to comprehensively review the latest available data to confirm the evidence about the association between chemerin and PCOS, highlighting its potential role as an upcoming biomarker and therapeutic target. Methods: A search in the literature of studies published between 2019 and 2024 was conducted using PubMed, Cochrane Library, and Web of Science, focusing on research related to chemerin, PCOS, and PCOS-related features, comorbidities, and complications. A qualitative structured synthesis of key findings was performed according to the specific thematic areas selected, including and discussing clinical data on women with PCOS and experimental studies in humans and animal models of PCOS. Results: Available data confirm increased serum levels of chemerin in women with PCOS compared with controls, independent of obesity and body mass index. Chemerin is associated with insulin resistance, hyperandrogenism, and ovarian dysfunction in PCOS individuals, inhibiting folliculogenesis and steroidogenesis. Experimental animal models underscore chemerin's regulatory roles through its receptors within the hypothalamic-pituitary-ovarian axis and peripheral tissues. High systemic levels of chemerin in PCOS may also be related to the increased risk of pregnancy complications, especially gestational diabetes mellitus and preeclampsia. Conclusions: The current review study highlights the role of chemerin in PCOS pathophysiology, severity, and associated comorbidities and complications, assessing its value as a future biomarker and foreshadowing its potential as a therapeutic target.

Follicular development and endometrial receptivity of different androgen phenotypes in women with polycystic ovary syndrome

Objective

Polycystic ovary syndrome (PCOS) is an important factor contributing to infertility in reproductive-aged women. Hyperandrogenism (HA) plays an important role in the pathogenesis of PCOS. This study was conducted to explore the follicular development and endometrial receptivity of different androgen phenotypes in reproductive-aged patients with PCOS.

Methods

A total of 268 PCOS patients with infertility were recruited and divided into two groups according to the different androgen phenotypes in this study: abnormal menstruation and hyperandrogenism (AM-HA group, n = 127) and abnormal menstruation and polycystic ovarian morphology (AM-PCOM group, n = 141). The follicular development, endometrial receptivity, pregnancy rate, and live birth rate during the natural menstrual cycle were compared between the two groups.

Results

The number of dominant follicles, number of ovulations, and normal ovulation rate in the AM-HA group were significantly lower compared with those in the AM-PCOM group (p < 0.05). The endometrial thickness (ET), endometrial volume (EV), vascularization index (VI), flow index (FI), and vascularization flow index (VFI) on days 14 to 24 of the menstrual cycle before ovulation were significantly lower in the AM-HA group than in the AM-PCOM group (p < 0.05). The endometrial VI, FI, and VFI, the integrin αvβ3, and VEGF concentrations in the uterine fluid during the implantation window were significantly lower in the AM-HA group compared with the AM-PCOM group (p < 0.05). However, no statistically significant differences were observed in the uterine artery blood flow parameters, ET and EV, between the two groups (p > 0.05). The biochemical pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate in the AM-HA group were significantly lower compared with those in the AM-PCOM group (p < 0.05).

Conclusion

PCOS patients with the AM-HA phenotype were vulnerable to ovulation disorders and impaired endometrial receptivity, which resulted in reduced pregnancy rate. Treatment with HA is likely to become an effective approach for improving endometrial receptivity and fecundity disorders in patients with PCOS.

Pharmacological and non-pharmacological interventions for improving endometrial receptivity in infertile patients with polycystic ovary syndrome: a comprehensive review of the available evidence

Direct and indirect evidence suggests that endometrial receptivity may play a crucial role in the reduced fertility rate of women with polycystic ovary syndrome (PCOS). Various pharmacological and non-pharmacological strategies with potential effects on endometrial receptivity in patients with PCOS have been proposed. The aim of this study was to summarize the rationale and the clinical and experimental evidence of interventions tested for improving endometrial receptivity in infertile patients with PCOS. A systematic review was conducted by consulting electronic databases. All interventions with a potential influence on endometrial receptivity in infertile patients with PCOS were evaluated, and their main biological mechanisms were analysed. In total, 24 interventions related to endometrial receptivity were identified. Notwithstanding a strong biological rationale, no intervention aimed at improving endometrial receptivity in women with PCOS is supported by an adequate body of evidence, limiting their use in clinical practice. Further high-quality research is needed in this field to limit potentially ineffective and unsafe add-on treatments in infertile patients with PCOS.

Dynamic changes in AI-based analysis of endometrial cellular composition: Analysis of PCOS and RIF endometrium

Background

The human endometrium undergoes a monthly cycle of tissue growth and degeneration. During the mid-secretory phase, the endometrium establishes an optimal niche for embryo implantation by regulating cellular composition (e.g., epithelial and stromal cells) and differentiation. Impaired endometrial development observed in conditions such as polycystic ovary syndrome (PCOS) and recurrent implantation failure (RIF) contributes to infertility. Surprisingly, despite the importance of the endometrial lining properly developing prior to pregnancy, precise measures of endometrial cellular composition in these two infertility-associated conditions are entirely lacking. Additionally, current methods for measuring the epithelial and stromal area have limitations, including intra- and inter-observer variability and efficiency.

Methods

We utilized a deep-learning artificial intelligence (AI) model, created on a cloud-based platform and developed in our previous study. The AI model underwent training to segment both areas populated by epithelial and stromal endometrial cells. During the training step, a total of 28.36 mm2 areas were annotated, comprising 2.56 mm2 of epithelium and 24.87 mm2 of stroma. Two experienced pathologists validated the performance of the AI model. 73 endometrial samples from healthy control women were included in the sample set to establish cycle phase-dependent dynamics of the endometrial epithelial-to-stroma ratio from the proliferative (PE) to secretory (SE) phases. In addition, 91 samples from PCOS cases, accounting for the presence or absence of ovulation and representing all menstrual cycle phases, and 29 samples from RIF patients on day 5 after progesterone administration in the hormone replacement treatment cycle were also included and analyzed in terms of cellular composition.

Results

Our AI model exhibited reliable and reproducible performance in delineating epithelial and stromal compartments, achieving an accuracy of 92.40% and 99.23%, respectively. Moreover, the performance of the AI model was comparable to the pathologists' assessment, with F1 scores exceeding 82% for the epithelium and >96% for the stroma. Next, we compared the endometrial epithelial-to-stromal ratio during the menstrual cycle in women with PCOS and in relation to endometrial receptivity status in RIF patients. The ovulatory PCOS endometrium exhibited epithelial cell proportions similar to those of control and healthy women's samples in every cycle phase, from the PE to the late SE, correlating with progesterone levels (control SE, r2 = 0.64, FDR < 0.001; PCOS SE, r2 = 0.52, FDR < 0.001). The mid-SE endometrium showed the highest epithelial percentage compared to both the early and late SE endometrium in both healthy women and PCOS patients. Anovulatory PCOS cases showed epithelial cellular fractions comparable to those of PCOS cases in the PE (Anovulatory, 14.54%; PCOS PE, 15.56%, p = 1.00). We did not observe significant differences in the epithelial-to-stroma ratio in the hormone-induced endometrium in RIF patients with different receptivity statuses.

Conclusion

The AI model rapidly and accurately identifies endometrial histology features by calculating areas occupied by epithelial and stromal cells. The AI model demonstrates changes in epithelial cellular proportions according to the menstrual cycle phase and reveals no changes in epithelial cellular proportions based on PCOS and RIF conditions. In conclusion, the AI model can potentially improve endometrial histology assessment by accelerating the analysis of the cellular composition of the tissue and by ensuring maximal objectivity for research and clinical purposes.

AI-algorithm training and validation for identification of endometrial CD138+ cells in infertility-associated conditions; polycystic ovary syndrome (PCOS) and recurrent implantation failure (RIF)

Background

Endometrial CD138+ plasma cells serve as a diagnostic biomarker for endometrial inflammation, and their elevated occurrence correlates positively with adverse pregnancy outcomes. Infertility-related conditions like polycystic ovary syndrome (PCOS) and recurrent implantation failure (RIF) are closely associated with systemic and local chronic inflammatory status, wherein endometrial CD138+ plasma cell accumulation could also contribute to endometrial pathology. Current methods for quantifying CD138+ cells typically involve laborious and time-consuming microscopic assessments of only a few random areas from a slide. These methods have limitations in accurately representing the entire slide and are susceptible to significant biases arising from intra- and interobserver variations. Implementing artificial intelligence (AI) for CD138+ cell identification could enhance the accuracy, reproducibility, and reliability of analysis.

Methods

Here, an AI algorithm was developed to identify CD138+ plasma cells within endometrial tissue. The AI model comprised two layers of convolutional neural networks (CNNs). CNN1 was trained to segment epithelium and stroma across 28,363 mm2 (2.56 mm2 of epithelium and 24.87 mm2 of stroma), while CNN2 was trained to distinguish stromal cells based on CD138 staining, encompassing 7345 cells in the object layers (6942 CD138- cells and 403 CD138+ cells). The training and performance of the AI model were validated by three experienced pathologists. We collected 193 endometrial tissues from healthy controls (n = 73), women with PCOS (n = 91), and RIF patients (n = 29) and compared the CD138+ cell percentages based on cycle phases, ovulation status, and endometrial receptivity utilizing the AI model.

Results

The AI algorithm consistently and reliably distinguished CD138- and CD138+ cells, with total error rates of 6.32% and 3.23%, respectively. During the training validation, there was a complete agreement between the decisions made by the pathologists and the AI algorithm, while the performance validation demonstrated excellent accuracy between the AI and human evaluation methods (intraclass correlation; 0.76, 95% confidence intervals; 0.36-0.93, p = 0.002) and a positive correlation (Spearman's rank correlation coefficient: 0.79, p < 0.01). In the AI analysis, the AI model revealed higher CD138+ cell percentages in the proliferative phase (PE) endometrium compared to the secretory phase or anovulatory PCOS endometrium, irrespective of PCOS diagnosis. Interestingly, CD138+ percentages differed according to PCOS phenotype in the PE (p = 0.03). On the other hand, the receptivity status had no impact on the cell percentages in RIF samples.

Conclusion

Our findings emphasize the potential and accuracy of the AI algorithm in detecting endometrial CD138+ plasma cells, offering distinct advantages over manual inspection, such as rapid analysis of whole slide images, reduction of intra- and interobserver variations, sparing the valuable time of trained specialists, and consistent productivity. This supports the application of AI technology to help clinical decision-making, for example, in understanding endometrial cycle phase-related dynamics, as well as different reproductive disorders.

High Fat Mass Index is Associated with Endometrial Hyperplasia in Polycystic Ovary Syndrome Patients: A Retrospective Study

Aim

To assess body composition, glucolipid metabolism, and uric acid levels in PCOS (Polycystic Ovary Syndrome) patients to determine their relationship with the risk of endometrial hyperplasia (EH).

Methods

A total of 232 patients were included and divided into groups according to whether they had PCOS and endometrial pathology (Group A: non-PCOS and normal endometrium; Group B: PCOS and normal endometrium; Group C: non-PCOS and EH; Group D: PCOS and EH). Body composition differences between groups and correlations between body composition, glucolipid metabolism, and uric acid levels were analyzed.

Results

In Group D, the patient's PSM (Percent Skeletal Muscle) of Trunk, PBF (Percent Body Fat) of Arm, free mass index, FMI (Fat Mass Index), and appendicular skeletal muscle mass index were significantly higher than in Groups A, B, and C. Waist-hip rate, PBF, PBF of Trunk, PSM of Leg, skeletal muscle mass index and visceral fat level were significantly higher than in Groups A and B. FMI was an independent risk factor for EH in PCOS patients, the AUC for FMI prediction of endometrial hyperplasia in PCOS patients was 0.82. FMI had significant positive correlations with fasting glucose, fasting insulin, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), total cholesterol, triglyceride, low-density lipoprotein, triglyceride/high-density lipoprotein, and uric acid levels. FMI was correlated with HOMA-IR and uric acid at 0.602 and 0.649 respectively in PCOS patients.

Conclusion

Increased FMI and altered glucolipid metabolism as key factors associated with a higher risk of EH in patients with PCOS. Monitoring body composition and metabolic health in PCOS patients could help identify those at greater risk of EH, guiding preventive interventions.

Live birth rates in IVF patients with and without polycystic ovary syndrome according to serum anti-Müllerian hormone concentrations

RESEARCH QUESTION

Is there a relationship between serum anti-Müllerian hormone (AMH) concentration and live birth rate (LBR) in patients with and without polycystic ovary syndrome (PCOS)?

DESIGN

This retrospective study included 4631 patients aged 20-35 years who underwent their first frozen embryo transfer cycle at the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2021. Participants were categorized as having or not having PCOS (PCOS group, n = 1428, and NPCOS group, n = 3203, respectively). In the two groups, AMH was categorized into subgroups 1, 2 and 3 using the 25th and 75th percentiles as cut-off lines.

RESULTS

In the NPCOS subgroups, LBR was significantly lower in NPCOS1 than in NPCOS2 and NPCOS3 (P < 0.001). In the PCOS subgroups, LBR was significantly lower in PCOS3 than in PCOS2 (P = 0.038), with no significant difference between PCOS1 and the other subgroups. In the NPCOS and PCOS groups, the preterm birth rate increased with the increase in AMH concentration in the subgroups (P = 0.018 and P = 0.016, respectively). Multivariate regression analysis revealed that AMH was an independent factor influencing the LBR and preterm birth rate in the NPCOS and PCOS groups (P < 0.05). The threshold effect analysis indicated a positive correlation between LBR and AMH in the NPCOS group at an AMH concentration of 2.98 ng/ml or less (P < 0.001), and a negative correlation in the PCOS group at an AMH concentration higher than 7.13 ng/ml (P = 0.043). Higher AMH concentrations were positively correlated with preterm birth rate in the NPCOS (P = 0.004) and PCOS (P = 0.017) groups.

CONCLUSIONS

Serum AMH concentrations could have a clinical predictive value for LBR in young patients, both with and without PCOS.

Recent developments in drug treatment strategies for infertility in patients with polycystic ovary syndrome

INTRODUCTION

Infertility related to polycystic ovary syndrome (PCOS) represents a significant challenge for women of reproductive age. Over the last few years, evidence-based medicine has driven new approaches for treating infertility in patients with PCOS, changing rapidly and deeply the clinical practice.

AREAS COVERED

The authors provide an in-depth examination of recent developments in drug treatment strategies that have impacted the clinical practice and changed the previous approach to infertility in patients with PCOS.

EXPERT OPINION

The authors identify four primary areas of interest that have impacted clinical practice in the last few years. Specifically, they discuss the current role of metformin administration in women with PCOS and infertility, the choice for using clomiphene citrate or letrozole as first-line treatment for ovulation induction, the use of new gonadotropin formulations for in vitro fertilization (IVF) program, and the elective embryo transfer in IVF cycles as golden standard treatment for patients with PCOS at high-risk for ovarian hyperstimulation syndrome.

Effects of preconceptional vitamin D levels on in vitro fertilization outcomes in infertile patients with polycystic ovary syndrome: A retrospective cohort study

BACKGROUND

Vitamin D plays various roles in different stages of reproduction, and abnormalities in its levels are associated with diseases such as polycystic ovary syndrome (PCOS). This study aimed to determine the relationship between initial vitamin D levels and in vitro fertilization (IVF) outcomes in PCOS patients.

METHODS

This retrospective cohort study included 1174 PCOS patients who consulted the Acıbadem Maslak Hospital IVF Clinic between January 2015 and March 2021. We investigated the effect of preconceptional vitamin D levels on IVF outcomes using data analysis with SigmaPlot 14.5.

RESULTS

We found a significant positive correlation between preconceptional vitamin D levels and positive clinical pregnancy rates (p < 0.001) as well as increased endometrial thickness (EMT) on human chorionic gonadotropin (hCG) day (p < 0.001, r = 0.262). The optimal vitamin D cut-off value for predicting positive hCG test results was identified as 13.24 ng/mL, as determined by receiver operating characteristic curve analysis (sensitivity = 0.839, specificity = 0.677). No association was observed with other IVF outcome parameters, miscarriage rates, or clinical pregnancy rates based on EMT.

CONCLUSIONS

The study suggests that PCOS patients with vitamin D levels above 13.24 ng/mL are more likely to achieve positive hCG results after IVF. These findings highlight the potential importance of vitamin D supplementation in improving pregnancy outcomes for PCOS patients. Additionally, increased EMT on hCG day may explain the higher clinical pregnancy rates associated with elevated vitamin D levels.

CystNet: An AI driven model for PCOS detection using multilevel thresholding of ultrasound images

Polycystic Ovary Syndrome (PCOS) is a widespread endocrinological dysfunction impacting women of reproductive age, categorized by excess androgens and a variety of associated syndromes, consisting of acne, alopecia, and hirsutism. It involves the presence of multiple immature follicles in the ovaries, which can disrupt normal ovulation and lead to hormonal imbalances and associated health complications. Routine diagnostic methods rely on manual interpretation of ultrasound (US) images and clinical assessments, which are time-consuming and prone to errors. Therefore, implementing an automated system is essential for streamlining the diagnostic process and enhancing accuracy. By automatically analyzing follicle characteristics and other relevant features, this research aims to facilitate timely intervention and reduce the burden on healthcare professionals. The present study proposes an advanced automated system for detecting and classifying PCOS from ultrasound images. Leveraging Artificial Intelligence (AI) based techniques, the system examines affected and unaffected cases to enhance diagnostic accuracy. The pre-processing of input images incorporates techniques such as image resizing, normalization, augmentation, Watershed technique, multilevel thresholding, etc. approaches for precise image segmentation. Feature extraction is facilitated by the proposed CystNet technique, followed by PCOS classification utilizing both fully connected layers with 5-fold cross-validation and traditional machine learning classifiers. The performance of the model is rigorously evaluated using a comprehensive range of metrics, incorporating AUC score, accuracy, specificity, precision, F1-score, recall, and loss, along with a detailed confusion matrix analysis. The model demonstrated a commendable accuracy of [Formula: see text] when utilizing a fully connected classification layer, as determined by a thorough 5-fold cross-validation process. Additionally, it has achieved an accuracy of [Formula: see text] when employing an ensemble ML classifier. This proposed approach could be suggested for predicting PCOS or similar diseases using datasets that exhibit multimodal characteristics.

GnRH agonist pretreatment for frozen embryo transfer among women with polycystic ovary syndrome: a narrow systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Frozen embryo transfer (FET) is usually recommended for women with polycystic ovary syndrome (PCOS) undergoing In vitro fertilization (IVF). While there is no consensus as to the optimal protocol of endometrial preparation for FET. The effect of gonadotropin-releasing hormone agonist (GnRH-a) pretreatment for FET among women with PCOS remains controversial.

PURPOSE

We intend to explore whether GnRH-a pretreatment could improve clinical outcomes for women with PCOS undergoing FET.

METHODS

PubMed, Embase, ClinicalTrials.gov, Cochrane Library, and Web of Science were searched up to May 16, 2024. Eligible studies involved patients with PCOS undergoing FET and receiving GnRH-a pretreatment for endometrial preparation, with artificial cycle (AC) as the control therapy. Only randomized controlled trials (RCTs) published in Chinese and English were included. Data extraction was performed independently by two authors. Effect was quantified using odd ratios (ORs) with 95% confidence intervals (CIs) using random-effect models with the Mantel-Hansel (M-H) method in Revman software. Quality of outcomes was evaluated using the GRADEpro system. Primary outcomes contained the clinical pregnancy rate, miscarriage rate, and live birth rate. Secondary outcomes included the incidence of preterm labor and gestational diabetes mellitus (GDM).

RESULTS

Ninety-seven records were initially retrieved, with 21 duplicates and 65 articles excluded after title and abstract screening. Seven studies were excluded due to retrospective design, leaving three RCTs with 709 participants. Among them, 353 received GnRH-a pretreatment as the intervention group and 356 received AC as the control group. No significant differences were observed in the clinical pregnancy rate (OR 1.09, 95% CI 0.75 to 1.56, P = 0.66), miscarriage rate (OR 0.73, 95% CI 0.28 to 1.90, P = 0.52), live birth rate (OR 0.87, 95% CI 0.61 to 1.25, P = 0.46), and the risk of preterm labor (OR 1.45, 95% CI 0.79 to 2.65, P = 0.23) and GDM (OR 0.73, 95% CI 0.37 to 1.48, P = 0.39) between the two groups.

CONCLUSIONS

In this meta-analysis, GnRH-a pretreatment does not confer any advantages and appears unnecessary for women with PCOS undergoing FET. Additional RCTs should focus on maternal complications and the health of offspring.