The prevalence and phenotypic manifestations of polycystic ovary syndrome (PCOS) among infertile Sudanese women: a cross-sectional study

Overview of infertility

Having a child is an innate trait in animals, including humans, and is required for the continued existence of all animal species. Therefore, for most women, the inability to conceive or to do so in a timely fashion - termed infertility - to enable the continuation of the family line can be emotionally distressing. The definition of infertility is controversial because of its separation into primary and secondary. This is further complicated by the loosely used term subfertility, which relates to couples who have reduced ability because they take longer than the natural time to conceive, as opposed to those who are infertile and are entirely unable to conceive after 6 to 12 months, depending on age. Infertility evaluation requires a thorough male and female history, physical examination of both partners, and targeted investigation to determine the cause of infertility in a particular couple. Various treatments apply to infertile couples depending on the age of the female partner, the results of investigations, the reason for infertility, the presence of inheritance of abnormal genes, the pregnancy rates the couple is happy with, the resources available, how desperate the couple is to achieve a live birth, and how much they want to commit to treatment. Infertility treatment could include counseling and expectant management only, intrauterine insemination in a natural or stimulated cycle, and IVF and or ICSI. Men with azoospermia will need surgical options to retrieve sperm for IVF/ ICSI, but rarely for IUI. This review overviews infertility's etiology, diagnosis, investigations, and treatment.

Distribution of polycystic ovary syndrome (PCOS) phenotypes in Iranian women: a cross-sectional study

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by diverse clinical and metabolic manifestations. This study aimed to investigate the prevalence of PCOS phenotypes and their association with hematological, biochemical, and hormonal parameters in PCOS, with a particular focus on infertile women and those with recurrent pregnancy loss (RPL).

RESULTS

Phenotype A was the most prevalent phenotype overall and within both infertile and RPL subgroups. However, no significant differences in hematological, biochemical, or hormonal parameters were observed among the PCOS phenotypes, except for lower RBC and hematocrit levels in phenotype F. PCOS women with RPL demonstrate significantly lower levels of RBC, hemoglobin, and hematocrit in phenotype F.

Effect of Junk Food on Hormonal and Metabolic Manifestations in Polycystic Ovarian Syndrome Phenotypes: A Case-Control Study of Kashmiri Population

Polycystic ovarian syndrome is the most common endocrinopathy with heterogeneous symptomatology and diverse etiological links. Apart from genetic predisposition, environmental toxins, lifestyle, diet have been seen as contributing factors in shaping the disease. This study was taken to underpin the phenotypic status of PCOS in Kashmiri population and to compare their metabolic and endocrinological features. We explored the relationship between the junk food consumption patterns with the clinical features of PCOS phenotypes and controls. A total of 404 PCOS patients and 126 controls were recruited and cases were classified as per Rotterdam criteria. Anthropometric measurements and biochemical parameters of both cases and controls were taken. A detailed account on the type and frequency of outdoor foods eaten was focused and accordingly the study population was classified into voracious eaters, moderately eaters and rarely eaters of junk food. We found highest prevalence of phenotype A, n = 131 (32.8%) with full-blown symptoms in terms of obesity, IR, hirsutism, dyslipidemia and metabolic syndrome in our population. Phenotype D was found to be least prevalent n = 72 (17.7%) with milder form of symptoms. Our study is the first to unravel the phenotypic status of PCOS in Kashmiri population employing Rotterdam criteria and undertake dietary factor to relate with the pathogenesis of this disease. There was a notable association between an increasingly affluent diet, the presence of hirsutism, raised body mass index, obesity and metabolic syndrome in our population, making diet as an imperative factor to govern PCOS presentation. This study clearly implies the effect of unhealthy dietary habits to be associated with increasingly severe phenotype of PCOS, which can likely have implications on metabolic and fertility outcomes.

The therapeutic effects of curcumin on polycystic ovary syndrome by upregulating PPAR-γ expression and reducing oxidative stress in a rat model

Objective

Polycystic ovary syndrome (PCOS) is a prevalent endocrine and metabolic disorder that impacts 8-13% of women in their reproductive years. However, the drugs commonly used to treat PCOS are often prescribed off-label and may carry potential side effects. This study aimed to investigate the therapeutic effects of curcumin in a PCOS rat model.

Materials and methods

A PCOS rat model was established through daily subcutaneous injection of 60 mg/kg body weight of dehydroepiandrosterone (DHEA) for 21 days. The PCOS rats received a daily intragastric dose of 50 mg/kg body weight of curcumin for another 21 days. Ovarian morphological changes, estrous cycle changes, and hormone level changes were measured to evaluate the therapeutic effectiveness of curcumin in PCOS rats. Oxidative stress markers in the ovaries were analyzed to explore the mechanisms of curcumin in PCOS rats.

Results

This study demonstrated that curcumin alleviated insulin resistance and significantly reduced serum levels of estradiol (p = 0.02), luteinizing hormone (p = 0.009), testosterone (p = 0.003), and the LH/FSH ratio (p = 0.008) in PCOS rats. Curcumin also restored normal ovarian morphology and the estrous cycle in these rats. Furthermore, curcumin treatment significantly decreased levels of oxidative stress markers, including malondialdehyde (p = 0.004) and reactive oxygen species (p = 0.005), while increasing antioxidant levels such as superoxide dismutase (p = 0.04), glutathione peroxidase (p = 0.002), and glutathione (p = 0.02) in ovarian tissues. Additionally, curcumin significantly upregulated PPAR-γ in the ovarian tissues of PCOS rats.

Conclusion

This study demonstrates that curcumin effectively restores ovarian morphology, hormone levels, and estrous cycles in PCOS rats. These effects may be linked to its ability to reduce oxidative stress in ovaries via the upregulation of PPAR-γ. Curcumin shows promise as a potential drug for the treatment of PCOS.

Lower Serum ATG7 Levels Linked to Insulin Resistance in Women with Polycystic Ovary Syndrome

BACKGROUND Previous studies have suggested that autophagy, a cellular process regulated by ATG7, plays a critical role in ovarian physiology and pathology. In this study, our objective was to examine ATG7 levels in women with and without polycystic ovary syndrome (PCOS) and to explore potential associations between serum ATG7 levels and PCOS. MATERIAL AND METHODS The study included 188 women diagnosed with PCOS, matched with an equal number of healthy women for comparison. Serum levels of ATG7 were determined using the ELISA technique, and the difference was assessed using an independent samples t test. The association between ATG7 serum levels and the risk of developing PCOS was evaluated by using a multivariable logistic regression model. Additionally, the potential of ATG7 to predict PCOS was investigated through logistic regression and receiver operating characteristic (ROC) analysis. RESULTS Our study found that women with PCOS had significantly lower serum ATG7 levels than their healthy counterparts. Lower ATG7 levels were associated with a higher risk of developing PCOS after adjusting for various confounding variables. The combination of ATG7 with HOMA-IR performed well in predicting PCOS, with an AUC of 92.3%, a sensitivity of 88.3%, and a specificity of 85.3%. CONCLUSIONS Our study found that serum ATG7 levels were significantly lower in women with PCOS and were associated with an increased risk of developing PCOS. This suggests that ATG7 could potentially serve as a biomarker for diagnosing and managing PCOS.

Predicting Unfavorable Pregnancy Outcomes in Polycystic Ovary Syndrome (PCOS) Patients Using Machine Learning Algorithms

Background and Objectives: Polycystic ovary syndrome (PCOS) is a complex disorder that can negatively impact the obstetrical outcomes. The aim of this study was to determine the predictive performance of four machine learning (ML)-based algorithms for the prediction of adverse pregnancy outcomes in pregnant patients diagnosed with PCOS. Materials and Methods: A total of 174 patients equally divided into 2 groups depending on the PCOS diagnosis were included in this prospective study. We used the Mantel-Haenszel test to evaluate the risk of adverse pregnancy outcomes for the PCOS patients and reported the results as a crude and adjusted odds ratio (OR) with a 95% confidence interval (CI). A generalized linear model was used to identify the predictors of adverse pregnancy outcomes in PCOS patients, quantifying their impact as risk ratios (RR) with 95% CIs. Significant predictors were included in four machine learning-based algorithms and a sensitivity analysis was employed to quantify their performance. Results: Our crude estimates suggested that PCOS patients had a higher risk of developing gestational diabetes and had a higher chance of giving birth prematurely or through cesarean section in comparison to patients without PCOS. When adjusting for confounders, only the odds of delivery via cesarean section remained significantly higher for PCOS patients. Obesity was outlined as a significant predictor for gestational diabetes and fetal macrosomia, while a personal history of diabetes demonstrated a significant impact on the occurrence of all evaluated outcomes. Random forest (RF) performed the best when used to predict the occurrence of gestational diabetes (area under the curve, AUC value: 0.782), fetal macrosomia (AUC value: 0.897), and preterm birth (AUC value: 0.901) in PCOS patients. Conclusions: Complex ML algorithms could be used to predict adverse obstetrical outcomes in PCOS patients, but larger datasets should be analyzed for their validation.

Significance of LHCGR polymorphisms in polycystic ovary syndrome: an association study

This study was conducted to analyze the association of Luteinizing Hormone/Choriogonadotropin Receptor (LHCGR) gene rs4953616 and rs7371084 polymorphisms with the risk of polycystic ovary syndrome (PCOS) in Punjab, India. A total of 823 women (443 PCOS cases and 380 healthy controls) were enrolled in the present study. The polymerase chain reaction-restriction fragment length polymorphism technique (PCR-RFLP) was used for genotyping. Anthropometric parameters, lipid and hormonal profiles, were compared between the two groups. Demographic features were compared using Mann Whitney U test while the Chi-square test and odds ratios (ORs) were used to assess the genetic association and risk towards PCOS, respectively. A one-way analysis of variance (ANOVA) test was employed to analyze the correlation of genotypes with baseline parameters in PCOS cases. A statistically significant difference was revealed in the genotypic and allelic frequencies of rs4953616 polymorphism between PCOS cases and controls (p = 0.01 and p = 0.004, respectively). The mutant genotype (TT), mutant allele (T), and recessive model of rs4953616 polymorphism conferred 1.77, 1.3, and 1.5 times risk towards PCOS, respectively. No significant distribution for genotypes and alleles was found for rs7371084 in both groups (p = 0.25 and p = 0.26, respectively). In addition to dyslipidemia, PCOS women also had significantly higher body mass index (BMI) and waist-to-hip ratio (WHR), testosterone (T), and luteinizing hormone (LH). Upon haplotype analysis, the TT haplotype was found to be significantly associated with the increased risk of PCOS. Our results demonstrated a significant role of LHCGR rs4953616 polymorphism in the development of PCOS.

Polycystic Ovary Syndrome: A Literature Review With a Focus on Diagnosis, Pathophysiology, and Management

In females with polycystic ovarian syndrome (PCOS), the most prevalent endocrine condition is chronic anovulation and hyperandrogenism. This illness influences females from conception to death, posing several risks to the health of a female, thus reducing the quality of life. It also increases the rates of mortality and morbidity. The first years of puberty are when PCOS symptoms first show. Menstrual irregularities, anovulation, and acne are features of both PCOS and typical puberty in females. There are many various phenotypes that fall under the same illness, so it is necessary to examine each one independently because they may need different treatments and result in different outcomes. Depending on the diagnostic criteria, approximately 6%-20% of females in the reproductive age group are believed to be affected by PCOS. As long as PCOS is still a syndrome, no single diagnostic indicator, such as hyperandrogenism or polycystic ovary (PCO), can be used to make a clinical diagnosis. The management of females with PCOS depends on the symptoms. These could include menstruation problems, androgen-related symptoms, or infertility caused by ovulatory disruption. In females with PCOS, anovulation is linked to low follicle-stimulating hormone (FSH) levels and a halt in antral follicle growth during the last stages of maturation. The condition may be treated surgically with laparoscopic ovarian drilling or medically with medications such as aromatase inhibitors, metformin, glucocorticoids, clomiphene citrate (CC), tamoxifen, or gonadotropins. Patients will experience different androgenic symptoms, such as hirsutism, acne, and/or baldness. Patients who appear with these troubling symptoms need to receive appropriate care. The review emphasizes the role it plays in the management of various conditions.

Free androgen index (FAI)'s relations with oxidative stress and insulin resistance in polycystic ovary syndrome

This study aimed to determine the levels of the free androgen index (FAI) and its association with oxidative stress and insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS). This cross-sectional study was performed on 160 women aged 18-45 years, visiting gynecology clinics of Urmia in northwestern Iran during 2020-2021 who were diagnosed with PCOS and exhibited one of the four phenotypes of PCOS. All the participants underwent clinical examinations, paraclinical tests, and ultrasounds. FAI cut-off point was considered to be 5%. The significance level was set at < 0.05. Among the 160 participants, the prevalence of the four phenotypes was as follows: phenotype A: 51.9%, phenotype B: 23.1%, phenotype C: 13.1%, and phenotype D: 11.9%. High FAI was detected in 30 participants (18.75%). Additionally, It was found that phenotype C had the highest FAI levels among the PCOS phenotypes, with a significant difference between phenotypes A and C (p value = 0.03). IR was observed in 119 (74.4%) of the participants, and the median (interquartile range: IQR) of malondialdehyde (MDA) levels among the participants was 0.64 (0.86) μM/L. In linear regression, the PCOS phenotype (standard beta = 0.198, p-value = 0.008), follicle-stimulating hormone (FSH) levels (standard beta = 0.213, p-value = 0.004), and MDA levels (standard beta = 0.266, p-value < 0.001) were significantly related to the FAI level, but the homeostatic model assessment for insulin resistance (HOMA-IR) was not statistically associated with FAI. Thus, in this study, PCOS phenotypes and MDA levels (an indicator of stress oxidative) were significantly related to FAI, but HOMA-IR (the indicator of IR) was not associated with it.

Non-alcoholic fatty liver disease across endocrinopathies: Interaction with sex hormones

Nonalcoholic fatty liver disease (NAFLD) has emerged as the most frequent chronic liver disease globally. NAFLD is strongly associated with metabolic syndrome and it has been recently suggested that to rename NAFLD as metabolic dysfunction-associated fatty liver disease (MAFLD). NAFLD has been studied in different endocrine axes and accumulating body of clinical and experimental studies have suggested that NAFLD is associated with polycystic ovarian syndrome (PCOS), hypopituitarism, growth hormone deficiency (GHD), hypogonadism and other endocrine disorders. In fact, endocrine dysfunction may be considered as the major contributor for the development, progression, and severity of NAFLD. In the present comprehensive review, we discussed the epidemiological and clinical evidence on the epidemiology, pathophysiology, and management of NAFLD in endocrine disorders, with an emphasis on the effects of sex-specific hormones/conditions as well as molecular basis of NAFLD development in these endocrine diseases.

Phenotypes of polycystic ovary syndrome and accompanying hormonal disturbances

Objective: PCOS, which is known as a symptom complex including menstrual dysfunction (OD) and or hirsutism/androgen excess (HA), and/or polycystic ovaries (PCOM), induces women's health damage beyond this classical criteria. Subphenotypes of PCOS have different clinical properties and criteria, and the metabolical differences between these phenotypes have not been elucidated properly. Therefore, we aimed to investigate the metabolic and endocrinological differences between these sub-phenotypes. Materials and Methods: 63 patients with PCOS followed by Istanbul Research and Education Hospital Endocrinology and Metabolism Department were included in the study. Patients were classified into subgroups according to phenotypes. The phenotype groups were compared according to blood glucose, lipid parameters, and serum hormone levels. MetS ratios between groups were also compared. Results: Androgen excess/hirsutism was the most prominent character with a 95.2% (n = 60) rate in this study group, and ovulatory dysfunction was the least prominent one. (n = 43, 68.2%) PCOM has been detected in 50 patients (80.8%). Patients were grouped according to PCOS phenotypes. Phenotype C was the most common type, and about 65% of the patients were in this group. Triglyceride levels were statistically significantly higher in the Phenotype A group than in the Phenotype B group (p = 0.03). MetS was the highest in the Phenotype A group (45.4%) and the lowest in the Phenotype C group (34.7%). Conclusions: Phenotype C has the highest prevalence in Turkish patients with PCOS, MetS was the highest in Phenotype A, and TG and LDL cholesterol levels were higher in Phenotype A. More studies are needed to explain these differences and their lifetime consequences.