Current Guidelines for Diagnosing PCOS

The genetic basis of male and female infertility

This review provides a comprehensive overview of the genetic factors underlying male and female infertility. Infertility affects an estimated one in six couples worldwide, with both male and female factors contributing equally to its prevalence. Approximately, 50% of infertility cases are attributed to genetic causes. We explore three main categories of genetic causes: chromosomal abnormalities, monogenic disorders, and syndromic conditions. Chromosomal causes, including numerical and structural aberrations, are discussed with a focus on their impact on gametogenesis and reproductive outcomes. We review key monogenic causes of infertility, highlighting recent discoveries in genes critical for gonadal development, gametogenesis, and hormonal regulation. Syndromic conditions affecting fertility are examined, highlighting their impact on reproductive function. Throughout the review, we address the challenges in identifying genetic mechanisms of infertility, particularly focusing on the intricate processes involved in oogenesis and spermatogenesis. We also discuss how advancements in genetic testing, such as next-generation sequencing (NGS) and genome-wide association studies (GWAS), have significantly enhanced our understanding of idiopathic infertility and promise further insights in the future. We also discuss the clinical implications of genetic diagnoses, including the role of preimplantation genetic testing (PGT) and genetic counseling in reproductive medicine. This review synthesizes current knowledge on the genetic basis of infertility, providing a comprehensive overview of chromosomal, monogenic, and syndromic causes. It aims to offer readers a solid foundation for understanding the complex genetic factors underlying reproductive disorders.

FSH, LH, lipid and adipokines in Polycystic Ovary Syndrome: Clinical biochemistry insights for diagnosis and management

Polycystic Ovary Syndrome (PCOS) is a common endocrine syndrome characterized by hormonal imbalances, metabolic disturbances, and clinical symptoms. The pathophysiology of this syndrome involves disruptions in hormonal signaling, particularly changes in levels of luteinizing hormone (LH), and follicle-stimulating hormone (FSH) which can lead to anovulation and infertility. Additionally, insulin resistance and dysfunctional adipose tissue are other complicating factors of this condition. Biochemical markers such as FSH, LH, lipid profiles, and adipokines (like leptin and adiponectin) are crucial for diagnosing PCOS and assessing its severity. In PCOS patients, elevated LH levels relative to FSH are typically observed, and lipid abnormalities increase the risk of cardiovascular diseases. Diagnosing this syndrome usually requires comprehensive biochemical tests to confirm hyperandrogenism and insulin resistance. Management strategies include lifestyle modifications and pharmacological interventions aimed at correcting hormonal imbalances and dyslipidemia. Monitoring treatment outcomes through biochemical markers is essential for evaluating therapeutic efficacy. This review article examines the roles of FSH and LH hormones, lipids, and adipokines in the diagnosis and management of PCOS, emphasizing the importance of clinical biochemistry in improving diagnostic and treatment methods for this disorder. Furthermore, research into identifying emerging biomarkers for early diagnosis and new therapeutic targets is suggested.

Evaluation of secondary amenorrhea in primary care

ABSTRACT

Amenorrhea can be a sign of a significant health issue and often causes distress for the patient. Secondary amenorrhea is more common than primary amenorrhea, and patients often present to the primary care setting for evaluation. Common causes, evaluation methods, and recommended treatment options appropriate for the primary care setting will be discussed.

A novel link between KCNQ1 genetic variants and polycystic ovary syndrome susceptibility

Genome-wide association studies (GWAS) have identified the potassium voltage-gated channel subfamily Q member 1 (KCNQ1) gene, as a potential contributor to the pathogenesis of type 2 diabetes (T2D). Given the known genetic overlap between T2D and polycystic ovary syndrome (PCOS), the present study aimed to investigate the potential association between KCNQ1 gene variants and PCOS susceptibility in a population of Tunisian women. A total of 230 patients and 230 healthy controls were recruited for this case control study. The Rotterdam consensus criteria were used to diagnose patients with PCOS. Genotyping of three KCNQ1 variants (rs231361, rs151290 and rs2237895), was performed using allelic discrimination (real-time PCR). After excluding false positive associations using the false discovery rate adjustment and ensuring statistical power >80%, the present results suggested that the KCNQ1 gene may play a role in PCOS susceptibility. Specifically, the rs231361 variant showed a significant association with an increased risk of PCOS through multiple genetic inheritance models. Additionally, the A/A genotype of the rs231361 variant displayed a correlation with increased levels of triglycerides compared with those with the G/G wild-type and the G/A heterozygous genotypes. To the best of our knowledge, this is the first study to identify the KCNQ1 rs231361 variant as a potential genetic risk factor for PCOS. These findings have important implications for risk assessment and the development of personalized treatment approaches for affected women.

SESN2 Ameliorates Dihydrotestosterone-induced Human Ovarian Granulosa Cell Damage by Activating AMPK/ULK1-mediated Mitophagy

Sestrin 2 (SESN2) has been reported to participate in the regulation of granulosa cell function in ovarian tissues. However, the role of SESN2 in polycystic ovarian syndrome (PCOS) is still incompletely understood. Here, we investigated the functional role and mechanism of SESN2 in dihydrotestosterone (DHT)-induced granulosa cells. In this study, DHT was utilized to induce PCOS cell model and the AMP-activated protein kinase (AMPK) inhibitor Compound C (CC) was utilized to inhibit the AMPK pathway. qRT-PCR was performed to detect the expression of SESN2 in HGLS cells. Cell apoptosis was evaluated by flow cytometry. Oxidative stress was detected by DCFH-DA staining, superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GSH-Px) kits. The expression of SESN2, cell apoptosis, oxidative stress, mitophagy and AMPK/ULK1 signaling-related proteins were measured by western blot. The results showed that SESN2 was downregulated in DHT-induced granulosa cells. Overexpression of SESN2 inhibited the DHT-induced apoptosis and oxidative stress of HGLS cells. DHT induction aggravated HGLS cell apoptosis and oxidative stress. SESN2 overexpression inhibited the DHT-induced apoptosis and oxidative stress of HGLS cells. In addition, overexpression of SESN2 activated the AMPK/ULK1 signaling pathway and promoted mitophagy. Treatment of CC reversed the regulatory effect of SESN2 on mitophagy. CC also reversed the influences of SESN2 overexpression on apoptosis and oxidative stress in DHT-induced HGLS cells. Overall, SESN2 suppressed DHT-induced apoptosis and oxidative stress in PCOS through AMPK/ULK1-mediated mitophagy.

Prediction of Transabdominal Ultrasound for Detection of Polycystic Ovary Using Hormonal Profile as Gold Standard

BACKGROUND

Polycystic ovary is a hormonal disorder affecting reproductive women, causing hormonal imbalances and multiple cysts. Transabdominal sonography is a noninvasive method for Polycystic ovary assessment, but its accuracy is debated, necessitating validation with gold standard hormonal profiles.

SIGNIFICANCE OF THE STUDY

In virginal females, transvaginal sonography is prohibited. The findings of this study provide valuable insights into transabdominal sonography prediction of polycystic ovary in those females.

AIM

This research addressed the need to evaluate the correlation of transabdominal sonography findings in the context of polycystic ovary with hormonal profile as the gold standard.

METHODS

This cross-sectional study retrospectively reviewed medical records and data to evaluate the prediction of transabdominal sonography for detecting polycystic ovary using hormonal profile as the gold standard. The researchers analyzed data from a randomly selected sample and compared it to laboratory investigations using a designed data collection sheet.

RESULTS

The analysis revealed significant correlations between certain diagnostic features and the luteinizing hormone to follicle-stimulating hormone ratio. These include right and left ovarian volume (p = 0.012 and 0.007, respectively) and right and left ovarian follicular diameter (p = 0.001 for both ovaries).

CONCLUSION

The study highlights the difficulties in diagnosing polycystic ovary syndrome using Transabdominal sonography and hormonal tests, emphasizing the need for a comprehensive approach that integrates both methods for accurate diagnosis.

Endocrine-disrupting chemicals and female reproductive health: a growing concern

Female fertility and reproductive health depend on a series of developmental steps from embryogenesis through puberty, in addition to the proper functioning of the reproductive system in adulthood. Two important steps are the establishment of the ovarian reserve and development of the hypothalamic-pituitary-ovarian axis. During reproductive years, maintaining an adequate ovarian reserve of follicles as well as balanced neuroendocrine control of reproductive organs is crucial for fertility. Dysregulation of either of these events, during development or in adulthood, can lead to reproductive disorders. Over the past five decades, human fertility rates have declined, whereas the incidence of female reproductive disorders has risen, trends partially linked to environmental factors such as exposure to endocrine-disrupting chemicals (EDCs). Here we outline epidemiological and mechanistic evidence for how EDCs affect the ovarian reserve during early development, its maintenance during adulthood and the establishment of the hypothalamic-pituitary control of puberty and ovulation. Our Review not only reveals strong support for the role of EDC exposure in the development of female reproductive disorders such as abnormal puberty, impaired fertility, premature menopause or polycystic ovarian syndrome, but also highlights knowledge gaps, including the difficulty to prove causality between exposure and human disease manifestation.

Polycystic Ovary Syndrome Underdiagnosis Patterns by Individual-level and Spatial Social Vulnerability Measures

OBJECTIVE

To use electronic health records (EHR) data at Boston Medical Center (BMC) to identify individual-level and spatial predictors of missed diagnosis, among those who meet diagnostic criteria for polycystic ovary syndrome (PCOS).

METHODS

The BMC Clinical Data Warehouse was used to source patients who presented between October 1, 2003, and September 30, 2015, for any of the following: androgen blood tests, hirsutism, evaluation of menstrual regularity, pelvic ultrasound for any reason, or PCOS. Algorithm PCOS cases were identified as those with International Classification of Diseases (ICD) codes for irregular menstruation and either an ICD code for hirsutism, elevated testosterone lab, or polycystic ovarian morphology as identified using natural language processing on pelvic ultrasounds. Logistic regression models were used to estimate odds ratios (ORs) of missed PCOS diagnosis by age, race/ethnicity, education, primary language, body mass index, insurance type, and social vulnerability index (SVI) score.

RESULTS

In the 2003-2015 BMC-EHR PCOS at-risk cohort (n = 23 786), there were 1199 physician-diagnosed PCOS cases and 730 algorithm PCOS cases. In logistic regression models controlling for age, year, education, and SVI scores, Black/African American patients were more likely to have missed a PCOS diagnosis (OR = 1.69 [95% CI, 1.28, 2.24]) compared to non-Hispanic White patients, and relying on Medicaid or charity for insurance was associated with an increased odds of missed diagnosis when compared to private insurance (OR = 1.90 [95% CI, 1.47, 2.46], OR = 1.90 [95% CI, 1.41, 2.56], respectively). Higher SVI scores were associated with increased odds of missed diagnosis in univariate models.

CONCLUSION

We observed individual-level and spatial disparities within the PCOS diagnosis. Further research should explore drivers of disparities for earlier intervention.

New Insights in the Diagnostic Potential of Sex Hormone-Binding Globulin (SHBG)-Clinical Approach

SHBG is a glycoprotein that not only controls serum sex hormone levels but is also strongly correlated with metabolic syndrome, cardiovascular risk, thyroid function, gynecological conditions, and even the process of carcinogenesis. Synthesis of SHBG is controlled by many factors related to obesity, lipogenesis, inflammatory status, and genetic predisposition. By influencing the bioavailability of sex hormones, SHBG regulates their effects not only on the reproductive system, but also cardiomyocytes, vascular epithelium, and more. In this review, we aim to gather and summarize current knowledge on the physiology of SHBG and its association with cardiovascular disease, metabolic syndrome, DM 2, thyroid function, PCOS, hypogonadism, infertility, and its correlations with oral contraception. What is more, genetic alterations are mentioned to highlight SHBG as a potential new diagnostic marker. Furthermore, we assess the clinical usefulness of this parameter in the diagnosis and treatment of patients suffering from the above-specified conditions.

The Role of AMH and AMHR2 Variants in Polycystic Ovary Syndrome: 'A Comprehensive Analysis'

BACKGROUND

Variants in the genes encoding anti-mullerian hormone (AMH) and its receptor 2 (AMHR2) have been identified as potential contributors to the development of polycystic ovary syndrome (PCOS). However, results from association studies examining their role in PCOS have been inconsistent. This study aims to investigate the potential association between AMH and AMHR2 gene variants and the risk of PCOS as well as their influence on serum AMH levels in a Tunisian cohort.

METHODS

The case-control study recruited 327 PCOS women and 396 healthy controls. DNA was extracted and genotyped for three variants in the AMH gene namely, rs4807216, rs10407022 and rs8112524 as well as three variants in the AMHR2 gene, including rs2002555, rs11170553 and rs2272002, using the TaqMan SNP genotyping assay. Fasting serum AMH levels were quantified using ELISA.

RESULTS

Significant metabolic differences were observed in the PCOS cohort, including higher BMI, and elevated levels of AMH, glucose, triglycerides, and cholesterol, along with lower FSH levels. The investigation of genetic associations between AMH and AMHR2 gene variants and PCOS susceptibility revealed notable genotype-specific correlations with lipid profiles. Specifically, the AMH rs8112524 A/A and G/A genotypes were correlated to increased triglyceride levels, while the AMHR2 rs2002555 G/G genotype, as well as the rs11170553 T/T and C/T genotypes, were correlated with decreased HDL levels. However, no significant allelic, genotypic or haplotypic associations were identified, nor was any substantial impact on serum AMH levels observed. Additionally, interaction and epistasis analyses indicated that the AMH and AMHR2 variants had no significant predictive capabilities regarding PCOS susceptibility.

CONCLUSION

Although AMH and AMHR2 variants may not directly influence PCOS susceptibility, they could play a role in modulating lipid metabolism associated with the syndrome.

Pharmacological and Non-Pharmacological Interventions for Polycystic Ovary Syndrome (PCOS) in Indian Women: A Systematic Review and Meta-Analysis

Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder prevalent in women of reproductive age. Treatment or management of this syndrome includes several pharmacological and non-pharmacological treatment approaches for different manifestations of the disease that vary with the patient's age, symptoms, requirements, and geographical location. Objective: This systematic review aims to conduct a comprehensive and evidence-based analysis of the various available treatment options and identify knowledge gaps in PCOS management in India. Methods: A comprehensive search was conducted in PubMed, Scopus, and Embase databases from January 2010 till February 2024. We included randomized control trials (RCTs) using any pharmacological drugs (e.g., insulin sensitizers, anti-androgens, anti-obesity drugs, oral contraceptive pills, ovulation induction drugs, etc.) or non-pharmacological intervention (e.g., yoga, diet, herbal supplements, etc.) with Indian PCOS patients for improving common manifestations of PCOS and written in the English language. Studies were screened by two authors independently in a two-level process. Data extraction was also performed by two authors. Risk of bias was performed using the RoB 2 Tool. Subgroup analysis and meta-analysis were performed using the RevMan tool. Results: Thirty RCTs on pharmacological and eight on non-pharmacological interventions were included in the study. However, all the RCTs were so heterogeneous in terms of intervention used, subject recruited, and outcomes measured that meta-analysis was possible for only three subgroups (metformin vs. inositol, metformin vs. metformin+ inositol, and letrozole vs. clomiphene citrate), with only two or three studies per analysis. Most studies were single-centric and small-sized and had a high risk of bias, limiting their generalizability. Conclusions: This systematic review synthesized existing research and evaluated the effectiveness and safety of existing treatments. Limitations and gaps in the current research were identified, which may inform future research for better understanding and management of PCOS in the Indian context.

Advancement in early diagnosis of polycystic ovary syndrome: biomarker-driven innovative diagnostic sensor

Polycystic ovary syndrome (PCOS) is a heterogeneous multifactorial endocrine disorder that affects one in five women around the globe. The pathology suggests a strong polygenic and epigenetic correlation, along with hormonal and metabolic dysfunction, but the exact etiology is still a mystery. The current diagnosis is mostly based on Rotterdam criteria, which resulted in a delayed diagnosis in most of the cases, leading to unbearable lifestyle complications and infertility. PCOS is not new; thus, constant efforts are made in the field of biomarker discovery and advanced diagnostic techniques. A plethora of research has enabled the identification of promising PCOS diagnostic biomarkers across hormonal, metabolic, genetic, and epigenetic domains. Not only biomarker identification, but the utilization of biosensing platforms also renders effective point-of-care diagnostic devices. Artificial intelligence also shows its power in modifying existing image-based analysis, even developing symptom-based prediction systems for the early diagnosis of this multifaceted disorder. This approach could affect the future management and treatment direction of PCOS, decreasing its severity and improving the reproductive life of women. The rationale of the current review is to identify the advancements in understanding the pathophysiology through biomarker discovery and the implementation of modern analytical techniques for the early diagnosis of PCOS.

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

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

Environmental exposure to selected non-persistent endocrine disrupting chemicals and polycystic ovary syndrome: a systematic review

Polycystic ovary syndrome (PCOS) is an endocrine disorder manifesting with symptoms such as irregular menstrual cycles, hyperandrogenism, and/or polycystic ovaries. The exact cause of PCOS remains unknown, but it is believed to result from a combination of genetic predisposition, insulin resistance, low-grade inflammation, and excessive androgen production. Various environmental factors, especially endocrine-disrupting chemicals (EDCs), in addition to genetic and hormonal ones, also may influence PCOS. This is one of the first systematic reviews dealing with the exposure to non-persistent endocrine disrupting chemicals and PCOS. The review summarizes the existing knowledge about the association of EDCs with PCOS based on significant findings on the toxicity of various non-persistent environmental EDCs and polycyclic ovarian syndrome risk. A systematic search of the literature was conducted in order to identify proper studies using PubMed, Scopus, Elsevier, and Springer databases. The results of the studies suggest that there is a positive association between bisphenol A (BPA), phthalates, octocrylene, and PCOS. The data concerning triclosan and PCOS were inconclusive. Additionally, no link between the exposures to parabens and PCOS was observed. These results of the presented studies highlight the urgent need for continued research on EDCs and their role in PCOS. Int J Occup Med Environ Health. 2025;38(2):98-121.

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

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

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

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

[Multimorbidity in endocrinological diseases: Clinical implications of PCOS]

Polycystic ovary syndrome (PCOS) is one of the most common endocrinological disorders in women of reproductive age. It affects up to 15% of this population worldwide and is characterized by a complex hormonal, metabolic and reproductive dysfunction. In this article, the multimorbidity of PCOS is reviewed, with a particular focus on the clinical implications and management of this complex disorder.

Age at Menarche and Its Potential Role in Early Detection of Hyperandrogenic Polycystic Ovary Syndrome

OBJECTIVES

Polycystic ovary syndrome (PCOS) is a multifaceted heritable endocrine disorder that affects 4%-20% of females worldwide. Characterized by symptoms such as polycystic ovaries, anovulation, and hyperandrogenism, PCOS remains challenging to diagnose, particularly in its early stages. Research suggests that women with PCOS may experience earlier onset of menarche, but the mechanisms behind this association are not well understood. This study explores whether early menarche could serve as an effective diagnostic marker for PCOS.

MATERIALS AND METHODS

A survey was conducted with 95 adult women (ages 19-62), divided into two groups: women diagnosed with PCOS (49%, n = 47) and women without PCOS (51%, n = 48). Participants with PCOS self-identified and were required to meet the Rotterdam Criteria for diagnosis. Notably, all self-identified participants with PCOS exhibited the hyperandrogenic phenotype. Independent samples t-tests and linear regression were used for data analysis.

RESULTS

Women with PCOS reached menarche an average of 1.8 years earlier than those without the condition (mean age 11.4 ± 1.6 years vs. 13.2 ± 1.2 years).

DISCUSSION

These findings suggest that early menarche may be a promising, underexplored indicator of PCOS, offering a potential new avenue for earlier diagnosis of the condition. This could be particularly valuable, as PCOS is often not diagnosed until more classic symptoms, such as anovulation or hirsutism, emerge. Further research is needed to confirm these results and investigate the underlying mechanisms.

Lepidium Sativum Extract Alleviates Reproductive and Developmental Toxicity in Polycystic Ovary Syndrome Induced by Letrozole and High-Fat Diet in Rats

Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by irregular menstrual cycles, hyperandrogenism, and polycystic ovarian morphology, leading to infertility and an increased risk of metabolic dysfunction. This study investigated the protective effects of Lepidium sativum seed extract (LSSE) on fertility and pregnancy outcomes in a rat model of PCOS induced by letrozole and a high-fat diet (HFD) (68% regular rat food pellets, 6% maize oil, 20% milk powder, and 6% ghee). PCOS was induced by oral administration of letrozole, an aromatase inhibitor, (1 mg/kg in 2% DMSO) along with an HFD for four weeks and the results were compared to the metformin antidiabetic agent. Sixty rats were divided into five groups (n = 12): control, PCOS, PCOS + LSSE (250 mg/kg), PCOS + LSSE (500 mg/kg), and metformin (200 mg/kg). Half of the rats were euthanized after four weeks, while the remaining rats were housed with males (1 male: 2 females) for testing pregnancy outcomes. LSSE led to remarkable improvements in body weight, glucose, sex hormonal balance, liver and kidney functions, antioxidant and anti-inflammatory systems, mating and fertility indices, pregnancy outcomes, and fetal morphology. Histologically, LSSE treatment reduced ovarian cyst number and size, and enhanced the blood vessel, Graafian follicle, and endometrial morphologies. LSSE showed dose-dependent effects, with the high-dose demonstrating superior results in the biochemical parameters, while the low-dose showed the most promising pregnancy outcomes. LSSE exhibits potent protective effects against PCOS, surpassing metformin in several aspects. LSSE acts through multi-mechanistic action, including anti-inflammatory, antioxidant, metabolic, and hormone-balancing properties, along with its positive impact on fertility, suggesting that LSSE could be a promising natural alternative for PCOS management.

Polycystic Ovary Syndrome in the Context of Pituitary Adenomas: Prevalence, Pathophysiology and Clinical Management

OBJECTIVE

Many review articles have explored data regarding the coexistence of specific types of pituitary adenomas (PAs) and polycystic ovary syndrome (PCOS), particularly focusing on the potential pathogenesis of this intersection and overlapping features. However, a comprehensive evaluation encompassing the full spectrum of PAs and their association with PCOS remains lacking. This review aims to provide a broad assessment of the interactions between these entities, emphasizing pathophysiological mechanisms, clinical presentations, diagnostic challenges and therapeutic implications.

METHODS

A comprehensive literature search was conducted in the PubMed/MEDLINE database, focusing primarily on publications from the years 2000 to 2024, while also including seminal papers from the 1950s. The reference lists of selected articles were also manually searched. Inclusion criteria encompassed review articles, retrospective studies, clinical trials, case reports and meta-analyses providing data on the pathogenesis, clinical features, diagnostic challenges and therapeutic approaches related to PCOS and different PAs.

RESULTS

PCOS and functioning PAs often exhibit overlapping clinical features, complicating diagnosis and management. PCOS may precede and delay the diagnosis of growth hormone (GH)-secreting adenomas. The prevalence of PCOS or its features in acromegaly is influenced by disease activity, while approximating 13% in cases with controlled disease. Excess GH and insulin-like growth factor 1 (IGF-1) adversely affect ovarian function through direct pathways and by inducing insulin resistance, contributing to acromegaly-associated PCOS. In Cushing's syndrome (CS), findings consistent with PCOS may be present in 46% of patients, with cortisol excess contributing to menstrual dysfunction, hyperandrogenism and insulin resistance. While the prevalence of PCOS in patients with prolactinomas remains under-researched, recent studies indicate a 2.8%-10% prevalence of prolactinomas in PCOS. Elevated prolactin (PRL) levels in these patients may promote insulin resistance, further contributing to PCOS pathogenesis. Moreover, increased androgen bioavailability may be observed in all three aforementioned adenomas. To date, no studies have provided prevalence data for PCOS in other types of PAs.

CONCLUSIONS

Distinct clinical features, along with biochemical evaluations and imaging, can help differentiate the presence of both PAs and PCOS. Moreover, excluding other mimicking disorders is essential for an accurate diagnosis of PCOS. The persistence or recurrence of menstrual dysfunction, hyperandrogenism and metabolic disturbances in patients with controlled functioning adenomas may indicate a coexisting PCOS diagnosis. Timely diagnosis may optimize management and improve long-term outcomes for both conditions. Future studies should focus on investigating the clinical differences between patients with co-occurring PCOS and PAs compared to those with PCOS alone, ideally in larger cohorts, to better understand unique diagnostic and therapeutic considerations.

The possible regulatory role of miRNA-30c-5p, miRNA-545-3p and miRNA-125a-5p in women with polycystic ovary syndrome: A case-control study and signaling pathways

INTRODUCTION

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrinopathy in women of reproductive age. MicroRNA (miRNAs) are small non-coding RNAs related to the control of gene expression in biological fluids. Our study analyzed the expression of miRNAs related to inflammation in individuals with PCOS compared to controls.

METHODS

Twenty patients with PCOS and 20 controls, matched by body mass index and age, were included in the study. The miRNAs evaluated were miRNA-30c-5p; miRNA-545-3p and miRNA-125a-5p.

RESULTS

The expression of the miRNAs was similar between the two groups. A positive correlation was observed between the expression of miRNA-125a-5p and LDLc levels only in the PCOS group. Subsequent analysis of biological pathways showed that miRNA-125a -5p is significantly involved in the regulation of SREBP/SREBF pathways of cholesterol biosynthesis, glycolysis, insulin receptor signaling, oxidative stress-induced senescence and estrogen-dependent gene expression.

CONCLUSION

The results suggest that the miRNA-125a-5p shows a potential implication to the regulation of lipid biosynthesis and LDL-c levels in PCOS women.

Should anti-Müllerian hormone be a diagnosis criterion for polycystic ovary syndrome? An in-depth review of pros and cons

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology (PCOM). Despite the widespread use of the Rotterdam criteria, challenges in diagnostic accuracy persist. Anti-Müllerian hormone (AMH), a glycoprotein secreted by ovarian follicles, has emerged as a promising biomarker for refining diagnosis due to its strong correlation with follicular count and elevated levels in women with PCOS. This review critically evaluates the advantages and limitations of incorporating AMH into PCOS diagnostic criteria. Elevated AMH levels are indicative of PCOM and anovulation, offering a non-invasive diagnostic tool that minimizes interobserver variability in ultrasound-based assessments. Additionally, AMH remains stable throughout the menstrual cycle and aligns with phenotypic diversity in PCOS, potentially supporting individualized management strategies. However, significant challenges remain. Variability in AMH assay methods, the absence of comparable cut-off values, and influences of age, ethnicity, and obesity on AMH levels limit its universal applicability. Additionally, AMH cut-offs for PCOS diagnosis, ranging from 3.5 to 5 ng/mL, raises questions about its clinical relevance, as there is not clear evidence of its biological significance. The review also highlights AMH's clinical utility in reproductive medicine, particularly in predicting ovarian response to stimulation, tailoring gonadotropin dosages, and optimizing assisted reproductive technology outcomes. While AMH holds promise as a complementary diagnostic criterion for PCOS, its fully integration into clinical practice requires further validation through standardized assays, population-specific cut-offs, and robust studies to address existing limitations. In conclusion, AMH harbours the potential to enhance the specificity and sensitivity of PCOS diagnosis, particularly in dubious cases. However, the inclusion of AMH in the current criteria for diagnosing PCOS still requires addressing methodological challenges and balancing its benefits against inherent limitations.

Elastography in Reproductive Medicine, a Game-Changer for Diagnosing Polycystic Ovary Syndrome, Predicting Intrauterine Insemination Success, and Enhancing In Vitro Fertilization Outcomes: A Systematic Review

Background: Elastography is an ultrasound-based imaging technology that allows for quantitative measurement of tissue stiffness and elasticity. In reproductive medicine, it is a potential non-invasive method for assessing ovarian activity, uterine contractility, and endometrial receptivity. While conventional ultrasound provides anatomical and vascular information, it does not assess biomechanical properties, which are important for understanding polycystic ovary syndrome (PCOS), predicting intrauterine insemination (IUI) success, and determining endometrial receptivity in in vitro fertilization (IVF). Methods: A systematic review was conducted in accordance with the PRISMA principles, and the protocol was recorded in PROSPERO. A comprehensive literature search was conducted across several databases to uncover studies that used real-time elastography (RTE) or shear wave elastography (SWE) for PCOS diagnosis, IUI result prediction, or endometrial receptivity evaluation in IVF. The risk of bias was assessed using the ROBINS-I technique. Results: Four studies fulfilled the inclusion criteria. One study indicated that PCOS patients had considerably increased ovarian stiffness, which supports elastography as a diagnostic marker. Another study found that increased uterine flexibility and decreased contractility were related with better IUI outcomes. A retrospective cohort research discovered that non-uniform endometrial echogenicity had no influence on IVF results. Furthermore, SWE successfully evaluated endometrial receptivity in unexplained infertility, with higher stiffness being related to reduced implantation potential. Conclusions: Elastography gives real-time, quantitative insights into reproductive biomechanics, with potential applications in infertility diagnosis and ART improvement. However, the absence of defined imaging procedures and confirmed clinical criteria prevent its broad use. More large-scale prospective investigations are required to improve elastographic parameters and define diagnostic cutoffs for clinical use.

The regulatory interplay between miRNA and DNA methylation orchestrates vital ovarian functions and associated traits in PCOS

Polycystic ovary syndrome (PCOS) is the leading cause of amenorrhea and anovulatory infertility in women of reproductive age. Both gene polymorphisms and tissue-specific epigenetic alterations, which determine gene transcription and translation dynamics in disease-states, strongly influence PCOS development. Particularly, promoter-proximal DNA methylation and microRNA expression changes show strong associations with follicular defects, suggesting post-transcriptional dysregulation of localized gene networks. Our recent methylome study and other studies, posit DNA methylation as a regulator of microRNA expression in PCOS. Here, we identified microRNAs, potentially regulated by DNA methylation, and investigated whether their altered expression influences target gene expression in the PCOS ovary. Using granulosa cell samples of women with PCOS and age-BMI matched controls, we evaluated the transcript levels of 14 microRNAs participating in different ovarian processes and assessed their CpG-DNA methylation levels. For 9 of these microRNAs, which revealed differential methylation consistent with their gene hypomethylation or hypermethylation profiles, we evaluated the expression of their predicted, proteincoding target transcripts. Our data indicated that microRNA hypermethylation and decreased transcription of miR-10b-5p, miR-127-3p, miR-5189, miR-410-3p and miR23a-3p were consistent with the upregulation of PTEN, MMP13, OLR1, TET3 and APAF1 in PCOS. Conversely, microRNA hypomethylation and increased expression of miR-140-5p, miR-182-3p, miR-200b-5p and miR-3687 were consistent with downregulation of FZD6, LRP6, ZEB1 and LDLR. However, these observations need robust validations in larger study cohorts complemented with functional and mechanistic studies. Overall, our study indicates that altered microRNA expression as a consequence of DNA methylation changes, may contribute to metabolic and reproductive dysfunction in PCOS.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Low progesterone levels and their role in the co-existence of polycystic ovary syndrome and rheumatoid arthritis: A comprehensive analysis among Iraqi patient

Polycystic ovarian syndrome (PCOS) is a low-grade and chronic inflammation defined by irregular hormonal status that primarily triggers females in their reproductive age. Multi cysts are a primary manifestation of PCOS; a high level of androgen production characterizes the condition via ovaries. Rheumatoid arthritis (RA) is a chronic, systemic, and symmetrical inflammatory autoimmune disease that affects 1-2 % of adults. Females are more likely to generate RA. During the inflammatory activity, immune cells attack the synovium and the synovial space. This invasion is essential in releasing many cytokines in the synovial and joint spaces, leading to joint damage and pain, stiffens, heat, and tenderness in the joint. To evaluate the strength of the link between PCOS and RA, the cross-sectional study examined hormonal, metabolic, and autoantibodies in PCOS, RA as a positive control and the study groups. Statistical analysis Shapiro-Wilk test, student t-test, one-way ANOVA, and multi-linear regression analysis were used to evaluate the results. The data highlights significant values for the BMI, WHR, and hirsutism of PCOS and RA groups in comparison to the negative control. The ANOVA results of these parameters also showed a significant p < 0.05 among the groups. According to the negative control, the levels of insulin, HOMA-IR, testosterone, LH, estradiol, and CRP showed a substantial increase in the PCOS group. Also, the RA group showed a significant p < 0.05 rise in CRP, RF, and Ani-CCP, and the ANOVA results showed significant value among the groups under investigation. Progesterone D as a model showed a correlation with Anti-CCP B, RF C, Anti-CCP C, CRP D, RF D, and Anti-CCP D with the highest level of f2 between other models. In addition, statistical tests show that progesterone D with R2= 0.565 and RMSE equal to 0.996 have heteroscedasticity, which means that low levels of progesterone are associated inversely with high levels of RF and Anit-CCP. There is a relative association between the progesterone D model and corresponding predictions. Regardless of solid f2, only 56 % of the sample shows an association between the model and predictors; this relation may differ if we consider the study's limitations.

Assessment of Serum Sestrin 2 Levels in Women With Polycystic Ovary Syndrome: A Single-Center Cross-Sectional Case-Control Study

Objective Sestrin 2 (SESN2) is a stress-responsive protein implicated in metabolic regulation and oxidative stress. This study aims to assess serum SESN2 levels in treatment-naive subjects with polycystic ovary syndrome (PCOS) and compare them to healthy controls. Methods The single-center cross-sectional case-control study was conducted from February 2020 to February 2021 at a multispecialty center in Bengaluru, India. The study included 37 newly diagnosed, drug-naive women with PCOS and 46 healthy, age-matched and body mass index (BMI)-matched controls. SESN2 levels, along with anthropometric and metabolic parameters, were measured for both groups. Ethical approval was obtained, and all participants provided informed consent. Results The study involved 83 participants, divided into two groups: 37 patients with PCOS and 46 healthy controls. Significant differences were observed between the groups in terms of weight, hip circumference, and serum SESN2 levels. The PCOS group had higher weight (P=0.024) and larger hip circumference (P=0.037), while the control group exhibited a higher waist-to-hip ratio (WHR) (P=0.007). Although no statistically significant difference was found in body mass index (BMI), the PCOS group showed elevated serum SESN2 levels (P=0.024). Correlation analysis revealed a negative correlation between follicle-stimulating hormone (FSH) and SESN2 levels in the PCOS group. Receiver operating characteristic (ROC) curve analysis determined a SESN2 cutoff of 1.484 ng/mL, which demonstrated moderate sensitivity and specificity for distinguishing PCOS patients from healthy controls. Conclusion SESN2 levels were significantly higher in PCOS patients, with moderate correlations observed with metabolic and anthropometric parameters. SESN2 may play a role in the hormonal and metabolic disturbances characteristic of PCOS, highlighting its potential as a biomarker for PCOS diagnosis and management.

Management of Adolescent Obesity

This article provides a contemporary review of adolescent obesity management, focusing on the importance of a comprehensive and multidisciplinary approach. It highlights the necessity of integrating lifestyle/behavioral modifications, pharmacologic interventions, and surgical options where applicable, tailored to the individual needs of adolescents to effectively combat obesity and its associated risks.

BMAL1 improves assisted reproductive technology outcomes in patients with polycystic ovary syndrome by targeting BMP6 and regulating ovarian granulosa cell apoptosis

PURPOSE

To investigate BMAL1 and BMP6 expressive differences in ovarian granulosa cells (OGCs) of patients with polycystic ovary syndrome (PCOS), explore regulatory relationship, assess their impacts on OGC proliferation and apoptosis, and analyze their correlations with ART outcomes of patients.

METHODS

A clinical study selected 40 PCOS patients who underwent IVF/ICSI in our hospital from January to October 2022 and 39 controls with male or tubal factor infertility. RT-qPCR and Western blot assessed BMAL1 and BMP6 mRNA/protein levels. The number of oocytes retrieved, 2PN fertilized oocytes, available embryos, and high-quality embryos were compared between groups and analyzed their correlations with BMAL1 and BMP6 expression levels. Cellular experiments were performed by overexpressing or knocking down BMAL1 in KGN cells by plasmid transfection. The dual-luciferase reporter assay was used to identify BMAL1/BMP6 regulatory relationship. CCK-8 and flow cytometry assessed cellular proliferation and apoptosis.

RESULTS

BMAL1 mRNA/protein expression (P < 0.001) in the PCOS group was significantly lower than that in controls, as was the number of high-quality embryos (P = 0.001). Contrastingly, BMP6 (P < 0.001) was significantly higher in the PCOS group. BMAL1 expression levels were negatively correlated with BMP6 (r = - 0.684, P = 0.002) and positively correlated with the number of 2PN fertilized oocytes, available embryos, and high-quality embryos (r = 0.659, P = 0.003; r = 0.623, P = 0.006; and r = 0.738, P < 0.001). Cellular experiments showed that overexpression of BMAL1 significantly decreased relative luciferase activity (P < 0.01). Overexpression of BMAL1 significantly decreased KGN cell apoptosis (P < 0.01) and enhanced proliferation (P < 0.01).

CONCLUSION

BMAL1 regulates OGCs proliferation and apoptosis by targeting BMP6, thereby influencing ART outcomes in patients with PCOS. This study might provide molecular factors that indicate ART outcomes and therapeutic targets for PCOS.

TRIAL REGISTRATION

Registration number: ChiCTR2100052331; registration date: 2021-10-24.

Insight into metabolic dysregulation of polycystic ovary syndrome utilizing metabolomic signatures: a narrative review

Polycystic ovary syndrome (PCOS) is a complex multifactorial endocrinopathy affecting reproductive aged women globally, whose presentation is strongly influenced by genetic makeup, ethnic, and geographic diversity leaving these affected women substantially predisposed to reproductive and metabolic perturbations. Sophisticated techniques spanning genomics, proteomics, epigenomics, and transcriptomics have been harnessed to comprehensively understand the enigmatic pathophysiology of PCOS, however, conclusive markers for PCOS are still lacking today. Metabolomics represents a paradigm shift in biotechnological advances enabling the simultaneous identification and quantification of metabolites and the use of this approach has added yet another dimension to help unravel the strong metabolic component of PCOS. Reports dissecting the metabolic signature of PCOS have revealed disparate levels of metabolites such as pyruvate, lactate, triglycerides, free fatty acids, carnitines, branched chain and essential amino acids, and steroid intermediates in major biological compartments. These metabolites have been shown to be altered in women with PCOS overall, after phenotypic subgrouping, in animal models of PCOS, and also following therapeutic intervention. This review seeks to supplement previous reviews by highlighting the aforementioned aspects and to provide easy, coherent and elementary access to significant findings and emerging trends. This will in turn help to delineate the metabolic plot in women with PCOS in various biological compartments including plasma, urine, follicular microenvironment, and gut. This may pave the way to design additional studies on the quest of unraveling the etiology of PCOS and delving into novel biomarkers for its diagnosis, prognosis and management.

Visceral and Dysfunctional Adiposity Indices as Predictors of Insulin Resistance and Metabolic Syndrome in Women with Polycystic Ovary Syndrome: A Cross-Sectional Study

Background and Objectives: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Women with PCOS often have metabolic disorders such as insulin resistance (IR), type 2 diabetes (T2DM), obesity, and metabolic syndrome (MetS). The assessment of visceral adiposity and dysfunctional adipose tissue is crucial for understanding the metabolic risks associated with PCOS. The visceral adiposity index (VAI) and the dysfunctional adiposity index (DAI) are two novel metabolic indices that more specifically assess adipose tissue dysfunction and visceral fat accumulation. This study aimed to evaluate the clinical utility of VAI and DAI as predictive markers for metabolic complications such as insulin resistance (IR) and metabolic syndrome (MetS) in women with PCOS. Materials and Methods: This cross-sectional study included 92 women diagnosed with PCOS based on the 2023 revised Rotterdam criteria, as well as 68 healthy controls. Anthropometric and biochemical parameters, including fasting glucose, insulin, lipid profile, and hormonal markers, were recorded. VAI and DAI were calculated using established formulas derived from previous validated studies. Results: The mean VAI in PCOS patients was 4.26 ± 3.23, compared to 2.61 ± 1.92 in controls (p = 0.003). The mean DAI in PCOS patients was 3.00 ± 1.86, while in controls it was 1.86 ± 1.22 (p = 0.003). Both VAI (Area Under the Curve [AUC] = 0.639) and DAI (AUC = 0.635) did not demonstrate statistically significant diagnostic performance for PCOS itself, but they were strongly associated with metabolic disturbances within the PCOS group. VAI and DAI values were significantly elevated in PCOS patients with IR (p < 0.001) and MetS (p < 0.001). For MetS in PCOS patients, VAI demonstrated the highest predictive ability, with an AUC of 0.87 and a cutoff of 4.73 (sensitivity 62%, specificity 92%), while DAI had an AUC of 0.86 with a cutoff of 2.44 (sensitivity 74%, specificity 80%). Regarding IR in PCOS patients, VAI had an AUC of 0.75 with a cutoff of 2.56 (sensitivity 82%, specificity 56%), while DAI had an AUC of 0.74 with a cutoff of 1.59, showing a sensitivity of 82% and a specificity of 55%. Conclusions: Although VAI and DAI are not suitable for diagnosing PCOS, they provide valuable insights into the metabolic risks associated with the condition. VAI and DAI can serve as promising biomarkers for identifying IR and MetS risk in women with PCOS. Their integration into clinical practice may facilitate the early detection of cardiometabolic complications, offering a more specific metabolic risk assessment compared to traditional anthropometric measures.

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.

Analysis of mutations in mitochondrial transfer RNA genes and the maternal inheritance of polycystic ovary syndrome

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Despite the escalating global prevalence, there is currently no definitive predisposition test available for this condition. Among the genetic causes, variations in the mitochondrial DNA (mtDNA) are increasingly recognized as a crucial contributor to the development of PCOS. However, cross-ethnic analysis of these mutations is lacking. To fill in this gap, our objective is to identify new maternal genetic risk factors associated with PCOS by investigating the mitochondrial transfer RNA (mt-tRNA) genes in PCOS patients from Pakistan and to compare these mutations to those in patients from other ethnic groups.

Methods

DNA was extracted from saliva samples of patients. Primers were designed for the amplification of all of 22 mt-tRNA genes, and PCR was employed under defined conditions. Subsequently, Sanger sequencing was employed to decipher the sequences of mt-tRNA genes. Following sequencing, mt-tRNA genes underwent mutation analysis. Finally, we utilized MitoTIP (Mitochondrial tRNA Informatics Predictor) to identify variations in mt-tRNA genes.

Results

In a cohort of 64 Pakistani patients with PCOS, our analysis unveiled eight variants in five mt-tRNA genes including MT-TH, MT-TL2, MT-TS1, MT-TS2, and MT-TT genes. All of these variants have not been previously reported in PCOS except one we have recently identified in a Pakistani patient with PCOS. Interestingly, most of these mt-tRNA genes carry variants found in patients with PCOS across distinct ethnic groups. Furthermore, these mutations occurred in highly conserved nucleotides of tRNA, essential for ensuring the stability and biochemical functionality of mt-tRNA. Finally, the pathogenic potential of these variations was assessed by in silico analysis. The pathogenicity prediction of these variants suggests their potential impact on mitochondrial dysfunction that was responsible for the clinical phenotypes of PCOS.

Conclusion

Our study identified novel variations in mt-tRNA genes in Pakistani women with PCOS. To our knowledge, this is the first report comparing mutations of mt-tRNA genes in PCOS patients across different ethnic groups. Our data revealed common mt-tRNA genes carrying PCOS-associated mutations that may be specific to certain ethnic populations. Together, our work provides new insights into the role of mt-tRNA genes in mitochondrial dysfunction underlying the pathophysiology of PCOS, highlighting mt-tRNA mutations as potential factors for future predisposition tests and more effective therapies for this globally prevalent condition.

Determinants of Health Care Dissatisfaction Among a US Population-Based Cohort of Women With Polycystic Ovary Syndrome

CONTEXT

The 2018 International Evidence-Based Guidelines (IEBG) for polycystic ovary syndrome (PCOS) were created, in part, in response to poor patient satisfaction on international surveys. Patient satisfaction in the United States before and after these guidelines has not yet been characterized.

OBJECTIVE

To evaluate care patterns and patient attitudes among US women with PCOS before and after IEBG.

METHODS

This was a cross-sectional study of a population-based community sample of US women with confirmed PCOS who completed standardized questionnaires on care patterns and satisfaction in care.

RESULTS

Among 1056 respondents, aged 23 ± 6 years at diagnosis, 69.2% had to wait ≥ 1 year and 72.9% saw > 1 provider prior to receiving a diagnosis. Less than 45% strongly agreed or agreed with statements regarding trusting their doctor and < 27% were very or somewhat satisfied with care across all questions. In multivariable analyses, composite outcome of trusting your physician was associated with insurance type (uninsured vs private) (odds ratio [95% CI] 0.5 [0.3-0.9], P = .020), race (Hispanic vs Caucasian) (0.6 [0.5-0.9], P = .007), (Black vs Caucasian) (1.6 [1.0-2.4], P = .045) and timing of diagnosis (within 5 years vs > 5 years) (1.3 [1.0-1.7], P = .038). Care satisfaction was associated with insurance type (public vs private) (0.6 [0.4-0.9], P = .010), (uninsured vs private) (0.5 [0.3-0.9], P = .021), and timing of diagnosis (within 5 years vs > 5 years) (1.4 [1.1-1.9], P = .010).

CONCLUSION

Satisfaction and trust in care is overall poor among US patients with PCOS. Higher scores among those diagnosed within the past 5 years, compared to those with a more remote diagnosis, may indicate an improving trend in care.

Ultrasound Assessment in Polycystic Ovary Syndrome Diagnosis: From Origins to Future Perspectives-A Comprehensive Review

Background: Polycystic ovary syndrome (PCOS) is the most prevalent endocrinopathy in women of reproductive age, characterized by a broad spectrum of clinical, metabolic, and ultrasound findings. Over time, ultrasound has evolved into a cornerstone for diagnosing polycystic ovarian morphology (PCOM), thanks to advances in probe technology, 3D imaging, and novel stromal markers. The recent incorporation of artificial intelligence (AI) further enhances diagnostic precision by reducing operator-related variability. Methods: We conducted a narrative review of English-language articles in PubMed and Embase using the keywords "PCOS", "polycystic ovary syndrome", "ultrasound", "3D ultrasound", and "ovarian stroma". Studies on diagnostic criteria, imaging modalities, stromal assessment, and machine-learning algorithms were prioritized. Additional references were identified via citation screening. Results: Conventional 2D ultrasound remains essential in clinical practice, with follicle number per ovary (FNPO) and ovarian volume (OV) functioning as primary diagnostic criteria. However, sensitivity and specificity values vary significantly depending on probe frequency, cut-off thresholds (≥12, ≥20, or ≥25 follicles), and patient characteristics (e.g., adolescence, obesity). Three-dimensional (3D) ultrasound and Doppler techniques refine PCOS diagnosis by enabling automated follicle measurements, stromal/ovarian area ratio assessments, and evaluation of vascular indices correlating strongly with hyperandrogenism. Meanwhile, AI-driven ultrasound analysis has emerged as a promising tool for minimizing observer bias and validating advanced metrics (e.g., SA/OA ratio) that may overcome traditional limitations of stroma-based criteria. Conclusions: The continual evolution of ultrasound, encompassing higher probe frequencies, 3D enhancements, and now AI-assisted algorithms, has expanded our ability to characterize PCOM accurately. Nevertheless, challenges such as operator dependency and inter-observer variability persist despite standardized protocols; the integration of AI holds promise in further enhancing diagnostic accuracy. Future directions should focus on robust AI training datasets, multicenter validation, and age-/BMI-specific cut-offs to optimize the balance between sensitivity and specificity, ultimately facilitating earlier and more precise PCOS diagnoses.

The association between the follicular distribution pattern of polycystic ovaries and metabolic syndrome development in patients with polycystic ovary syndrome a prospective cohort study

Since a limited number of studies have investigated the different pattern of follicular distribution in the ovaries of PCOS patient, the present study was designed to evaluate the relationship of the follicular distribution pattern (FDP) in the ovaries and MetS as well as insulin resistance index, the sex hormones levels and menstrual status in women with PCOS diagnosis. This prospective study was carried out at Arash Women's Hospital (Tehran, Iran) from September 2023 to June 2024. All PCOS women who were referred for any gynecological examination were screened. The ultrasound images of polycystic ovarian morphology ovaries were further classified as having a peripheral cystic pattern (PCP) if the follicles were arranged at the periphery of the ovary, or a general cystic pattern (GCP) if the follicles were dispersed heterogeneously throughout the ovarian stroma. The association between the ultrasound follicular distribution patterns and the reproductive items (menstrual status, sex hormones levels and Ferriman-Gallwey score), as well as the metabolic features (insulin resistance index and the MetS rate) were evaluated. Of the 108 PCOS patients evaluated during the study, 51 patients were classified in the PCP ovaries group and 57 patients in the GCP ovaries group. There was no statistically significant difference in terms of women' age, body mass index, waist circumstance, and the Ferriman-Gallwey score between groups. The frequency of cases with oligo menorrhea in the PCP group was significantly higher than the GCP group (P = 0.006). However, no significant relationship was found between FDP and the baseline serum hormonal levels, total testosterone, and insulin resistance index as well as MetS rate and any components of MetS. No association was identified between the FDP and the rate of MetS, as well as other sex hormones, glucose, and lipids profiles in patients with PCOS; however, the PCP ovaries was linked to menstrual irregularities.

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

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

Insulin Resistance in an Underweight Woman with Polycystic Ovary Syndrome: A Case Study

BACKGROUND Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrine disorders affecting women of reproductive age. PCOS has a typical presentation with obesity, hirsutism, and menstrual irregularity but can also be associated with insulin resistance and an increased risk of type 2 diabetes mellitus. This report presents the case of a 24-year-old underweight woman with a body mass index (BMI) of 15.9 kg/m2 with insulin resistance, hirsutism, and a diagnosis of PCOS. CASE REPORT A 24-year-old woman presented with hyperandrogenic signs, hirsutism, acne, and irregular menstrual cycles. During the clinical examination, acne vulgaris on the face was recorded, but not alopecia or acanthosis nigricans. Blood pressure was 110/70 mmHg, WHR (waist-to-hip-ratio)=87 and BMI (body mass index)=15.9. Ferriman-Gallwey's scoring system was used to assess for hirsutism. All hematological and biochemical results were normal. Hormonal tests revealed elevated testosterone, androstenedione, and 17-OH progesterone levels, confirming the diagnosis. Conditions such as Cushing's syndrome, hyperprolactinemia, and thyroid disorders were excluded based on normal levels of adrenocorticotropic hormone, cortisol, prolactin, triiodothyronine, thyroxine, and thyroid-stimulating hormone. Despite the patient's underweight status, insulin resistance was identified with OGTT (oral glucose tolerance test), making it the primary treatment target. Treatment addressed the underlying pathology with metformin and dexamethasone. Significant improvement in menstrual cycle, acne, and hirsutism was observed after 6 months. CONCLUSIONS This report has highlighted that when patients with PCOS also have insulin resistance, they may be of normal weight or underweight and require a multidisciplinary approach to diagnosis and management.

Targeting UGT2B15 and NR1H4 interaction: a novel therapeutic strategy for polycystic ovary syndrome using naftopidil enantiomers

BACKGROUND

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age. It is characterized by hyperandrogenism, ovulatory dysfunction, and the presence of polycystic ovarian morphology (PCOM) on ultrasound, often accompanied by metabolic disturbances such as insulin resistance and obesity. Current treatments, including oral contraceptives and anti-androgen medications, often yield limited efficacy and undesirable side effects. This study investigates the role of UGT2B15, an essential enzyme for androgen metabolism, in PCOS pathogenesis and its potential as a therapeutic target.

METHODS

We used RNA sequencing to examine the effects of UGT2B15 knockdown in KGN cells. To modulate UGT2B15 expression, we employed siRNA and (R)/(S)-NAF (naftopidil), a chemical inducer of UGT2B15 identified in our previous studies on a prostate hyperplasia model. The effects of siRNA and (R)/(S)-NAF on dihydrotestosterone (DHT) levels, cell apoptosis, and the expression of apoptosis-related proteins in KGN cells were evaluated. In a PCOS mouse model, we assessed the effects of (R)-NAF and (S)-NAF on serum androgen levels, menstrual cycles, ovarian morphology, and UGT2Bs expression. Additionally, luciferase reporter and ChIP assays were utilized to study UGT2B15 regulation by NR1H4.

RESULTS

Elevated androgens were found to suppress UGT2B15 expression in ovarian granulosa cells, leading to DHT accumulation and apoptosis. (R)-NAF and (S)-NAF treatments reversed these effects, alleviating PCOS symptoms in mice such as hyperandrogenism, irregular menstrual cycles, and the presence of ovarian cysts. NR1H4 negatively regulated the transcription of UGT2B15 in KGN cells. (R)-NAF and (S)-NAF disrupted NR1H4 binding to the UGT2B15 promoter without affecting its protein levels, indicating direct interference with its regulation.

CONCLUSIONS

UGT2B15 represents a promising target for novel PCOS therapies by modulating androgen metabolism and protecting ovarian granulosa cells from apoptosis. (R)-NAF and (S)-NAF regulate UGT2B15 by disrupting NR1H4's binding to its promoter, implying potential therapeutic compounds for PCOS treatment.

Association of Glycemic Index, Glycemic Load, and Carbohydrate Intake with Antral Follicle Counts Among Subfertile Females

BACKGROUND/OBJECTIVES

Few studies have investigated the association of dietary glycemic index (GI), glycemic load (GL), and carbohydrate intake with antral follicle count (AFC). This study aimed to investigate the association of total carbohydrate intake and carbohydrate quality, measured by dietary GI and GL, with ovarian reserve assessed by AFC.

METHODS

This study included 653 females from the Environment And Reproductive Health Study who completed AFC and food frequency questionnaire. Of these, 579 female individuals had a quantifiable AFC in both ovaries and were included in the primary analysis. We estimated average GI and GL for each participant from self-reported intakes of carbohydrate-containing foods and divided participants into tertiles. Poisson regression models were used to quantify the relations of GI, GL, carbohydrates, and AFC while adjusting for potential confounders.

RESULTS

Participants had a median age of 35 y. Compared to participants in the lowest tertile of dietary GI, those in the highest tertile had a 6.3% (0.6%, 12.3%) higher AFC (p, trend 0.03) after adjustment for potential confounders. Stratified analyses revealed that the association between GI and AFC was present only among participants who had not undergone infertility evaluations.

CONCLUSIONS

A higher dietary GI was associated with a higher AFC. Subgroup analyses among individuals who had not had a diagnostic evaluation of infertility before joining the study suggest that high-glycemic carbohydrates may be related to PCOM.

Ovarian dysfunction and polycystic ovary syndrome in the U.S. military active component, 2014-2023

This retrospective cohort study examined ovarian dysfunction diagnosis incidence among female active component service members in the U.S. military from 2014 to 2023 using medical encounter data from the Defense Medical Surveillance System. Ovarian dysfunction diagnosis incidence gradually increased during this period, driven almost entirely by polycystic ovary syndrome (PCOS), of which the incidence increased from 32.0 cases per 10,000 person-years in 2014 to 60.3 cases per 10,000 person-years in 2023. Increases occurred among all demographic subcategories. This study also assessed independent association between ovarian dysfunction and socio-demographic and medical covariates, including COVID-19 infection and vaccination status. History of obesity had the strongest association with PCOS incidence, with an adjusted incident rate ratio (aIRR) of 2.5 and 95% confidence interval (CI) of 2.3-2.6. COVID-19 infection was modestly associated with PCOS incidence (aIRR 1.2; 95% CI, 1.1-1.3). COVID-19 vaccination status was not independently associated with increased PCOS incidence. A potential contributing factor of increased PCOS diagnosis incidence is that recent updates to the diagnostic criteria enabled more clinical and telehealth diagnoses. The increased incidence may also reflect the increasing rate of obesity and other related health burdens in the U.S. military. Incidence of diagnosis of ovarian dysfunction, driven almost entirely by PCOS, increased steadily among female active component service members from 2014 to 2023. This increase in incidence was observed in all demographic subgroups and had the strongest independent association with pre-existing obesity.

Association of polycystic ovary syndrome with endothelial health, cardiovascular risk, and cellular aging

OBJECTIVE

To study measures of endothelial health, cardiovascular risk, and cellular aging between patients with polycystic ovary syndrome (PCOS) and a reproductive age normative cohort.

DESIGN

Cross-sectional study.

SUBJECTS

Community-based patients with PCOS and a normative ovarian aging cohort as controls, aged ≤45 years at the time of evaluation.

EXPOSURE

Noninvasive measure of endothelial health measured by the EndoPAT reactive hyperemia index.

MAIN OUTCOME MEASURES

Reactive hyperemia index as measure of endothelial health. The secondary outcomes included Framingham score, telomere length, and mitochondrial deoxyribonucleic acid copy number from leukocyte cells.

RESULTS

Our cohort included 63 participants with PCOS and 130 non-PCOS participants. The mean age was significantly lower in the PCOS cohort (33.1; standard deviation, 4.7 years) than in the non-PCOS cohort (40.8; standard deviation, 2.9 years). In multivariable-adjusted models, we found that PCOS was significantly associated with endothelial dysfunction as both categorical (odds ratio for PCOS, 0.31; 95% confidence interval [CI], 0.10-0.97) and continuous (PCOS coefficient, -0.37; 95% CI, -0.69 to -0.05) outcomes. For secondary outcomes, PCOS status was not significantly associated with mitochondrial deoxyribonucleic acid (PCOS coefficient, -48.1; 95% CI, -175.0 to 78.9), telomere length (PCOS coefficient, 0.05; 95% CI, -0.05 to 0.15), Framingham score (PCOS coefficient, 0.002; 95% CI, -0.01 to 0.02), or metabolic syndrome (odds ratio for PCOS, 1.29; 95% CI, 0.31-5.44).

CONCLUSION

Our findings suggest that patients with PCOS have impaired endothelial function compared with non-PCOS patients, although measures of cellular aging and cardiovascular risk as measured by the Framingham score did not differ between the cohorts.

T cells are necessary for development of PCOS reproductive symptoms in a letrozole-induced mouse model of PCOS

Polycystic ovary syndrome (PCOS) is a complex condition with clear genetic susceptibilities that impact the heterogeneous clinical presentation of symptoms and severity through unknown mechanisms. Chronic inflammation is linked to PCOS, but a clear cause-and-effect relationship has yet to be established. This study used an in depth systems immunology approach and a letrozole-induced PCOS mouse model to identify changes in inflammatory factors associated with PCOS symptoms. By analyzing immune cells and secreted cytokines from 22 different mouse strains, we identified TNF-β as a key T cell-derived cytokine associated with PCOS, regardless of genetic background. We confirmed elevated TNF-β transcripts in immune cells from women with PCOS. Importantly, we used a knockout of TCRα to show that functional T cells are a necessary component of driving PCOS features in letrozole-treated female mice. These findings implicate T cells and specifically TNF-β production in the development of PCOS impairments. T cells are therefore an attractive target for the future development of anti-inflammatory therapeutics to improve PCOS symptoms.

The Role of the Liver in the Pathophysiology of PCOS: A Literature Review

Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder found in women of reproductive age and is characterized by both metabolic and reproductive dysfunction. Women with PCOS commonly have insulin resistance, increased susceptibility to type 2 diabetes mellitus, dyslipidemia, hyperinsulinemia, increased cardiovascular risk, hepatic steatosis, infertility, and an overall reduction in physical and psychological well-being. Several previous studies have shown a causal association between PCOS and hepatic disorders, such as chronic liver disease (CLD) and nonalcoholic fatty liver disease (NAFLD), where PCOS was identified as contributing to the hepatic features. Whilst it is recognized that PCOS may contribute to hepatic dysfunction, there is also evidence that the liver may contribute to the features of PCOS. The purpose of this review is to discuss the current understanding regarding hepatic involvement in PCOS pathophysiology, the inflammatory markers and hepatokines involved in the development of PCOS, and the role of genetics in the occurrence of PCOS. This review illustrates that PCOS and NAFLD are both common disorders and that there is both genetic and metabolic linkage between the disorders. As such, whilst PCOS may contribute to NAFLD development, the converse may also be the case, with a potential bidirectional relationship between PCOS and liver disease.

Reproductive Endocrine Disorders: A Comprehensive Guide to the Diagnosis and Management of Infertility, Polycystic Ovary Syndrome, and Endometriosis

Reproductive endocrine disorders, including infertility, polycystic ovary syndrome (PCOS), and endometriosis, significantly impact women's reproductive health and overall well-being. This comprehensive review explores the diagnosis and management strategies for these prevalent conditions. Infertility, affecting millions globally, is often linked to ovulatory dysfunction, PCOS, and endometriosis. PCOS is characterized by hyperandrogenism, menstrual irregularities, and insulin resistance, contributing to anovulation and infertility. The Rotterdam criteria are widely used for PCOS diagnosis, and management includes lifestyle modifications, pharmacological treatments like ovulation inducers, and, in some cases, surgical interventions. Endometriosis, caused by the presence of endometrial-like tissue outside the uterus, leads to chronic pain and infertility through inflammation, adhesions, and impaired ovarian function. Laparoscopy remains the gold standard for diagnosing endometriosis, and treatment focuses on pain relief, fertility preservation, and reducing recurrence. In cases of endometriosis-related infertility, assisted reproductive technologies (ARTs) like in vitro fertilization (IVF) are often recommended. In addition, the role of diet and lifestyle changes in managing these conditions is gaining recognition. This review emphasizes the complexity of reproductive endocrine disorders and underscores the need for individualized treatment plans, combining medical, surgical, and lifestyle approaches to improve fertility outcomes and enhance the quality of life for affected women. The review also highlights the importance of early diagnosis and advances in therapeutic interventions to ensure optimal patient care in the management of infertility, PCOS, and endometriosis.

Polycystic Ovary Syndrome and Eating Disorders-A Literature Review

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects women of reproductive age and is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology. PCOS is often associated with hormonal imbalances, metabolic dysfunction and comorbid psychiatric disorders, including eating disorders (EDs). The review identifies key hormonal factors-serotonin, leptin, insulin, ghrelin, kisspeptin and cortisol-and their roles in the pathophysiology of PCOS and associated psychiatric symptoms. Serotonin deficiency, commonly seen in PCOS patients, is associated with mood and eating disorders. Fluctuations in leptin, the satiety hormone, affect hypothalamic-pituitary-ovarian axis function and ovarian follicle maturation, increasing the risk of infertility. Elevated levels of kisspeptin in PCOS patients contribute not only to hormonal dysregulation but also to increased susceptibility to eating disorders such as bulimia and binge eating, likely due to its influence on the limbic system and glucose metabolism. Hyperinsulinemia and insulin resistance further impair reproductive and metabolic health, while promoting eating disorders such as binge eating and bulimia. Ghrelin and cortisol also emerge as significant factors. The review emphasizes the bidirectional relationship between PCOS and eating disorders, in which hormonal imbalances perpetuate psychiatric conditions, creating a vicious cycle. A multidisciplinary approach including gynecologists, endocrinologists, psychiatrists and nutritionists is recommended to ensure complex treatment. Early identification of those at risk through targeted screening and personalized interventions is key. Future research should focus on discovering the underlying hormonal mechanisms to improve treatment strategies and quality of life for women with PCOS.

Unveiling the molecular landscape of PCOS: identifying hub genes and causal relationships through bioinformatics and Mendelian randomization

Background

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder with various contributing factors. Understanding the molecular mechanisms underlying PCOS is essential for developing effective treatments. This study aimed to identify hub genes and investigate potential molecular mechanisms associated with PCOS through a combination of bioinformatics analysis and Mendelian randomization (MR).

Methods

This study employed bioinformatics analysis in conjunction with MR methods using publicly available databases to identify hub genes. We employed complementary MR methods, including inverse-variance weighted (IVW), to determine the causal relationship between the hub genes and PCOS. Sensitivity analyses were performed to ensure results reliability. Enrichment analysis and immune infiltration analysis were further conducted to assess the role and mechanisms of hub genes in the development of PCOS. Additionally, we validated hub gene expression in both an animal model and serum samples from PCOS patients using qRT-PCR.

Results

IVW analysis revealed significant associations between 10 hub genes and the risk of PCOS: CD93 [P= 0.004; OR 95%CI= 1.150 (1.046, 1.264)], CYBB [P= 0.013; OR 95%CI= 1.650 (1.113,2.447)], DOCK8 [P= 0.048; OR 95%CI= 1.223 (1.002,1.494)], IRF1 [P= 0.036; OR 95%CI= 1.343 (1.020,1.769)], MBOAT1 [P= 0.033; OR 95%CI= 1.140 (1.011,1.285)], MYO1F [P= 0.012; OR 95%CI= 1.325 (1.065,1.649)], NLRP1 [P= 0.020; OR 95%CI= 1.143 (1.021,1.280)], NOD2 [P= 0.002; OR 95%CI= 1.139 (1.049,1.237)], PIK3R1 [P= 0.040; OR 95%CI= 1.241 (1.010,1.526)], PTER [P= 0.015; OR 95%CI= 0.923 (0.866,0.984)]. No heterogeneity and pleiotropy were observed. Hub genes mainly enriched in positive regulation of cytokine production and TNF signaling pathway, and exhibited positive or negative correlations with different immune cells in individuals with PCOS. qRT-PCR validation in both the rat model and patient serum samples confirmed hub gene expression trends consistent with our combined analysis results.

Conclusions

Our bioinformatics combined with MR analysis revealed that CD93, CYBB, DOCK8, IRF1, MBOAT1, MYO1F, NLRP1, NOD2, PIK3R1 increase the risk of PCOS, while PTER decreases the risk of PCOS. This discovery has implications for clinical decision-making in terms of disease diagnosis, prognosis, treatment strategies, and opens up novel avenues for drug development.

The Effect of Bisphenol and Its Cytotoxicity on Female Infertility and Pregnancy Outcomes: A Narrative Review

Bisphenols, particularly bisphenol A (BPA), are among the most thoroughly investigated endocrine disrupting chemicals (EDCs). BPA was the first synthetic estrogen to be identified, exerting its estrogenic effects through interaction with human estrogen receptors (ERs). The aim of the present narrative review is to summarize the most recent literature regarding the adverse effects of bisphenols on female fertility and pregnancy outcomes. A review of the literature in the PubMed/Medline and Scopus databases was conducted in November 2024 and 15 studies were included in the present review. BPA levels were higher in women with diminished ovarian reserve, polycystic ovary syndrome, and recurrent miscarriages. Furthermore, one study showed a significant association between BPA levels and the onset of gestational diabetes mellitus. Higher levels of BPA are associated with disruptions to the female reproductive system, such as ovarian function, reduced number of antral follicles, and lower anti-Müllerian hormone (AMH) levels. Bisphenols A and S were associated with an increased risk of developing gestational diabetes mellitus. Bisphenols A and F were correlated with an increased risk of lower birth weight and bisphenol F seemed to be associated with an increased risk of preterm delivery. Ultimately, further research is necessary to fully understand the extent of the harmful effects that bisphenols have separately and as mixtures on the female reproductive system.

Assessment of factors related to poly cystic ovarian syndrome - A comparative and correlational study

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder that primarily affects women of reproductive age. It is particularly prevalent among adolescent females who receive an insufficient diagnosis despite having potentially adverse consequences. The use of PCOS screening questionnaires has the potential to aid in the early detection of symptoms. The goal of this study is to observe if a self-administered questionnaire may be useful for a clear cognizance of the associated conditions like mental stress and menstrual characteristics correlated to polycystic ovary syndrome. In this study, we selected women within an age group of 17-40 with and without PCOS based on the modified Rotterdam criteria to fill out a self-administrated questionnaire based on the signs and symptoms of PCOS majorly focusing on mental stress and menstrual characteristics. SPSS software, univariate analyses were employed to elucidate the associations among the components of PCOS, demographic factors, and lifestyle characteristics, hence providing insights into the interrelationships among those variables. 64 women with PCOS and 141 women without PCOS participated in the present study. The present study revealed PCOS is greatly influenced by age at menarche (p-value= .043), typical cycle length (p-value = .000) mental health problems during menstruation (p-value = .032), and body mass index (p-value = .001). Multivariate hierarchical logistic regression analysis showed only 2 variables BMI (a-OR 1.156,95% CI (1.067-1.242), p-value = .000), and typical cycle length (a-OR 2.278, 95% CI (1.079-4.809), p-value = .003) were significant. The present study showed that BMI and menstrual cycle length were most closely associated with the incidence of PCOS, which is important in diagnosing and treating the condition. Considering the high incidence of PCOS among women of reproductive age and its potential for significant health implications, it would be prudent to incorporate inquiries regarding mental health concerns and menstrual patterns into routine medical assessments for this demographic analysis. This approach aims to ascertain whether additional diagnostic evaluations and screenings for PCOS are warranted.