101
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Shah D, Rasool S. Ethnicity in polycystic ovary syndrome. Climacteric 2023; 26:15-20. [PMID: 36459492 DOI: 10.1080/13697137.2022.2144211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the commonest gynecological endocrinopathy. Little is known about the exact etiopathogenesis and cardiometabolic mortality and morbidity in women with PCOS. PCOS is beyond the cosmetic concerns of an adolescent and fertility concerns of an adult and can cause serious unhealthy consequences in perimenopausal and postmenopausal age. This area needs to be assessed and addressed since the majority of these patients are lost to follow-up after completion of their families. Good evidence suggests that there are significant racial and ethnic differences in prevalence, insulin resistance, metabolic syndrome, hyperandrogenemia and the related cardiometabolic risk in women with PCOS.
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Affiliation(s)
- D Shah
- The Center for Women's Health and Fertility, Gynaecworld, Mumbai, India
| | - S Rasool
- Government Medical College, Dr Sabahat's Fertility Center, Srinagar, India
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102
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Guscott A, Deslandes A, Parange N, Childs J. Australasian sonographers' knowledge, awareness, and attitudes towards the international evidence-based guidelines for the diagnosis of polycystic ovarian syndrome. Australas J Ultrasound Med 2023; 26:34-45. [PMID: 36960132 PMCID: PMC10030092 DOI: 10.1002/ajum.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction/Purpose Many guidelines have been utilised to diagnose polycystic ovarian syndrome (PCOS). The most recent are the International Evidence Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018 (2018 IEBG). This study aimed to assess the awareness, knowledge, and attitudes of Australasian sonographers' regarding these guidelines. Methods An online cross-sectional survey was disseminated to sonographers. Qualitative and quantitative questions were asked around awareness, knowledge, and attitudes towards the 2018 IEBG. Statistical and thematic analyses of the results were performed. Results Ninety responses were included in the final analysis. Fifty-two percent (52.2%) of participants were aware of the 2018 IEBG but only 31.1% used it in their workplaces. Fifty-eight percent (57.9%) of participants correctly identified the sonographic features that suggest PCOS, and 3.5% correctly identified all minimum recommended inclusions for reporting a gynaecological ultrasound for PCOS. Prior to being supplied the 2018 IEBG, 15.8% of participants correctly answered clinical scenario-based knowledge questions, which increased to 29.4% correctly after being supplied the guideline; however, this difference was not statistically significant. There were no statistically significant associations between demographics and knowledge of the 2018 IEBG. Discussion Several areas of confusion surrounding wording and interpretation of the 2018 IEBG were highlighted. Consideration should be given to barriers of implementation and strategies to overcome these. Conclusion More education surrounding the sonographic diagnosis of PCOS and the 2018 IEBG is needed. Scanning protocols used amongst sonographers varied, suggesting that inconsistency in sonographic diagnosis may exist. Future reviews of the 2018 IEBG should focus on reducing ambiguity in wording, which may be responsible for some of the varied interpretation of these guidelines.
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Affiliation(s)
- Alexandra Guscott
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Alison Deslandes
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Nayana Parange
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Jessie Childs
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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103
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Dou Y, Xin J, Zhou P, Tang J, Xie H, Fan W, Zhang Z, Wu D. Bidirectional association between polycystic ovary syndrome and periodontal diseases. Front Endocrinol (Lausanne) 2023; 14:1008675. [PMID: 36755917 PMCID: PMC9899846 DOI: 10.3389/fendo.2023.1008675] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) and periodontal disease (PDD) share common risk factors. The bidirectional interaction between PCOS and PDD has been reported, but until now, the underlying molecular mechanisms remain unclear. Endocrine disorders including hyperandrogenism (HA) and insulin resistance (IR) in PCOS disturb the oral microbial composition and increase the abundance of periodontal pathogens. Additionally, PCOS has a detrimental effect on the periodontal supportive tissues, including gingiva, periodontal ligament, and alveolar bone. Systemic low-grade inflammation status, especially obesity, persistent immune imbalance, and oxidative stress induced by PCOS exacerbate the progression of PDD. Simultaneously, PDD might increase the risk of PCOS through disturbing the gut microbiota composition and inducing low-grade inflammation and oxidative stress. In addition, genetic or epigenetic predisposition and lower socioeconomic status are the common risk factors for both diseases. In this review, we will present the latest evidence of the bidirectional association between PCOS and PDD from epidemiological, mechanistic, and interventional studies. A deep understanding on their bidirectional association will be beneficial to provide novel strategies for the treatment of PCOS and PDD.
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Affiliation(s)
- Yang Dou
- Department of Stomatology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, Guangdong, China
| | - Jinglei Xin
- Department of Stomatology, Guangdong Women and Children hospital, Guangzhou, Guangdong, China
| | - Peng Zhou
- Department of Stomatology, Guangdong Women and Children hospital, Guangzhou, Guangdong, China
| | - Jianming Tang
- Department of Stomatology, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
| | - Hongliang Xie
- Department of Stomatology, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
| | - Wanting Fan
- Department of Stomatology, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
| | - Zheng Zhang
- Department of Stomatology, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
| | - Donglei Wu
- Department of Stomatology, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
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Zhou X, Wang Y, Chen W, Zhang H, He Y, Dai H, Hu W, Li K, Zhang L, Chen C, Yang G, Li L. Circulating HHIP Levels in Women with Insulin Resistance and PCOS: Effects of Physical Activity, Cold Stimulation and Anti-Diabetic Drug Therapy. J Clin Med 2023; 12:888. [DOI: https:/doi.org/10.3390/jcm12030888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2024] Open
Abstract
Serum human hedgehog-interacting protein (HHIP) concentration is associated with diabetes. However, the relationship between HHIP and polycystic ovary syndrome (PCOS) or abnormal sex hormones remains unknown. This study was an observational cross-sectional study, with additional short-term intervention studies and follow-up studies. Bioinformatics analysis was performed to explore the association of PCOS with metabolic-related genes and signaling pathways. OGTT and EHC were performed on all participants. Lipid infusion, cold exposure, and 45-min treadmill test were performed on all healthy women. A total of 137 women with PCOS were treated with metformin, GLP-1RA, or TZDs for 24 weeks. Serum HHIP levels were higher in insulin resistance (IR) and PCOS women. Circulating HHIP levels were significantly correlated with adiponectin (Adipoq) levels, obesity, IR, and metabolic indicators. A correlation presented between HHIP and DHEA-S, FAI, SHBG, and FSH. Serum HHIP levels were significantly elevated by oral glucose challenge in healthy women, but not affected by EHC. Lipid infusion decreased serum HHIP levels, while cold exposure increased HHIP levels in healthy women. GLP-1RA and TZD treatment reduced serum HHIP levels in PCOS women, while metformin treatment did not affect HHIP levels. HHIP may be a useful biomarker and novel drug target for PCOS and IR individuals.
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Affiliation(s)
- Xin Zhou
- The Key Laboratory of Laboratory Medical Diagnostics in the Ministry of Education and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing 400042, China
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Yanping Wang
- The Key Laboratory of Laboratory Medical Diagnostics in the Ministry of Education and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing 400042, China
| | - Wenyun Chen
- The Key Laboratory of Laboratory Medical Diagnostics in the Ministry of Education and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing 400042, China
| | - Hongmin Zhang
- Department of Endocrinology, The First People’s Hospital of Chongqing Liang Jiang New Area, Chongqing 401121, China
| | - Yirui He
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Han Dai
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Wenjing Hu
- The Key Laboratory of Laboratory Medical Diagnostics in the Ministry of Education and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing 400042, China
| | - Ke Li
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Lili Zhang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Chen Chen
- Endocrinology and Metabolism, SBMS, The University of Queensland, Brisbane 4072, Australia
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Ling Li
- The Key Laboratory of Laboratory Medical Diagnostics in the Ministry of Education and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing 400042, China
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105
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Circulating HHIP Levels in Women with Insulin Resistance and PCOS: Effects of Physical Activity, Cold Stimulation and Anti-Diabetic Drug Therapy. J Clin Med 2023; 12:jcm12030888. [PMID: 36769536 PMCID: PMC9918013 DOI: 10.3390/jcm12030888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Serum human hedgehog-interacting protein (HHIP) concentration is associated with diabetes. However, the relationship between HHIP and polycystic ovary syndrome (PCOS) or abnormal sex hormones remains unknown. This study was an observational cross-sectional study, with additional short-term intervention studies and follow-up studies. Bioinformatics analysis was performed to explore the association of PCOS with metabolic-related genes and signaling pathways. OGTT and EHC were performed on all participants. Lipid infusion, cold exposure, and 45-min treadmill test were performed on all healthy women. A total of 137 women with PCOS were treated with metformin, GLP-1RA, or TZDs for 24 weeks. Serum HHIP levels were higher in insulin resistance (IR) and PCOS women. Circulating HHIP levels were significantly correlated with adiponectin (Adipoq) levels, obesity, IR, and metabolic indicators. A correlation presented between HHIP and DHEA-S, FAI, SHBG, and FSH. Serum HHIP levels were significantly elevated by oral glucose challenge in healthy women, but not affected by EHC. Lipid infusion decreased serum HHIP levels, while cold exposure increased HHIP levels in healthy women. GLP-1RA and TZD treatment reduced serum HHIP levels in PCOS women, while metformin treatment did not affect HHIP levels. HHIP may be a useful biomarker and novel drug target for PCOS and IR individuals.
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106
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Baracat MCP, Baracat EC, Simões RS, Simões MJ, Maciel GAR, Azziz R, Soares JM. Hormonal and Metabolic Factors Influence the Action of Progesterone on the Endometrium of Women with Polycystic Ovary Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13030382. [PMID: 36766487 PMCID: PMC9914468 DOI: 10.3390/diagnostics13030382] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
Hormonal and metabolic factors may influence endometrial quality and interfere with the action of progesterone. Therefore, the aim of our study was to address this issue. Participants were recruited from an outpatient reproductive endocrinology clinic at an academic tertiary medical care centre. All subjects underwent endometrial biopsy (EB) in the follicular phase of the cycle prior to treatment. Thereafter, they were treated with micronized progesterone (400 mg/day × 10 days intravaginally) from days 14-28 of the next cycle. A second EB was performed between days 21-24 of the cycle (the second phase). The metabolic and hormonal serum levels were evaluated during the implantation window. EB samples were analysed using light microscopy for histomorphometric analysis. The endometrium of women with Polycystic Ovarian Syndrome (PCOS) in the second phase demonstrated a uniform surface epithelium with less leukocyte infiltration and an absence of apoptotic figures compared to the control group. (p < 0.021). The thickness of the surface epithelium in the second phase of the PCOS group correlated positively with free and bioavailable testosterone values. The number of stromal cells increases with increasing insulin levels. Our results suggest that histomorphometric abnormalities of the endometrium persist and are linked to androgen and insulin levels despite progesterone supplementation in PCOS.
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Affiliation(s)
- Maria Candida P. Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403 000, Brazil
| | - Edmund C. Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403 000, Brazil
| | - Ricardo S. Simões
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403 000, Brazil
| | - Manuel J. Simões
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403 000, Brazil
| | - Gustavo A. R. Maciel
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403 000, Brazil
| | - Ricardo Azziz
- Department of Obstetrics & Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, SUNY, Albany, NY 12222, USA
| | - José Maria Soares
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403 000, Brazil
- Correspondence: ; Tel.: +55-(11)-982075781
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107
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Zhao H, Zhang J, Cheng X, Nie X, He B. Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment. J Ovarian Res 2023; 16:9. [PMID: 36631836 PMCID: PMC9832677 DOI: 10.1186/s13048-022-01091-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by chronic ovulation dysfunction and overabundance of androgens; it affects 6-20% of women of reproductive age. PCOS involves various pathophysiological factors, and affected women usually have significant insulin resistance (IR), which is a major cause of PCOS. IR and compensatory hyperinsulinaemia have differing pathogeneses in various tissues, and IR varies among different PCOS phenotypes. Genetic and epigenetic changes, hyperandrogenaemia, and obesity aggravate IR. Insulin sensitization drugs are a new treatment modality for PCOS. We searched PubMed, Google Scholar, Elsevier, and UpToDate databases in this review, and focused on the pathogenesis of IR in women with PCOS and the pathophysiology of IR in various tissues. In addition, the review provides a comprehensive overview of the current progress in the efficacy of insulin sensitization therapy in the management of PCOS, providing the latest evidence for the clinical treatment of women with PCOS and IR.
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Affiliation(s)
- Han Zhao
- grid.412467.20000 0004 1806 3501Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110000 People’s Republic of China
| | - Jiaqi Zhang
- grid.412467.20000 0004 1806 3501Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110000 People’s Republic of China
| | - Xiangyi Cheng
- grid.412467.20000 0004 1806 3501Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110000 People’s Republic of China
| | - Xiaozhao Nie
- grid.412467.20000 0004 1806 3501Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110000 People’s Republic of China
| | - Bing He
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110000, People's Republic of China.
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108
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Bansal A, Sethi J, Parasher RK. Role of structured exercise programs in polycystic ovary syndrome: a systematic review. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2022.2163076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Anu Bansal
- Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India
| | - Jasobanta Sethi
- Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India
| | - Raju K. Parasher
- Amar Jyoti Institute of Physiotherapy, University of Delhi, New Delhi, India
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109
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Abruzzese GA, Velazquez ME, Cerrone GE, Motta AB. Polycystic ovary syndrome in Latin American populations: What is known and what remains unresolved. J Steroid Biochem Mol Biol 2023; 225:106195. [PMID: 36183993 DOI: 10.1016/j.jsbmb.2022.106195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 02/01/2023]
Abstract
Polycystic ovary syndrome (PCOS) is one of the main endocrine and reproductive disorders affecting women in their reproductive age. The syndrome is considered a multifactorial pathology. Therefore, genetic susceptibility and environmental factors contribute to PCOS development and phenotypic manifestation. Ethnicity and socioeconomic factors influence the development of PCOS and could affect the possibility of its diagnosis. Latin America is a unique case of study because of the heterogeneity within the region, complex socioeconomic status, and the mixed ancestry found in these populations. Up-to-date, most studies have focused on developed countries' populations, and there is a lack of evidence regarding Latin-American countries. We propose to review the state of the art of PCOS knowledge regarding Latin American populations, including the metabolic and reproductive aspects of the syndrome and the different influencing factors, and suggest future directions to deepen the study of PCOS.
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Affiliation(s)
- Giselle Adriana Abruzzese
- Laboratorio de Fisio-Patología Ovárica, Centro de Estudios Farmacológicos y Botánicos, Consejo Nacional de Investigaciones Científicas y Técnicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Mariela Edith Velazquez
- Laboratorio de Fisio-Patología Ovárica, Centro de Estudios Farmacológicos y Botánicos, Consejo Nacional de Investigaciones Científicas y Técnicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Gloria Edith Cerrone
- Universidad de Buenos Aires, Departamento de Microbiología, Inmunología, Biotecnología y Genética, Facultad de Farmacia y Bioquímica, Cátedra de Genética, Buenos Aires, Argentina; CONICET-Universidad de Buenos Aires, Instituto de Inmunología, Genética y Metabolismo (INIGEM), Laboratorio de Diabetes y Metabolismo, Buenos Aires, Argentina
| | - Alicia Beatriz Motta
- Laboratorio de Fisio-Patología Ovárica, Centro de Estudios Farmacológicos y Botánicos, Consejo Nacional de Investigaciones Científicas y Técnicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
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110
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Dong XC, Liu C, Zhuo GC, Ding Y. Potential Roles of mtDNA Mutations in PCOS-IR: A Review. Diabetes Metab Syndr Obes 2023; 16:139-149. [PMID: 36760584 PMCID: PMC9884460 DOI: 10.2147/dmso.s393960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common heterogeneous endocrine disease that affecting females in reproductive age. Insulin resistance (IR), an important molecular basis for PCOS, accounts for at least 75% of women carrying this syndrome. Although there have been many studies on PCOS-IR, the detailed mechanisms are not fully understood. As essential hub for energy generation, mitochondria are critical to insulin secretion and normal function, whereas mutations in mitochondrial DNA (mtDNA) result in mitochondrial dysfunctions contributing to the pathophysiology of PCOS-IR via the regulation of balance of oxidative stress (OS), energy deficiency, or hormone metabolism. In the current review, we summarize the clinical and molecular features of PCOS-IR and discuss molecular mechanisms related to mtDNA mutations.
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Affiliation(s)
- Xiao-Chao Dong
- Department of Gynecology and Obstetrics, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Chang Liu
- Department of Gynecology and Obstetrics, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Guang-Chao Zhuo
- Central Laboratory, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yu Ding
- Central Laboratory, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Correspondence: Yu Ding, Central Laboratory, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, People’s Republic of China, Tel/Fax +86-571-5600-5600, Email
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111
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Kharb S, Joshi A. Multi-omics and machine learning for the prevention and management of female reproductive health. Front Endocrinol (Lausanne) 2023; 14:1081667. [PMID: 36909346 PMCID: PMC9996332 DOI: 10.3389/fendo.2023.1081667] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Females typically carry most of the burden of reproduction in mammals. In humans, this burden is exacerbated further, as the evolutionary advantage of a large and complex human brain came at a great cost of women's reproductive health. Pregnancy thus became a highly demanding phase in a woman's life cycle both physically and emotionally and therefore needs monitoring to assure an optimal outcome. Moreover, an increasing societal trend towards reproductive complications partly due to the increasing maternal age and global obesity pandemic demands closer monitoring of female reproductive health. This review first provides an overview of female reproductive biology and further explores utilization of large-scale data analysis and -omics techniques (genomics, transcriptomics, proteomics, and metabolomics) towards diagnosis, prognosis, and management of female reproductive disorders. In addition, we explore machine learning approaches for predictive models towards prevention and management. Furthermore, mobile apps and wearable devices provide a promise of continuous monitoring of health. These complementary technologies can be combined towards monitoring female (fertility-related) health and detection of any early complications to provide intervention solutions. In summary, technological advances (e.g., omics and wearables) have shown a promise towards diagnosis, prognosis, and management of female reproductive disorders. Systematic integration of these technologies is needed urgently in female reproductive healthcare to be further implemented in the national healthcare systems for societal benefit.
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Affiliation(s)
- Simmi Kharb
- Department of Biochemistry, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
- *Correspondence: Simmi Kharb, ; Anagha Joshi,
| | - Anagha Joshi
- Computational Biology Unit (CBU), Department of Clinical Science, University of Bergen, Bergen, Norway
- *Correspondence: Simmi Kharb, ; Anagha Joshi,
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112
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Patten RK, Bourke M, McIlvenna LC, Moreno-Asso A, Woessner MN, Stepto NK, Parker A. Longitudinal affective response to high-intensity interval training and moderate-intensity continuous training in overweight women with polycystic ovary syndrome: A randomised trial. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 64:102325. [PMID: 37665810 DOI: 10.1016/j.psychsport.2022.102325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 09/06/2023]
Abstract
BACKGROUND Women with polycystic ovary syndrome (PCOS) experience general and PCOS-specific barriers that limit their engagement with exercise and contribute to high attrition from exercise programs, hindering the potential benefits of exercise to address their increased cardio-metabolic risk. A positive remembered affective response can predict future intentions and adherence to exercise prescription. OBJECTIVES To compare the longitudinal changes in remembered affect to high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) in women with PCOS and to determine whether longitudinal changes in remembered affect are correlated with changes in fitness, body mass index, adherence and exercise enjoyment. METHODS Physically inactive, overweight women with PCOS were randomly assigned to 12 weeks of either HIIT (n = 15) or MICT (n = 14) (3 sessions per week). Remembered affective valence (Feeling Scale) was collected after each exercise session. Cardiorespiratory fitness (VO2peak) was assessed at baseline and post-intervention. Exercise enjoyment was assessed post-intervention. RESULTS The longitudinal changes in the remembered affect were more positive in the HIIT group compared to MICT (β = 0.017, p = 0.047). HIIT was also considered more enjoyable than MICT (p = 0.002). Adherence was high in both groups (>90%). We found a moderate correlation with longitudinal changes between the remembered affect and change in fitness (rs = 0.398) and exercise enjoyment (rs = 0.376) using the combined group, however, these were not statistically significant (p = 0.054 and p = 0.064, respectively). CONCLUSIONS HIIT demonstrated a more positive longitudinal remembered affective response and greater exercise enjoyment compared to MICT in overweight women with PCOS.
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Affiliation(s)
- Rhiannon K Patten
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Matthew Bourke
- Institute for Health and Sport, Victoria University, Melbourne, Australia; School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Luke C McIlvenna
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Epigenetics & Cellular Senescence Group, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Alba Moreno-Asso
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, Melbourne, Victoria, Australia
| | - Mary N Woessner
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Nigel K Stepto
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Alexandra Parker
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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113
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Dare A, Olaniyan O, Adetunji C, Okotie G, Dare J, Adigun B, Adebayo F. Vitamin E modulates androgen receptor gene expression to attenuate ovarian dysfunctions in a rat model of dehydroepiandrosterone-induced polycystic ovary. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2023. [DOI: 10.4103/2305-0500.372379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Zhulikova MV, Myroshnychenko MS, Nakonechna OA, Zhulikov OO, Pustova NO, Bibichenko VO, Lytvynenko OY, Kucheriavchenko MO. REACTIVE OXYGEN SPECIES GENERATION BY BLOOD LEUCOCYTES OF RATS WITH POLYCYSTIC OVARY SYNDROME UNDER THE CONDITIONS OF INTERMITTENT COLD EXPOSURE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1670-1676. [PMID: 37622513 DOI: 10.36740/wlek202307123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE The aim of this study was to determine the level of ROS production by blood leukocytes of rats with PCOS under the conditions of intermittent cold exposure. PATIENTS AND METHODS Materials and methods: In the study, 40 immature female rats of the WAG population at the age of 27 days with a body weight of 80-90 g were used. Five groups were formed (8 animals in each group). Group 1 was represented by intact rats that were not subjected to any manipulations. Group 2 was represented by rats that were injected subcutaneously with 0.2 ml of purified and sterilized olive oil daily for 25 days. Group 3 was represented by rats that were exposed to intermittent cold for 25 days. Group 4 was represented by rats that were modeled with PCOS. Group 5 was represented by rats, which were simulated PCOS against the background of intermittent cold exposure. ROS production was estimated in leukocytes isolated from rats of all groups by flow cytometry using the fluorescent probe of 2,7-dichlorodihydrofluorescein diacetate (H2DCFDA). RESULTS Results: The experimental study revealed an intracellular excessive production of ROS by leukocytes in rats with polycystic ovary syndrome. The use of inter¬mittent cold exposure normalized the production of reactive oxygen species by leukocytes in rats with polycystic ovary syndrome. CONCLUSION Conclusions: The effectiveness of intermittent cold exposure, proven by the authors, allows recommending its use as one of the methods of prevention and treatment of the polycystic ovary syndrome.
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Affiliation(s)
- Maryna V Zhulikova
- KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE; MEDICAL CENTER MARIA, KHARKIV, UKRAINE
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Pruett JE, Romero DG, Yanes Cardozo LL. Obesity-associated cardiometabolic complications in polycystic ovary syndrome: The potential role of sodium-glucose cotransporter-2 inhibitors. Front Endocrinol (Lausanne) 2023; 14:951099. [PMID: 36875461 PMCID: PMC9974663 DOI: 10.3389/fendo.2023.951099] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. PCOS is characterized by androgen excess, oligo/anovulation, and polycystic appearance of the ovaries. Women with PCOS have an increased prevalence of multiple cardiovascular risk factors such as insulin resistance, hypertension, renal injury, and obesity. Unfortunately, there is a lack of effective, evidence-based pharmacotherapeutics to target these cardiometabolic complications. Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide cardiovascular protection in patients with and without type 2 diabetes mellitus. Although the exact mechanisms of how SGLT2 inhibitors confer cardiovascular protection remains unclear, numerous mechanistic hypotheses for this protection include modulation of the renin-angiotensin system and/or the sympathetic nervous system and improvement in mitochondrial function. Data from recent clinical trials and basic research show a potential role for SGLT2 inhibitors in treating obesity-associated cardiometabolic complications in PCOS. This narrative review discusses the mechanisms of the beneficial effect of SGLT2 inhibitors in cardiometabolic diseases in PCOS.
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Affiliation(s)
- Jacob E. Pruett
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Damian G. Romero
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, United States
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS, United States
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS, United States
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, MS, United States
| | - Licy L. Yanes Cardozo
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, United States
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS, United States
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS, United States
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, MS, United States
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
- *Correspondence: Licy L. Yanes Cardozo,
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Suturina L, Lizneva D, Atalyan A, Lazareva L, Belskikh A, Bairova T, Sholokhov L, Rashidova M, Danusevich I, Nadeliaeva I, Belenkaya L, Darzhaev Z, Sharifulin E, Belkova N, Igumnov I, Trofimova T, Khomyakova A, Ievleva K, Babaeva N, Egorova I, Salimova M, Yildiz BO, Legro RS, Stanczyk FZ, Azziz R. Establishing Normative Values to Determine the Prevalence of Biochemical Hyperandrogenism in Premenopausal Women of Different Ethnicities from Eastern Siberia. Diagnostics (Basel) 2022; 13:diagnostics13010033. [PMID: 36611327 PMCID: PMC9818891 DOI: 10.3390/diagnostics13010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Androgen assessment is a key element for diagnosing polycystic ovary syndrome (PCOS), and defining a "normal" level of circulating androgens is critical for epidemiological studies. We determined the upper normal limits (UNLs) for androgens in a population-based group of premenopausal "healthy control" women, overall and by ethnicity (Caucasian and Asian), in the cross-sectional Eastern Siberia PCOS Epidemiology and Phenotype (ESPEP) Study (ClinicalTrials.gov ID: NCT05194384) conducted in 2016-2019. Overall, we identified a "healthy control" group consisting of 143 healthy premenopausal women without menstrual dysfunction, hirsutism, polycystic ovaries, or medical disorders. We analyzed serum total testosterone (TT) by using liquid chromatography with tandem mass spectrometry (LC-MS/MS), and DHEAS, sex-hormone-binding globulin (SHBG), TSH, prolactin, and 17-hydroxyprogesterone (17OHP) were assessed with an enzyme-linked immunosorbent assay (ELISA). The UNLs for the entire population for the TT, free androgen index (FAI), and DHEAS were determined as the 98th percentiles in healthy controls as follows: 67.3 (95% confidence interval (CI): 48.1, 76.5) ng/dl, 5.4 (3.5, 14.0), and 355 (289, 371) μg/dl, respectively. The study results demonstrated that the UNLs for TT and FAI varied by ethnicity, whereas the DHEAS UNLs were comparable in the ethnicities studied.
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Affiliation(s)
- Larisa Suturina
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
- Correspondence: ; Tel.: +7-902-5774-906
| | - Daria Lizneva
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
- Center of Excellence for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Alina Atalyan
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Ludmila Lazareva
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Aleksey Belskikh
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Tatyana Bairova
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Leonid Sholokhov
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Maria Rashidova
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Irina Danusevich
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Iana Nadeliaeva
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Lilia Belenkaya
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Zorikto Darzhaev
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Eldar Sharifulin
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Natalia Belkova
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Ilia Igumnov
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Tatyana Trofimova
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Anastasiya Khomyakova
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Kseniia Ievleva
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Natalia Babaeva
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Irina Egorova
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Madinabonu Salimova
- Federal State Public Institution “Scientific Center for Family Health and Human Reproduction Problems”, 16, Timiryazeva Str., 664003 Irkutsk, Russia
| | - Bulent O. Yildiz
- Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Hacettepe, 06100 Ankara, Turkey
| | - Richard S. Legro
- Hershey Medical Center, Penn State College of Medicine, 500 University Dr, Hershey, PA 17033, USA
| | - Frank Z. Stanczyk
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Ricardo Azziz
- School of Medicine and Public Health, University of Alabama at Birmingham, 1700 6th Ave, South Birmingham, AL 35249, USA
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El-Eshmawy MM, Ibrahim A, Bahriz R, Shams-Eldin N, Mahsoub N. Serum uric acid/creatinine ratio and free androgen index are synergistically associated with increased risk of polycystic ovary syndrome in obese women. BMC Endocr Disord 2022; 22:315. [PMID: 36514085 PMCID: PMC9746110 DOI: 10.1186/s12902-022-01240-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Features of metabolic syndrome such as abdominal obesity, insulin resistance, hypertension and dyslipidemia are commonly encountered in polycystic ovary syndrome (PCOS). Recent evidence has suggested an association between high serum uric acid/creatinine (UA/Cr) ratio and metabolic syndrome however, no studies have investigated this association in PCOS. The current study was conducted to investigate the relationship between UA/Cr ratio and PCOS and to identify whether UA/Cr ratio and free androgen index (FAI) have an additive interaction for detection of PCOS risk in obese women. METHODS This study enrolled 40 obese women with PCOS and 40 control women with regular menstrual cycles matched for age and body mass index (BMI). Anthropometric measurements, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), lipids profile, luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG), total testosterone, free androgen index (FAI), UA/Cr ratio were assessed. RESULTS Serum UA/Cr ratio was significantly higher in obese women with PCOS than in non-PCOS women. UA/Cr ratio was correlated with BMI, waist and neck circumferences, blood pressure, fasting insulin, HOMA-IR, lipids, LH/FSH, estradiol, DHEAS, total testosterone, FAI and SHBG. UA/Cr ratio and FAI were independent risk factors for PCOS in obese women however, the addictive interaction between UA/Cr ratio and FAI had a higher fold risk (OR: 4.3, 95% CI, 3.4-7.58) and a more significance (P = 0.002) for determination of PCOS. CONCLUSION Serum UA/Cr ratio combined with FAI can exert an additive or synergistic impact on prediction of PCOS in obese women.
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Affiliation(s)
- Mervat M El-Eshmawy
- Internal Medicine Department, Mansoura Specialized Medical Hospital, Faculty of Medicine, Mansoura University, P.O. Box: 35516 Mansoura, Egypt
| | - Asmaa Ibrahim
- Internal Medicine Department, Meet Salsil Central Hospital, Ministry of Health and Population, Meet Salsil, Egypt
| | - Rania Bahriz
- Internal Medicine Department, Mansoura Specialized Medical Hospital, Faculty of Medicine, Mansoura University, P.O. Box: 35516 Mansoura, Egypt
| | - Nermeen Shams-Eldin
- Gynecology and Obstetric Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nancy Mahsoub
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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118
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Li H, Zhang Y, Liu C, Zhang Y, Yang H, Fu S, Lv H. Association of Insulin-Like Growth Factor-1 With Polycystic Ovarian Syndrome: A Systematic Review and Meta-analysis. Endocr Pract 2022; 29:388-397. [PMID: 36516939 DOI: 10.1016/j.eprac.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/13/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Circulating concentration of insulin-like growth factor (IGF)-1 in patients with polycystic ovary syndrome (PCOS) is still unclear. Therefore, we aimed to investigate the association of IGF-1 with PCOS through this meta-analysis. METHODS Literature search was conducted through PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (up to July 2022). A manual search was performed on the references of related original research. Then, we applied the random-effects model to evaluate the overall effect size by calculating the standard mean difference and its 95% CI. Subgroup analyses were used to explore the sources of heterogeneity. In addition, a sensitivity analysis was performed and publication bias was assessed. RESULTS Twenty studies were included in this meta-analysis involving 657 individuals: 362 patients with PCOS and 295 normal controls. The results of meta-analysis showed that serum IGF-1 levels were significantly higher in patients with PCOS than in controls (standard mean difference, 0.89; 95% CI, 0.34-1.45; P = .002). The final pooled data were determined by the random-effects model because a significant high heterogeneity (I2 = 89%) was found. A subgroup analysis based on body mass index showed that elevated IGF-1 level was associated with normal-weight and overweight patients in the PCOS group, but there was no significant association with obesity. The sensitivity analysis indicated that no individual study significantly affected the overall pooled result and no publishing bias was observed. CONCLUSION These data suggest that elevated serum IGF-1 levels may not be a major cause of PCOS pathogenesis. Body mass index may be a major determinant of serum IGF-1.
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Affiliation(s)
- Huanhuan Li
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China; The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Yuqi Zhang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China; The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Chunhua Liu
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China; The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Yangyang Zhang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China; The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Hong Yang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China; The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Songbo Fu
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Haihong Lv
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.
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Khant Aung Z, Masih RR, Desroziers E, Campbell RE, Brown RSE. Enhanced pup retrieval behaviour in a mouse model of polycystic ovary syndrome. J Neuroendocrinol 2022; 34:e13206. [PMID: 36416198 PMCID: PMC10077988 DOI: 10.1111/jne.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/23/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy to affect women of reproductive-age world-wide. Hyperandrogenism is both a hallmark feature of PCOS, and is hypothesised to be an underlying mechanism driving the development of the condition in utero. With circulating hormones known to profoundly influence maternal responses in females, we aimed to determine whether maternal behaviour is altered in a well-described prenatally androgenised (PNA) mouse model of PCOS. Mouse dams were administered with dihydrotestosterone or vehicle on days 16, 17 and 18 of pregnancy. Maternal responses were assessed in both the dihydrotestosterone-injected dams following parturition and in their adult female PNA offspring. Exposure of dams to excess androgens during late pregnancy had no detrimental effects on pregnancy outcomes, including gestation length, pup survival and gestational weight gain, or on subsequent maternal behaviour following parturition. By contrast, PNA virgin females, modelling PCOS, exhibited enhanced maternal behaviour when tested in an anxiogenic novel cage environment, with females rapidly retrieving pups and nesting with them. In comparison, most control virgin females failed to complete this retrieval task in the anxiogenic environment. Assessment of progesterone receptor and oestrogen receptor α immunoreactivity in the brains of virgin PNA and control females revealed increased numbers of oestrogen receptor α positive cells in the brains of PNA females in regions well known to be important for maternal behaviour. This suggests that increased oestrogenic signalling in the neural circuit that underlies maternal behaviour may be a possible mechanism by which maternal behaviour is enhanced in PNA female mice.
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Affiliation(s)
- Zin Khant Aung
- Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Renee R Masih
- Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Elodie Desroziers
- Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Sorbonne Université - Faculté de Sciences et Ingénierie, Neuroplasticité des Comportements de la Reproduction, Neurosciences Paris Seine, UM119 - CNRS UMR 8246 - INSERM UMRS 1130, Paris, France
| | - Rebecca E Campbell
- Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Rosemary S E Brown
- Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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Bharali MD, Rajendran R, Goswami J, Singal K, Rajendran V. Prevalence of Polycystic Ovarian Syndrome in India: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e32351. [PMID: 36628015 PMCID: PMC9826643 DOI: 10.7759/cureus.32351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Stein-Leventhal syndrome, often known as polycystic ovarian syndrome (PCOS), is a syndrome that affects women's reproductive health. PCOS is one of the most common endocrine and metabolic disorders in women of reproductive age. The etiology of PCOS remains unknown mainly, and the estimation of PCOS burden in a specific geographical location will impact disease control strategies. Hence, this study estimated the pooled prevalence of PCOS in Indian women. Databases such as PubMed, CINHAL, Scopus, and Google Scholar were thoroughly searched. Only those published Indian studies that reported the prevalence of PCOS from 2010 to 2021 and had at least one of the following diagnostic PCOS criteria were included in the systematic review: the National Institutes of Health (NIH), Rotterdam's criteria, or/and Androgen Excess Society (AES). MetaXL version 5.3 software was used for data analysis. The risk of bias was assessed using modified Joanna Briggs Institute criteria for cross-sectional studies. Out of 17132 articles, 11 articles were selected for systematic review and meta-analysis. The pooled prevalence of PCOS was 11.33(7.69-15.59) using the random effect. The proportion of Hirsute using the Ferriman-Gallwey score was highly variable, ranging from 1.6% to 37.9% (n=6). The prevalence rate of PCOS is high among Indian women. The pooled prevalence of PCOS was close to 10% using Rotterdam's criteria and AES criteria, while it was 5.8% using NIH criteria. The study's overall finding emphasizes the need for more acceptable and uniform diagnostic criteria for screening PCOS. At the same time, policy-makers should consider giving more importance to PCOS in their effort to control non-communicable diseases.
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Affiliation(s)
- Mintu Dewri Bharali
- Department of Community Medicine, Guwahati Medical College and Hospital, Guwahati, IND
| | - Radhika Rajendran
- Department of Biotechnology, Indian Institute of Technology, Guwahati, Guwahati, IND
| | - Jayshree Goswami
- Department of Obstetrics and Gynecology, Gauhati Medical College and Hospital, Guwahati, IND
| | - Kusum Singal
- Center For Advanced Research Evidence-Based Child Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, IND
| | - Vinoth Rajendran
- Department of Community Medicine/Family Medicine, All India Institute of Medical Sciences, Jodhpur, IND
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Fitz VW, Mahalingaiah S. Optimization of assisted reproductive technology outcomes in patients with polycystic ovarian syndrome: updates and unanswered questions. Curr Opin Endocrinol Diabetes Obes 2022; 29:547-553. [PMID: 36218224 DOI: 10.1097/med.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Narrative review of recent literature on optimization of assisted reproduction technology outcomes in patients with polycystic ovarian syndrome (PCOS). RECENT FINDINGS The key areas of focus include pre cycle treatment with the goal of cohort synchronization, methods of ovulation suppression and trigger medication. There is no definitive evidence that precycle treatment with combined oral contraceptives (COCs) or progestins improve or negatively impact in vitro fertilization outcomes in patients with PCOS. The reviewed evidence supports consideration of progestins as suppression of premature ovulation in patients with PCOS as an alternative to gonadotropin releasing hormone (GnRH) antagonist if a freeze all protocol is planned. There is limited prospective evidence in PCOS populations regarding use of a dual trigger using GnRH agonist and human chorionic gonadotropin (hCG). SUMMARY This review has implications for clinical practice regarding ovarian stimulation protocols for patients with PCOS. We also identified areas of research need including the further exploration of the value of pre cycle COC or progestin use in a PCOS population, also the use of GnRH agonist in combination with hCG in a well defined PCOS population and using GnRH agonist trigger alone as a control.
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Affiliation(s)
- Victoria W Fitz
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital
| | - Shruthi Mahalingaiah
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Dapas M, Dunaif A. Deconstructing a Syndrome: Genomic Insights Into PCOS Causal Mechanisms and Classification. Endocr Rev 2022; 43:927-965. [PMID: 35026001 PMCID: PMC9695127 DOI: 10.1210/endrev/bnac001] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Indexed: 01/16/2023]
Abstract
Polycystic ovary syndrome (PCOS) is among the most common disorders in women of reproductive age, affecting up to 15% worldwide, depending on the diagnostic criteria. PCOS is characterized by a constellation of interrelated reproductive abnormalities, including disordered gonadotropin secretion, increased androgen production, chronic anovulation, and polycystic ovarian morphology. It is frequently associated with insulin resistance and obesity. These reproductive and metabolic derangements cause major morbidities across the lifespan, including anovulatory infertility and type 2 diabetes (T2D). Despite decades of investigative effort, the etiology of PCOS remains unknown. Familial clustering of PCOS cases has indicated a genetic contribution to PCOS. There are rare Mendelian forms of PCOS associated with extreme phenotypes, but PCOS typically follows a non-Mendelian pattern of inheritance consistent with a complex genetic architecture, analogous to T2D and obesity, that reflects the interaction of susceptibility genes and environmental factors. Genomic studies of PCOS have provided important insights into disease pathways and have indicated that current diagnostic criteria do not capture underlying differences in biology associated with different forms of PCOS. We provide a state-of-the-science review of genetic analyses of PCOS, including an overview of genomic methodologies aimed at a general audience of non-geneticists and clinicians. Applications in PCOS will be discussed, including strengths and limitations of each study. The contributions of environmental factors, including developmental origins, will be reviewed. Insights into the pathogenesis and genetic architecture of PCOS will be summarized. Future directions for PCOS genetic studies will be outlined.
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Affiliation(s)
- Matthew Dapas
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Andrea Dunaif
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Yasmin A, Roychoudhury S, Paul Choudhury A, Ahmed ABF, Dutta S, Mottola F, Verma V, Kalita JC, Kumar D, Sengupta P, Kolesarova A. Polycystic Ovary Syndrome: An Updated Overview Foregrounding Impacts of Ethnicities and Geographic Variations. LIFE (BASEL, SWITZERLAND) 2022; 12:life12121974. [PMID: 36556340 PMCID: PMC9785838 DOI: 10.3390/life12121974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/29/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common heterogeneous conditions of the endocrine reproductive system in women of childbearing age. Hyperandrogenism and oligomenorrhea are the two core characteristics of PCOS, a complicated and multifaceted illness. The condition is also linked to several major side effects, which include type 2 diabetes, early atherosclerosis, infertility, and endometrial cancer. There are few facts and statistics available on PCOS prevalence internationally due to the significant degree of geographic and ethnic variance and inconsistency caused by different diagnosis standards. Limited (n = 179) explorations have been made in the context of the prevalence of this complicated illness so far, and out of these, only 55 studies have discussed its association with race and/or ethnicity. However, those studies remain restricted due to the small sample size, biased selection, and the lack of comparative studies. Variations in PCOS prevalence frequency also arise due to different diagnostic criteria, as well as racial and ethnic differences, associated lifestyle factors, and subsequent illnesses that affect the accuracy of the diagnosis. The main objective behind this systematic review is to provide comprehensive epidemiological data on PCOS that is organized geographically. This evidence-based study also provides an overview of the clinical management of PCOS to instigate further research on this complex endocrinological condition and the subsequent development of preventive treatment strategies.
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Affiliation(s)
- Afrin Yasmin
- Department of Life Science and Bioinformatics, Assam University, Silchar 788011, India
| | - Shubhadeep Roychoudhury
- Department of Life Science and Bioinformatics, Assam University, Silchar 788011, India
- Correspondence: (S.R.); (A.P.C.)
| | - Arun Paul Choudhury
- Department of Obstetrics and Gynecology, Silchar Medical College and Hospital, Silchar 788014, India
- Correspondence: (S.R.); (A.P.C.)
| | - A. B. Fuzayel Ahmed
- Department of Obstetrics and Gynecology, Silchar Medical College and Hospital, Silchar 788014, India
| | - Sulagna Dutta
- School of Medical Sciences, Bharath Institute of Higher Education and Research (BIHER), Chennai 600126, India
| | - Filomena Mottola
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Vivek Verma
- Department of Statistics, Assam University, Silchar 788011, India
| | - Jogen C. Kalita
- Department of Zoology, Gauhati University, Guwahati 781014, India
| | - Dhruv Kumar
- School of Health Sciences and Technology, UPES University, Dehradun 248007, India
| | - Pallav Sengupta
- Physiology Unit, Department of Biomedical Sciences, College of Medicine, Gulf Medical University, Ajman 4184, United Arab Emirates
| | - Adriana Kolesarova
- Faculty of Biotechnology and Food Sciences, Slovak University of Agriculture in Nitra, 94901 Nitra, Slovakia
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Ranathunga I, Athukorala TG, Sumanatilleke MR, Somasundaram NP. Evaluation of socio-demographic and clinical characteristics of PCOS patients attending a tertiary care institute in Colombo. BMC Endocr Disord 2022; 22:289. [PMID: 36411444 PMCID: PMC9677619 DOI: 10.1186/s12902-022-01206-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Polycystic ovary syndrome (PCOS) is a common endocrine disorder with heterogeneous aetiology. It is characterized by irregular menses and or oligo/anovulation, hyper-androgenism, and polycystic ovaries. The prevalence and diagnosis of PCOS changes depending on which clinical criteria are utilized to confirm the diagnosis. The prevalence can be high as 8-13% when the Rotterdam criteria are used. However, there is significant inter-individual variation in presentation. We have studied the socio-demographic and clinical characteristics of PCOS patients attending the Endocrinology clinic in a tertiary care institute in Sri Lanka. METHODS A descriptive cross sectional study was conducted from September 2019 to September 2020 at the Endocrinology Unit of the National Hospital of Sri Lanka. All the patients who met the inclusion and exclusion criteria and who has a diagnosis of PCOS made according to Rotterdam criteria were recruited in to the study. After obtaining informed written consent, the data was collected using an interviewer administered questionnaire. HOMA-IR was calculated using the fasting insulin and blood glucose level. RESULTS The study enrolled sixty females. The mean age was 26.7 years (range 18-44). The mean weight was 64.8 (SD = 11.9) kg and BMI was 27.1 (SD = 4.8) kg/m-2. According to Asian BMI cut-offs, 1 (1.7%) patient was underweight and 13 (21.7%) had normal weight. Forty six (76.7%) had their weight in the overweight or obese category. Fifty four (90.0%) patients had clinical or biochemical evidence of hyperandrogenism while 24 (40%) had polycystic ovaries on trans-abdominal ultrasound scan and 50 (83.3%) had irregular menstrual cycles. According to the body fat percentage assessed by the whole body DEXA scan 4.1% normal body fat, while 50.0% and 45.8% had overweight and obesity respectively. HOMA-IR detected 61.1% to have high insulin resistance. Out of the patients who had USS of the abdomen 27.5% had co-existent non-alcoholic fatty liver. Fifty four percent of the patients had sub/infertility. CONCLUSIONS The majority of the population were overweight or obese and had higher prevalence of insulin resistance and non-alcoholic fatty liver. Out of the clinical characteristics used to make the diagnosis of PCOS, the presence of clinical or biochemical evidence of hyperandrogenism and irregular menstrual cycles are more common than the detection of polycystic ovaries on trans-vaginal USS. The higher prevalence of overweight, obesity, insulin resistance and NAFLD associated with PCOS makes the diagnosis and management of the disease crucial to prevent long term consequences of the disease.
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Affiliation(s)
- I Ranathunga
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka.
| | - T G Athukorala
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka
| | - M R Sumanatilleke
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka
| | - N P Somasundaram
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka
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Patil P, D'Souza N, Ghate SD, Nagendra L, Girijashankar HB. Free-androgen Index in Women with Polycystic Ovarian Syndrome: A Meta-Analysis. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1757445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Objectives Hyperandrogenism, a key feature of polycystic ovarian syndrome (PCOS), is caused by excess androgen secretion, most commonly of ovarian origin. Although the serum total testosterone (TT) levels have long been used as a traditional measure of hyperandrogenemia in women with PCOS, it is associated with many fallacies due to the fact that a component of TT is linked to sex hormone-binding globulin (SHBG). Recent research has discovered that measuring free testosterone levels and computing the free androgen index (FAI), which is a ratio of TT and SHBG, are better predictors of androgen excess in PCOS. The aim of this meta-analysis is to determine the association of FAI in diagnosing hyperandrogenism and its ability to discriminate PCOS from controls.
Materials and Methods The publicly available databases PubMed, Scopus and Web of Science were searched using MeSH terms, ‘Polycystic Ovarian Syndrome’ OR ‘PCOS’ OR ‘PCOD’ AND ‘Testosterone’ AND ‘Sex Hormone Binding Globulin’ OR ‘SHBG’ to collect the full-text articles for the retrieval of related data of case–control and cross-sectional studies. The studies quality was assessed using the Newcastle–Ottawa scale, and a sub-group analysis and publication bias between the studies was evaluated by funnel plot.
Statistical Analysis The R program (v4.0.3) and R packages ‘metafor’ and ‘dmetar’ were used for statistical analyses of quantitative data and the plots were generated using ‘ggplot2’ package through a comparison of pooled SMD by Egger's linear regression and Beggs-Mazumdar tests.
Results Twenty-four studies involving 7,847 participants including 3,290 controls and 4,557 PCOS were included in the meta-analysis. The pooled data analysis of the included studies showed that the PCOS women had higher FAI than controls, with SMD of 1.56 (95%CI 1.08–2.04; p < 0.01). The publication bias was tested using a funnel plot and Egger's regression asymmetry test, which revealed no risk of publishing bias (p = 0.1727). Additionally, the sub-group meta-analysis of geographic region revealed that FAI levels were more significant in PCOS subjects of Asia and Europe, compared with the American region.
Conclusion Overall, this meta-analysis indicates that FAI could be a reliable marker to differentiate PCOS patients from controls in Asian and European ethnicities.
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Affiliation(s)
- Prakash Patil
- Central Research Laboratory, KS Hegde Medical Academy, NITTE (Deemed to be University), Mangaluru, Karnataka, India
| | - Neevan D'Souza
- Center for Bioinformatics and Biostatistics, NITTE (Deemed to be University), Mangaluru, Karnataka, India
| | - Sudeep D. Ghate
- Center for Bioinformatics and Biostatistics, NITTE (Deemed to be University), Mangaluru, Karnataka, India
| | - Lakshmi Nagendra
- Department of Endocrinology, Justice KS Hegde Charitable Hospital, K S Hegde Medical Academy, NITTE (Deemed to be University), Mangaluru, Karnataka, India
| | - Harish B. Girijashankar
- Department of Anesthesiology, Justice KS Hegde Charitable Hospital, K S Hegde Medical Academy, NITTE (Deemed to be University), Mangaluru, Karnataka, India
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Mirza FG, Tahlak MA, Rjeili RB, Hazari K, Ennab F, Hodgman C, Khamis AH, Atiomo W. Polycystic Ovarian Syndrome (PCOS): Does the Challenge End at Conception? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214914. [PMID: 36429632 PMCID: PMC9690374 DOI: 10.3390/ijerph192214914] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 05/14/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a prevalent condition that not only has the potential to impede conception but also represents the most common endocrine dysfunction in fertile women. It is considered a heterogeneous and multifaceted disorder, with multiple reproductive and metabolic phenotypes which differently affect the early- and long-term syndrome's risks. Undoubtedly, the impact of PCOS on infertility has attracted most of the attention of healthcare providers and investigators. However, there is growing evidence that even after conception is achieved, PCOS predisposes the parturient to several adverse pregnancy outcomes including a high risk of pregnancy-induced hypertension, spontaneous abortion, gestational diabetes, preeclampsia, and preterm birth, which increase the risks of stillbirth and neonatal death. Fetal growth abnormalities may also be more common, but the relationship is less well defined. This narrative review aims to summarize current knowledge regarding these conditions as they interplay with PCOS and concludes that although there appears to be an increase in these complications during the pregnancy of women with PCOS, there is a need for further research to clarify the possible confounding impact of obesity. Implications for clinical practice and future research are outlined.
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Affiliation(s)
- Fadi G. Mirza
- Latifa Women and Children Hospital, Dubai P.O. Box 9115, United Arab Emirates
- Department of Obstetrics and Gynaecology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, Dubai P.O. Box 505055, United Arab Emirates
- Department of Obstetrics and Gynaecology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Muna A. Tahlak
- Latifa Women and Children Hospital, Dubai P.O. Box 9115, United Arab Emirates
| | - Rachelle Bou Rjeili
- Faculty of Medicine, American University of Beirut, Beruit P.O. Box 11-0236, Lebanon
| | - Komal Hazari
- Latifa Women and Children Hospital, Dubai P.O. Box 9115, United Arab Emirates
| | - Farah Ennab
- Department of Obstetrics and Gynaecology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, Dubai P.O. Box 505055, United Arab Emirates
| | - Charlie Hodgman
- School of Biosciences, University of Nottingham, Loughborough LE12 5RD, UK
| | - Amar Hassan Khamis
- Department of Obstetrics and Gynaecology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, Dubai P.O. Box 505055, United Arab Emirates
| | - William Atiomo
- Department of Obstetrics and Gynaecology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, Dubai P.O. Box 505055, United Arab Emirates
- Correspondence:
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Kazemi M, Kim JY, Wan C, Xiong JD, Michalak J, Xavier IB, Ganga K, Tay CT, Grieger JA, Parry SA, Moran LJ, Lujan ME. Comparison of dietary and physical activity behaviors in women with and without polycystic ovary syndrome: a systematic review and meta-analysis of 39 471 women. Hum Reprod Update 2022; 28:910-955. [PMID: 35639552 PMCID: PMC9629501 DOI: 10.1093/humupd/dmac023] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/08/2022] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Lifestyle (dietary and/or physical activity [PA]) modification is recommended as first-line therapy to manage polycystic ovary syndrome (PCOS). Current recommendations are based on healthy lifestyle practices for the general public since evidence for unique lifestyle approaches in PCOS is limited and low quality. OBJECTIVE AND RATIONALE We aimed to synthesize evidence on dietary and PA behaviors between women with PCOS and those without PCOS. Primary outcomes were overall diet quality, total energy intake and total PA, and secondary outcomes included macronutrients, micronutrients, food groups, foods, glycemic indices, sedentary time and sitting levels. We conducted this work to identify any unique lifestyle behaviors in women with PCOS that could underlie the propensity of weight gain and obesity in PCOS and be targeted for precision nutrition and PA interventions. These findings could be used to inform future practice recommendations and research that more effectively address complications (weight gain, obesity, diabetes, infertility, cardiovascular disease and mental health) in this high-risk population. SEARCH METHODS Databases of MEDLINE, Web of Science, Scopus and CINAHL were searched until 15 February 2022 to identify observational studies documenting dietary and PA behaviors between women with PCOS and without PCOS (Controls). Studies on children, adolescents (<18 years), pregnant or menopausal-aged women (>50 years) were excluded. Data were pooled by random-effects models and expressed as (standardized) mean differences (MD) and 95% CIs. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). OUTCOMES Fifty-four studies (N = 39 471 participants; [n = 8736 PCOS; 30 735 Controls]) were eligible (96%; [52/54] NOS scores ≥ 7). Women with PCOS had higher cholesterol (MD: 12.78, 95% CI: 1.48 to 24.08 mg/day; P = 0.03; I2 = 19%), lower magnesium (MD: -21.46, 95% CI: -41.03 to -1.91 mg/day; P = 0.03; I2 = 76%), and a tendency for lower zinc (MD: -1.08, 95% CI: -2.19 to -0.03 mg/day; P = 0.05; I2 = 96%) intake, despite lower alcohol consumption (MD: -0.95, 95% CI: -1.67 to 0.22 g/day; P = 0.02; I2 = 0%) versus Controls. Also, women with PCOS had lower total PA (standardized mean difference: -0.38, 95% CI: -0.72 to 0.03; P = 0.03; I2 = 98%). Conversely, energy, macronutrients (carbohydrate, fat, protein, fiber), micronutrients (folic acid, iron, calcium, sodium), glycemic index and glycemic load were similar (all: P ≥ 0.06). Most eligible studies reported lower total adherence to healthy eating patterns or poorer consumption of major food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy) in women with PCOS, as described narratively since variable study methodology did not permit meta-analyses. WIDER IMPLICATIONS Collective evidence supports that women with PCOS have a lower overall diet quality, poorer dietary intakes (higher cholesterol, lower magnesium and zinc) and lower total PA, despite lower alcohol consumption versus those without PCOS. Considerable heterogeneity among studies reinforces the need for research to address any relative contributions of other factors (e.g. genetic, metabolic or sociodemographic) to the observed differences. These clarifications may contribute to future evidence-based guideline recommendations on monitoring and managing PCOS in the era of precision lifestyle medicine.
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Affiliation(s)
- Maryam Kazemi
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
- Hilda and J. Lester Gabrilove Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joy Y Kim
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Cynthia Wan
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Julia D Xiong
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Julia Michalak
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Isabella B Xavier
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Kiran Ganga
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Chau Thien Tay
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Jessica A Grieger
- Robinson Research Institute, University of Adelaide, North Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Stephen A Parry
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY, USA
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
- Robinson Research Institute, University of Adelaide, North Adelaide, SA, Australia
| | - Marla E Lujan
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
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Blanco CE. Early diagnosis in polycystic ovary syndrome. Nurse Pract 2022; 47:18-24. [PMID: 36165968 DOI: 10.1097/01.npr.0000873528.58247.9e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT NPs are in an ideal position to educate patients on the lifelong implications of polycystic ovary syndrome (PCOS). A timely diagnosis and comprehensive plan are needed to appropriately manage patients with PCOS. This article highlights diagnostic criteria, common comorbid conditions, psychological impacts of the clinical manifestations, management approaches, and implications for NPs.
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Affiliation(s)
- Christy E Blanco
- Christy E. Blanco is an associate professor at Hunt School of Nursing at Texas Tech University Health Sciences Center El Paso in El Paso, Tex
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Franik S, Le QK, Kremer JA, Kiesel L, Farquhar C. Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome. Cochrane Database Syst Rev 2022; 9:CD010287. [PMID: 36165742 PMCID: PMC9514207 DOI: 10.1002/14651858.cd010287.pub4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common cause of infrequent periods (oligomenorrhoea) and absence of periods (amenorrhoea). It affects about 5% to 20% of women worldwide and often leads to anovulatory infertility. Aromatase inhibitors (AIs) are a class of drugs that were introduced for ovulation induction in 2001. Since about 2001 clinical trials have reached differing conclusions as to whether the AI, letrozole, is at least as effective as the first-line treatment clomiphene citrate (CC), a selective oestrogen receptor modulator (SERM). OBJECTIVES To evaluate the effectiveness and safety of AIs (letrozole) (with or without adjuncts) compared to SERMs (with or without adjuncts) for infertile women with anovulatory PCOS for ovulation induction followed by timed intercourse or intrauterine insemination. SEARCH METHODS We searched the following sources, from their inception to 4 November 2021, to identify relevant randomised controlled trials (RCTs): the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase and PsycINFO. We also checked reference lists of relevant trials, searched the trial registers and contacted experts in the field for any additional trials. We did not restrict the searches by language or publication status. SELECTION CRITERIA We included all RCTs of AIs used alone or with other medical therapies for ovulation induction in women of reproductive age with anovulatory PCOS. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted the data and assessed risks of bias using RoB 1. We pooled trials where appropriate using a fixed-effect model to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for most outcomes, and risk differences (RDs) for ovarian hyperstimulation syndrome (OHSS). The primary outcomes were live birth rate and OHSS rate. Secondary outcomes were clinical pregnancy, miscarriage and multiple pregnancy rates. We assessed the certainty of the evidence for each comparison using GRADE methods. MAIN RESULTS This is a substantive update of a previous review; of six previously included trials, we excluded four from this update and moved two to 'awaiting classification' due to concerns about validity of trial data. We included five additional trials for this update that now includes a total of 41 RCTs (6522 women). The AI, letrozole, was used in all trials. Letrozole compared to SERMs with or without adjuncts followed by timed intercourse Live birth rates were higher with letrozole (with or without adjuncts) compared to SERMs followed by timed intercourse (OR 1.72, 95% CI 1.40 to 2.11; I2 = 0%; number needed to treat for an additional beneficial outcome (NNTB) = 10; 11 trials, 2060 participants; high-certainty evidence). This suggests that in women with a 20% chance of live birth using SERMs, the live birth rate in women using letrozole with or without adjuncts would be 27% to 35%. There is high-certainty evidence that OHSS rates are similar with letrozole or SERMs (0.5% in both arms: risk difference (RD) -0.00, 95% CI -0.01 to 0.01; I2 = 0%; 10 trials, 1848 participants; high-certainty evidence). There is evidence for a higher pregnancy rate in favour of letrozole (OR 1.69, 95% CI 1.45 to 1.98; I2 = 0%; NNTB = 10; 23 trials, 3321 participants; high-certainty evidence). This suggests that in women with a 24% chance of clinical pregnancy using SERMs, the clinical pregnancy rate in women using letrozole with or without adjuncts would be 32% to 39%. There is little or no difference between treatment groups in the rate of miscarriage per pregnancy (25% with SERMs versus 24% with letrozole: OR 0.94, 95% CI 0.66 to 1.32; I2 = 0%; 15 trials, 736 participants; high-certainty evidence) and multiple pregnancy rate (2.2% with SERMs versus 1.6% with letrozole: OR 0.74, 95% CI 0.42 to 1.32; I2 = 0%; 14 trials, 2247 participants; high-certainty evidence). However, a funnel plot showed mild asymmetry, indicating that some trials in favour of SERMs might be missing. Letrozole compared to laparoscopic ovarian drilling (LOD) One trial reported very low-certainty evidence that live birth rates may be higher with letrozole compared to LOD (OR 2.07, 95% CI 0.99 to 4.32; 1 trial, 141 participants; very low-certainty evidence). This suggests that in women with a 22% chance of live birth using LOD with or without adjuncts, the live birth rate in women using letrozole with or without adjuncts would be 24% to 47%. No trial reported OHSS rates. Due to the low-certainty evidence we are uncertain if letrozole improves pregnancy rates compared to LOD (OR 1.47, 95% CI 0.95 to 2.28; I² = 0%; 3 trials, 367 participants; low-certainty evidence). This suggests that in women with a 29% chance of clinical pregnancy using LOD with or without adjuncts, the clinical pregnancy rate in women using letrozole with or without adjuncts would be 28% to 45%. There seems to be no evidence of a difference in miscarriage rates per pregnancy comparing letrozole to LOD (OR 0.65, 95% CI 0.22 to 1.92; I² = 0%; 3 trials, 122 participants; low-certainty evidence). This also applies to multiple pregnancies (OR 3.00, 95% CI 0.12 to 74.90; 1 trial, 141 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Letrozole appears to improve live birth rates and pregnancy rates in infertile women with anovulatory PCOS, compared to SERMs, when used for ovulation induction, followed by intercourse. There is high-certainty evidence that OHSS rates are similar with letrozole or SERMs. There was high-certainty evidence of no difference in miscarriage rate and multiple pregnancy rate. We are uncertain if letrozole increases live birth rates compared to LOD. In this update, we added good quality trials and removed trials with concerns over data validity, thereby upgrading the certainty of the evidence base.
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Affiliation(s)
- Sebastian Franik
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Quang-Khoi Le
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Jan Am Kremer
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Ludwig Kiesel
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Cindy Farquhar
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Manzoor F, Nisa MU, Shakoor A, Hussain L, Mahmood A, Younas A. Effect of sodium alginate supplementation on weight management and reproductive hormones in polycystic females. Food Funct 2022; 13:9847-9855. [PMID: 36047511 DOI: 10.1039/d2fo01539k] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dietary fiber is getting attention these days due to its tendency to improve the reproductive performance in human beings. Sodium alginate (SA) is one of the natural dietary fibers. The present study aimed to evaluate the effect of SA on serum insulin, blood sugar, lipid profile, estrogen and testosterone in polycystic (PCOS) females. A single in vivo trial was conducted on thirty adult PCOS females (25 ± 5 years old) with a body mass index (BMI) of 27.5 ± 3.5 kg m-2. Blood samples of all PCOS females were drawn for the initial biochemical analysis and considered as the negative control (NC). A complete randomized design was used to divide the NC group into three equal subgroups (n = 9) i.e. SA3: with 0.03 g; SA6: with 0.06 g per kg body weight per day of sodium alginate; the positive control (PC): metformin 500 mg day-1 for 60 days (two months). A significant reduction (p < 0.05) in the body weight, BMI, blood sugar, serum insulin, lipids and testosterone was observed, while a significant incremental effect (p < 0.05) was observed in the high-density lipoprotein level. The percentages of some physical parameters were also improved like obesity, menstrual cycle, physical activity, psychological issues and hirsutism. Therefore, the study concluded that SA exhibited therapeutic potential for weight management and the improvement of serum testosterone in PCOS females.
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Affiliation(s)
- Faiza Manzoor
- Department of Nutritional Sciences, Faculty of Medical Sciences, Government College University, Faisalabad, 38000, Punjab, Pakistan.
| | - Mahr-Un Nisa
- Department of Nutritional Sciences, Faculty of Medical Sciences, Government College University, Faisalabad, 38000, Punjab, Pakistan.
| | - Abdul Shakoor
- Department of Medical Sciences, University of Medical and Dental College, 38000, Punjab, Pakistan
| | - Liaqat Hussain
- Department of Pharmacology, Faculty of Pharmaceutical sciences, Government College University Faisalabad, 38000 Pakistan
| | - Abid Mahmood
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical sciences, Government College University Faisalabad, 38000 Pakistan
| | - Anam Younas
- Department of Pharmacology, Faculty of Pharmaceutical sciences, Government College University Faisalabad, 38000 Pakistan
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Kumar N, Agarwal H. Early Clinical, Biochemical and Radiological Features in Obese and Non-Obese Young Women with Polycystic Ovarian Syndrome: A Comparative Study. Horm Metab Res 2022; 54:620-624. [PMID: 35858631 DOI: 10.1055/a-1880-1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is a heterogenous condition accounting for serious health complications. The present study was conducted to assess the early clinical, biochemical, and radiological features in obese, non-obese young women with PCOS as compared to non-PCOS women. The study was conducted on 120 young women (18-22 years) with 80 having features of PCOS [40 obese (BMI≥25 kg/m2) and 40 non-obese (BMI<25 kg/m2) PCOS] as cases and 40 without PCOS as controls in a rural tertiary care center of Northern India over one year (2017-2018). After enrolment of cases and control, the anthropometric measurements, early clinical symptoms, and biochemical and ultrasonographic features were compared between the groups. Statistical analysis was done using SPSS software version 22.0 (p-value<0.05). A significant difference in anthropometric measurements were observed between obese and non-obese PCOS cases. Clinical features like acne, acanthosis nigricans, and hirsutism were more prevalent in obese PCOS as compared to non-obese and controls. On ultrasound, PCOS cases had a significantly increased number of peripherally arranged ovarian follicles, and ovarian volume. The LH: FSH ratio was significantly higher in cases as compared to controls. The levels of serum LH (10.04±1.60 vs. 8.93±2.40 mIU/ml) and total testosterone (2.71±0.39 vs. 2.21±0.39 pg/ml) were higher in obese PCOS as compared to non-obese PCOS cases. In conclusion, clinical, biochemical, and radiological features can be used in the early diagnosis of PCOS. Obesity is an independent risk factor for PCOS and is associated with an increased risk of complications.
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Affiliation(s)
- Naina Kumar
- Obstetrics and Gynecology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, India
| | - Himani Agarwal
- Obstetrics and Gynecology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, India
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Contemporary Advice for Medical Providers Caring for Pilonidal Disease in Women. Dis Colon Rectum 2022; 65:1075-1076. [PMID: 35333795 DOI: 10.1097/dcr.0000000000002463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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133
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Tsukui Y, Kitahara Y, Hasegawa Y, Kobayashi M, Osuka S, Iwase A. Anti-Müllerian hormone levels in the diagnosis of adolescent polycystic ovarian syndrome: a systematic review and meta-analysis. Endocr J 2022; 69:897-906. [PMID: 35675999 DOI: 10.1507/endocrj.ej22-0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine disorder that causes menstrual cycle irregularities and infertility. PCOS is diagnosed based on hyperandrogenism, polycystic ovarian morphology (PCOM), and an-/oligo-ovulation. Upregulation of anti-Müllerian hormone (AMH) in the serum of women with PCOS may be another suitable alternative diagnostic criterion for PCOM. However, previous meta-analyses have reported conflicting results due to the age-dependent decline in serum AMH levels. Therefore, we performed a meta-analysis to evaluate the threshold of AMH for the diagnosis of PCOS in adolescents and women in their early twenties. Fifteen trials were included in this meta-analysis. PCOS is diagnosed with either Rotterdam criteria, NIH, or AE-PCOS. AMH levels were significantly higher in adolescents with PCOS (weighted mean difference, 3.05; 95% confidence interval: 2.09-4.01) than in the control group. The cutoff values of AMH for the diagnosis of adolescent PCOS were 6.1, 6.26, 7.03, 7.11, 7.2, and 7.25 ng/mL in the studies that reported the usefulness of AMH levels. The summary receiver operating characteristic analysis of the diagnostic accuracy demonstrated that the specificity and sensitivity were 81% and 66.3%, respectively. Our meta-analysis demonstrates that AMH may be a useful diagnostic test for adolescent PCOS and, based on the previous studies included in the meta-analysis, its cutoff value was estimated to be 6-7 ng/mL.
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Affiliation(s)
- Yumiko Tsukui
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoshikazu Kitahara
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yuko Hasegawa
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Mio Kobayashi
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
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134
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Vural Solak GT, Akkus G, Solak Y, Kose S, Sert M. Regional variability of modified Ferriman-Gallwey scorring in premenopausal healthy women in Southern Turkey. Gynecol Endocrinol 2022; 38:666-671. [PMID: 35801645 DOI: 10.1080/09513590.2022.2096876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
ObjectiveAlthough modified Ferriman-Gallwey (mF-G) scorring has been the gold standard for assessing hirsutism, also known that this scorring could show variability according to ethnicity. Hence, false positive hirsutism diagnosis and unnecessary anti-androgen therapy can prescribed. It was aimed to disclose the regional characteristics of this scorring in healthy women living in Southern Turkey.Methods360 women between 18 and 50 years of age were randomly screened. Their medical history, including ovulation periods, gestation(s), family history, known drug use was obtained. Physical examination with mF-G scoring and serum hormone measurements were performed. Women with hirsutism who scored ≥ 8 were further investigated for any underlying disease or cause of hirsutism. After these investigations, the women were divided into three groups according to the mF-G ≥ 8 score and evaluated. Group A (n = 59) had an mF-G ≥ 8 and, revealed an underlying disease causing hirsutism; group B (n = 42) had an mF-G ≥ 8, but no underlying disease responsible for hirsutism; and the third group (Group C, n = 259) had an mF-G ≤ 8 and thus, no signs of hirsutism.ResultsThe mean mF-G scores of three groups were 12.78 ± 4.4, 11.48 ± 4.6, and 5.53 ± 3.4, respectively. Of the 59 (16.1%) women in Group A, 46 (44.2%) were diagnosed as polycystic ovary syndrome (PCOS), 8 (7.7%) had idiopathic hyperandrogenism, 7 (6.7%) had nonclassic congenital adrenal hyperplasia, and 1 (1%) had a prolactinoma. When compared to group B, group A women had significantly decreased fertility (p = .001) and menstrual irregularities (p = .001).ConclusionsIn this study, results revealed a significant rate of healthy women (11.6%) who had an mF-G ≥ 8, but no underlying disease causing hirsutism yet were considered hirsute according to their mF-G cutoff. Also, the majority of the studied women (71.9%) living in Southern Turkey were found to have a hair-pattern similar to the European Women. Therefore, we suggest that regional and ethnical body-hair patterns should be considered before prescribing anti-androgen therapy.
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Affiliation(s)
- Gurgun Tugce Vural Solak
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education And Research Hospital, Ankara, Turkey
| | - Gamze Akkus
- Department of Endocrinology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Yavuzalp Solak
- Department of Public Health, Keçiören District Health Directorate, Ankara, Turkey
| | - Sevgul Kose
- Department of Radiology Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Murat Sert
- Department of Endocrinology, Faculty of Medicine, Cukurova University, Adana, Turkey
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Cussen L, McDonnell T, Bennett G, Thompson CJ, Sherlock M, O'Reilly MW. Approach to androgen excess in women: Clinical and biochemical insights. Clin Endocrinol (Oxf) 2022; 97:174-186. [PMID: 35349173 PMCID: PMC9541126 DOI: 10.1111/cen.14710] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/15/2021] [Accepted: 01/17/2022] [Indexed: 12/12/2022]
Abstract
Androgen excess in women typically presents clinically with hirsutism, acne or androgenic alopecia. In the vast majority of cases, the underlying aetiology is polycystic ovary syndrome (PCOS), a common chronic condition that affects up to 10% of all women. Identification of women with non-PCOS pathology within large cohorts of patients presenting with androgen excess represents a diagnostic challenge for the endocrinologist, and rare pathology including nonclassic congenital adrenal hyperplasia, severe insulin resistance syndromes, Cushing's disease or androgen-secreting tumours of the ovary or adrenal gland may be missed in the absence of a pragmatic screening approach. Detailed clinical history, physical examination and biochemical phenotyping are critical in risk-stratifying women who are at the highest risk of non-PCOS disorders. Red flag features such as rapid onset symptoms, overt virilization, postmenopausal onset or severe biochemical disturbances should prompt investigations for underlying neoplastic pathology, including dynamic testing and imaging where appropriate. This review will outline a proposed diagnostic approach to androgen excess in women, including an introduction to androgen metabolism and provision of a suggested algorithmic strategy to identify non-PCOS pathology according to clinical and biochemical phenotype.
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Affiliation(s)
- Leanne Cussen
- Department of Medicine, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinRepublic of Ireland
- Department of EndocrinologyBeaumont HospitalDublinRepublic of Ireland
| | - Tara McDonnell
- Department of Medicine, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinRepublic of Ireland
- Department of EndocrinologyBeaumont HospitalDublinRepublic of Ireland
| | - Gillian Bennett
- Department of EndocrinologyBeaumont HospitalDublinRepublic of Ireland
| | - Christopher J. Thompson
- Department of Medicine, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinRepublic of Ireland
- Department of EndocrinologyBeaumont HospitalDublinRepublic of Ireland
| | - Mark Sherlock
- Department of Medicine, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinRepublic of Ireland
- Department of EndocrinologyBeaumont HospitalDublinRepublic of Ireland
| | - Michael W. O'Reilly
- Department of Medicine, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinRepublic of Ireland
- Department of EndocrinologyBeaumont HospitalDublinRepublic of Ireland
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Vitale SG, Fulghesu AM, Mikuš M, Watrowski R, D’Alterio MN, Lin LT, Shah M, Reyes-Muñoz E, Sathyapalan T, Angioni S. The Translational Role of miRNA in Polycystic Ovary Syndrome: From Bench to Bedside—A Systematic Literature Review. Biomedicines 2022; 10:biomedicines10081816. [PMID: 36009364 PMCID: PMC9405312 DOI: 10.3390/biomedicines10081816] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
Abstract
MicroRNAs (miRNAs) are small, non-coding RNAs that are essential for the regulation of post-transcriptional gene expression during tissue development and differentiation. They are involved in the regulation of manifold metabolic and hormonal processes and, within the female reproductive tract, in oocyte maturation and folliculogenesis. Altered miRNA levels have been observed in oncological and inflammatory diseases, diabetes or polycystic ovary syndrome (PCOS). Therefore, miRNAs are proving to be promising potential biomarkers. In women with PCOS, circulating miRNAs can be obtained from whole blood, serum, plasma, urine, and follicular fluid. Our systematic review summarizes data from 2010–2021 on miRNA expression in granulosa and theca cells; the relationship between miRNAs, hormonal changes, glucose and lipid metabolism in women with PCOS; and the potential role of altered miRNAs in fertility (oocyte quality) in PCOS. Furthermore, we discuss miRNAs as a potential therapeutic target in PCOS and as a diagnostic marker for PCOS.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy;
| | - Anna Maria Fulghesu
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (A.M.F.); (M.N.D.)
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, 10 000 Zagreb, Croatia;
| | - Rafał Watrowski
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Maurizio Nicola D’Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (A.M.F.); (M.N.D.)
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan;
- Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Pei-Tou, Taipei 112, Taiwan
- Department of Biological Science, National Sun Yat-sen University, 70 Lienhai Rd., Kaohsiung City 80424, Taiwan
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25100, Pakistan;
| | - Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull HU6 7RX, UK;
| | - Stefano Angioni
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy;
- Correspondence:
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Evaluation of Hormonal Profile and Ovarian Morphology among Adolescent Girls with Menstrual Irregularities in a Tertiary Care Centre at Central India. ScientificWorldJournal 2022; 2022:3047526. [PMID: 35874845 PMCID: PMC9307389 DOI: 10.1155/2022/3047526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Menstrual disturbances are common among adolescents with a prevalence rate of 11.3–26.7%. The most frequent menstrual irregularities are oligomenorrhea, menorrhagia, polymenorrhoea, and hypomenorrhea. PCOS (polycystic ovarian syndrome) is now recognized as the most prevalent endocrine disorder among the women of reproductive age. The current study was planned to evaluate socio-demographic factors, endocrine profiles, and ovarian morphology among adolescent girls with menstrual irregularities and compare these parameters in different phenotypes of adolescent PCOS cases. It is a hospital-based cross-sectional study among 248 adolescent girls (10–19 years) with menstrual irregularities. After obtaining informed consent, history and clinical examination findings were recorded on preform proforma. All girls were assessed on day 2/3 of the menstrual cycle for hormonal profile (serum TSH, FSH, LH, prolactin, and serum testosterone) and ovarian morphology (by transabdominal ultrasonography). All participating girls were divided into three groups (groups 1, 2, and 3) corresponding to phenotypes A, B, & D as per the Rotterdam criteria. In the study, oligomenorrhea was the most common menstrual disorder (70.97%). Biochemical hyperandrogenism and thyroid dysfunction were reported in 14.91% and 8.46% of girls, respectively. Our study noted that phenotype D ,i.e., group 3 (MI + PCOM-HA; 49.43%) was the most common phenotype in the study. In a comparative analysis of different groups, significant differences (p < 0.05) in hormonal and metabolic parameters showed highest in group 2, which represents phenotype B of PCOS (hyperandrogenic anovulation). This analysis revealed that adolescent hyperandrogenism (phenotypes A and B) is associated with a more deranged hormonal and metabolic profile than nonandrogenic PCOS (phenotype D). To prevent long-term sequelae, lifestyle changes, early treatment, and close follow-up are recommended in this subset of girls.
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138
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Sex Steroid Receptors in Polycystic Ovary Syndrome and Endometriosis: Insights from Laboratory Studies to Clinical Trials. Biomedicines 2022; 10:biomedicines10071705. [PMID: 35885010 PMCID: PMC9312843 DOI: 10.3390/biomedicines10071705] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) and endometriosis are reproductive disorders that may cause infertility. The pathology of both diseases has been suggested to be associated with sex steroid hormone receptors, including oestrogen receptors (ER), progesterone receptors (PRs) and androgen receptors (ARs). Therefore, with this review, we aim to provide an update on the available knowledge of these receptors and how their interactions contribute to the pathogenesis of PCOS and endometriosis. One of the main PCOS-related medical conditions is abnormal folliculogenesis, which is associated with the downregulation of ER and AR expression in the ovaries. In addition, metabolic disorders in PCOS are caused by dysregulation of sex steroid hormone receptor expression. Furthermore, endometriosis is related to the upregulation of ER and the downregulation of PR expression. These receptors may serve as therapeutic targets for the treatment of PCOS-related disorders and endometriosis, considering their pathophysiological roles. Receptor agonists may be applied to increase the expression of a specific receptor and treat endometriosis or metabolic disorders. In contrast, receptor antagonist functions to reduce receptor expression and can be used to treat endometriosis and induce ovulation. Understanding PCOS and the pathological roles of endometriosis sex steroid receptors is crucial for developing potential therapeutic strategies to treat infertility in both conditions. Therefore, research should be continued to fill the knowledge gap regarding the subject.
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139
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Muccee F, Bijou O, Harakeh S, Adawiyah R, Sayyed RZ, Haghshenas L, Alshehri D, Ansari MJ, Ghazanfar S. In-Silico Investigation of Effects of Single-Nucleotide Polymorphisms in PCOS-Associated CYP11A1 Gene on Mutated Proteins. Genes (Basel) 2022; 13:genes13071231. [PMID: 35886014 PMCID: PMC9317558 DOI: 10.3390/genes13071231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a reproductive disorder with multiple etiologies, mainly characterized by the excess production of androgens. It is equally contributed to by genes and environment. The CYP11A1 gene is imperative for steroidogenesis, so any dysregulation or mutation in this gene can lead to PCOS pathogenesis. Therefore, nucleotide diversity in this gene can be helpful in spotting the likelihood of developing PCOS. The present study was initiated to investigate the effect of single nucleotide polymorphisms in human CYP11A1 gene on different attributes of encoded mutated proteins, i.e., sub-cellular localization, ontology, half-life, isoelectric point, instability index, aliphatic index, extinction coefficient, 3-D and 2-D structures, and transmembrane topology. For this purpose, initially coding sequence (CDS) and single nucleotide polymorphisms (SNPs) were retrieved for the desired gene from Ensembl followed by translation of CDS using EXPASY tool. The protein sequence obtained was subjected to different tools including CELLO2GO, ProtParam, PHYRE2, I-Mutant, SIFT, and PolyPhen. It was found that out of seventy-eight SNPs analyzed in this project, seventeen mutations, i.e., rs750026801 in exon 1, rs776056840, rs779154292 and rs1217014229 in exon 2, rs549043326 in exon 3, rs755186597 in exon 4, rs1224774813, rs757299093 and rs1555425667 in exon 5, rs1454328072 in exon 7, rs762412759 and rs755975808 in exon 8, and rs754610565, rs779413653, rs765916701, rs1368450780, and rs747901197 in exon 9 considerably altered the structure, sub-cellular localization, and physicochemical characteristics of mutated proteins. Among the fifty-nine missense SNPs documented in present study, fifty-five and fifty-three were found to be deleterious according to SIFT and PolyPhen tools, respectively. Forty-nine missense mutations were analyzed to have a decreasing effect on the stability of mutant proteins. Hence, these genetic variants can serve as potential biomarkers in human females for determining the probability of being predisposed to PCOS.
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Affiliation(s)
- Fatima Muccee
- School of Biochemistry and Biotechnology, University of Punjab, Lahore 52254, Pakistan
- Correspondence: ; Tel.: +92-0331-4767254
| | - Osama Bijou
- Obstetrics and Gynaecology Department, Faculty of Medicine (FM), King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Steve Harakeh
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Yousef Abdul Latif Jameel Scientific Chair of Prophetic Medicine Application, Faculty of Medicine (FM), King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Rabi’atul Adawiyah
- Faculty of Health and Life Sciences, INTI International University, Nilai 71800, Negeri Sembilan, Malaysia;
| | - R. Z. Sayyed
- Department of Microbiology, P.S.G.V.P. Mandal’s S I Patil Arts, G B Patel Science and S.T.K.V.S. Sangh Commerce College, Shahada 425409, India;
| | - Leila Haghshenas
- Department of Molecular Genetics, Postdoc Association Member of Harvard Medical School, Boston, MA 02138, USA;
| | - Dikhnah Alshehri
- Department of Biology, Faculty of Science, Tabuk University, Tabuk 71491, Saudi Arabia;
| | - Mohammad Javed Ansari
- Department of Botany, Hindu College Moradabad, Mahatma Jyotiba Phule Rohilkhand University, Bareilly 244001, India;
| | - Shakira Ghazanfar
- National Institute for Genomics Advanced Biotechnology (NIGAB), National Agricultural Research Centre (NARC), Islamabad 45500, Pakistan;
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Ameliorative effects of Guilandina bonduc L. aqueous seed extract on letrozole induced polycystic ovary syndrome in female wistar albino rats. ADVANCES IN TRADITIONAL MEDICINE 2022. [DOI: 10.1007/s13596-022-00652-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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141
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Polyzos NP, Ayoubi JM, Pirtea P. General infertility workup in times of high assisted reproductive technology efficacy. Fertil Steril 2022; 118:8-18. [PMID: 35725122 DOI: 10.1016/j.fertnstert.2022.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/04/2022]
Abstract
The assessments of oocyte quality and quantity and endocrine profile have traditionally been the cornerstone of the general workup of couples with infertility. Over the years, several clinical, hormonal, and functional biomarkers have been adopted to assess ovarian function and identify endocrine disorders before assisted reproductive technology. Furthermore, the genetic workup of patients has drastically changed, introducing novel markers. This not only allowed the prediction of response to ovarian stimulation but also contributed toward the development of a safer and more efficient management of women undergoing assisted reproductive technology. The scope of this review is to provide an overview of the current and novel strategies adopted for the assessment of ovarian function and ovulatory and endocrine disorders in women planning to conceive. Furthermore, it aims to provide an insight in the role of novel genetic biomarkers and use of expanded carrier screening as part of preliminary workup of women with infertility.
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Affiliation(s)
- Nikolaos P Polyzos
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain; Faculty of Medicine and Health Sciences, Ghent University (UZ Gent), Gent, Belgium.
| | - Jean Marc Ayoubi
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch-Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
| | - Paul Pirtea
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch-Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
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142
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Gleicher N, Darmon S, Patrizio P, Barad DH. Reconsidering the Polycystic Ovary Syndrome (PCOS). Biomedicines 2022; 10:biomedicines10071505. [PMID: 35884809 PMCID: PMC9313207 DOI: 10.3390/biomedicines10071505] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/08/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
Though likely the most common clinical diagnosis in reproductive medicine, the Polycystic Ovary Syndrome (PCOS) is still only poorly understood. Based on previously published research, and here newly presented supportive evidence, we propose to replace the four current phenotypes of PCOS with only two entities—a hyperandrogenic phenotype (H-PCOS) including current phenotypes A, B, and C, and a hyper-/hypoandrogenic phenotype (HH-PCOS), representing the current phenotype D under the Rotterdam criteria. Reclassifying PCOS in this way likely establishes two distinct genomic entities, H-PCOS, primarily characterized by metabolic abnormalities (i.e., metabolic syndrome) and a hyperandrogenic with advancing age becoming a hypoandrogenic phenotype (HH-PCOS), in approximately 85% characterized by a hyperactive immune system mostly due to autoimmunity and inflammation. We furthermore suggest that because of hypoandrogenism usually developing after age 35, HH-PCOS at that age becomes relatively treatment resistant to in vitro fertilization (IVF) and offer in a case-controlled study evidence that androgen supplementation overcomes this resistance. In view of highly distinct clinical presentations of H-PCOS and HH-PCOS, polygenic risk scores should be able to differentiate between these 2 PCOS phenotypes. At least one clustering analysis in the literature is supportive of this concept.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, New York, NY 10021, USA; (S.D.); (P.P.); (D.H.B.)
- The Foundation for Reproductive Medicine, New York, NY 10022, USA
- Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, NY 10065, USA
- Department of Obstetrics and Gynecology, Vienna University School of Medicine, 1009 Vienna, Austria
- Correspondence: or
| | - Sarah Darmon
- The Center for Human Reproduction, New York, NY 10021, USA; (S.D.); (P.P.); (D.H.B.)
| | - Pasquale Patrizio
- The Center for Human Reproduction, New York, NY 10021, USA; (S.D.); (P.P.); (D.H.B.)
- Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - David H. Barad
- The Center for Human Reproduction, New York, NY 10021, USA; (S.D.); (P.P.); (D.H.B.)
- The Foundation for Reproductive Medicine, New York, NY 10022, USA
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143
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Reckelhoff JF, Shawky NM, Romero DG, Yanes Cardozo LL. Polycystic Ovary Syndrome: Insights from Preclinical Research. KIDNEY360 2022; 3:1449-1457. [PMID: 36176644 PMCID: PMC9416822 DOI: 10.34067/kid.0002052022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/13/2022] [Indexed: 01/11/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting approximately 10%. PCOS is diagnosed by the presence of at least two of these three criteria: hyperandrogenemia, oligo- or anovulation, and polycystic ovaries. The most common type (80%) of PCOS includes hyperandrogenemia. PCOS is also characterized by obesity or overweight (in 80% of US women with PCOS), insulin resistance with elevated plasma insulin but not necessarily hyperglycemia, dyslipidemia, proteinuria, and elevated BP. Although elevated compared with age-matched controls, BP may not reach levels considered treatable according to the current clinical hypertension guidelines. However, it is well known that elevated BP, even modestly so, increases the risk of cardiovascular disease. We have developed a model of hyperandrogenemia in rodents that mimics the characteristics of PCOS in women, with increases in body weight, insulin resistance, dyslipidemia, andproteinuria and elevated BP. This review discusses potential mechanisms responsible for the elevated BP in the adult and aging PCOS rat model that may be extrapolated to women with PCOS.
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Affiliation(s)
- Jane F. Reckelhoff
- Department of Cell and Molecular Biology Women’s Health Research Center, Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, Mississippi
| | - Noha M. Shawky
- Department of Cell and Molecular Biology Women’s Health Research Center, Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, Mississippi
| | - Damian G. Romero
- Department of Cell and Molecular Biology Women’s Health Research Center, Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, Mississippi
| | - Licy L. Yanes Cardozo
- Department of Cell and Molecular Biology Women’s Health Research Center, Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, Mississippi
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144
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Abdalla MA, Shah N, Deshmukh H, Sahebkar A, Östlundh L, Al-Rifai RH, Atkin SL, Sathyapalan T. Impact of pharmacological interventions on anthropometric indices in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Clin Endocrinol (Oxf) 2022; 96:758-780. [PMID: 34918367 DOI: 10.1111/cen.14663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is a heterogeneous condition affecting women of reproductive age and is associated with increased body weight. OBJECTIVE To review the literature on the effect of different pharmacological interventions on the anthropometric indices in women with PCOS. DATA SOURCES We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library, and the Web of Science in April 2020 with an update in PubMed in March 2021. STUDY SELECTION The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)2020. DATA EXTRACTION Reviewers extracted data and assessed the risk of bias using the Cochrane risk of bias tool. RESULTS 80 RCTs were included in the meta-analysis. Metformin vs placebo showed significant reduction in the mean body weight (MD: -3.13 kg; 95% confidence interval [CI]: -5.33 to -0.93, I² = 5%) and the mean body mass index (BMI) (MD: -0.75 kg/m2 ; 95% CI: -1.15 to -0.36, I² = 0%). There was a significant reduction in the mean BMI with orlistat versus placebo (MD: -1.33 kg/m²; 95% CI: -2.16 to -0.66, I² = 0.0%), acarbose versus metformin (MD: -1.26 kg/m²; 95% CI: -2.13 to -0.38, I² = 0%), and metformin versus pioglitazone (MD: -0.91 kg/m²; 95% CI: -1.62 to -0.19, I² = 0%). A significant increase in the mean BMI was also observed in pioglitazone versus placebo (MD: + 2.59 kg/m²; 95% CI: 1.78-3.38, I² = 0%) and in rosiglitazone versus metformin (MD: + 0.80 kg/m²; 95% CI: 0.32-1.27, I² = 3%). There was a significant reduction in the mean waist circumference (WC) with metformin versus placebo (MD: -1.21 cm; 95% CI: -3.71 to 1.29, I² = 0%) while a significant increase in the mean WC with pioglitazone versus placebo (MD: + 5.45 cm; 95% CI: 2.18-8.71, I² = 0%). CONCLUSION Pharmacological interventions including metformin, sitagliptin, pioglitazone, rosiglitazone orlistat, and acarbose have significant effects on the anthropometric indices in women with PCOS.
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Affiliation(s)
- Mohammed A Abdalla
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School (HYMS), University of Hull, Hull, UK
| | - Najeeb Shah
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School (HYMS), University of Hull, Hull, UK
| | - Harshal Deshmukh
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School (HYMS), University of Hull, Hull, UK
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- School of Medicine, University of Western Australia, Perth, Australia
| | - Linda Östlundh
- College of Medicine and Health Sciences, The National Medical Library, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rami H Al-Rifai
- College of Medicine and Health Sciences, Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Stephen L Atkin
- School of Postgraduate Studies and Research, RCSI Medical University of Bahrain, Busaiteen, Kingdom of Bahrain
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School (HYMS), University of Hull, Hull, UK
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145
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Guo Y, Peng X, Cheng R, Chen H, Luo X. Long non-coding RNA-X-inactive specific transcript inhibits cell viability, and induces apoptosis through the microRNA-30c-5p/Bcl2-like protein 11 signaling axis in human granulosa-like tumor cells. Bioengineered 2022; 13:14107-14117. [PMID: 35730492 PMCID: PMC9342309 DOI: 10.1080/21655979.2022.2080366] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The role of long noncoding RNAs (lncRNAs) is being actively explored in polycystic ovary syndrome (PCOS). Recent research has shown that long non-coding RNA (lncRNA) X–inactive Specific Transcript (XIST) is overexpressed in patients with PCOS and is associated with poor pregnancy outcomes. However, the precise function and mechanism of action of lncRNA XIST in PCOS are unknown. We aimed to determine whether lncRNA XIST contributes to PCOS by modulating ovarian granulosa cell physiology. We also investigated any potential molecular regulatory mechanisms. In this study, we discovered that the lncRNA XIST was significantly downregulated in human ovarian granulosa-like tumor (KGN) cells. Notably, overexpression of lncRNA XIST decreased miR-30c-5p expression in KGN cells, inhibited proliferation, and induced apoptosis in KGN cells. However, cotransfection with amiR-30c-5p mimic significantly reduced these effects. Additionally, we discovered that the miR-30c-5p mimic effectively inhibited Bcl2-like protein 11 (BCL2L11) expression, a critical apoptotic promoter, whereas silencing of miR-30c-5p increased BCL2L11 expression, inhibited KGN cell proliferation, and induced apoptosis. In contrast, cotransfection of BCL2L11 with siRNA significantly reversed these effects. In conclusion, this study established that lncRNA XIST plays a critical role in PCOS by modulating the miR-30c-5p/BCL2L11 signaling axis and regulating ovarian granulosa cell physiology.
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Affiliation(s)
- Yichuan Guo
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xueping Peng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ran Cheng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyan Luo
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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146
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Kiconco S, Tay CT, Rassie KL, Azziz R, Teede HJ, Joham AE. Where are we in understanding the natural history of polycystic ovary syndrome? A systematic review of longitudinal cohort studies. Hum Reprod 2022; 37:1255-1273. [PMID: 35535684 PMCID: PMC9206535 DOI: 10.1093/humrep/deac077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/25/2022] [Indexed: 11/21/2022] Open
Abstract
STUDY QUESTION What is the natural history of reproductive, psychological and oncological features in women with polycystic ovary syndrome (PCOS) in comparison to those without PCOS across the life course? SUMMARY ANSWER Existing longitudinal data on changes in reproductive, psychological and oncological features in PCOS are inadequate and conflicting, but the limited evidence suggests that total testosterone (T) and dehydroepiandrosterone sulphate (DHEAS) levels decline more significantly in women with PCOS than in those without PCOS, and the risk of gestational diabetes is higher in pregnant women with PCOS compared to their counterparts without PCOS. WHAT IS KNOWN ALREADY The progression of reproductive, psychological and oncological features in PCOS remains unclear, which limits prevention and early diagnosis strategies across the lifespan. Understanding the natural history of PCOS is one of the overarching priorities in PCOS research. STUDY DESIGN, SIZE, DURATION This is a systematic review of longitudinal cohort studies with a narrative presentation of findings. Databases MEDLINE, EMBASE, Ovid PsycInfo, CINAHL PLUS and EBM reviews were searched between 15 January 2020 and 11 February 2021 with no language restrictions. Only studies published from the year 1990 to February 2021 were included. PARTICIPANTS/MATERIALS, SETTING, METHODS In line with current guidelines for the assessment and management of PCOS, we included studies where participants were females with PCOS diagnosed according to the 2003 Rotterdam or the 1990 National Institutes of Health (NIH) consensus criteria. MAIN RESULTS AND THE ROLE OF CHANCE A total of 21 longitudinal studies including 62 123 participants over four continents reported reproductive, psychological and/or oncological outcomes. Participants were females aged between 15 and 49 years at baseline, with follow-up periods ranging from 4 weeks to 32 years. Consistent evidence based on limited studies suggests that total T and DHEAS levels decline to a greater degree in women with PCOS compared to those without PCOS, and the risk gestational diabetes is higher in women with PCOS than in those without PCOS. Evidence reporting changes over time in the majority of the remaining outcomes was unclear due to conflicting and/or insufficient information. LIMITATIONS, REASONS FOR CAUTION There was extreme heterogeneity between studies in terms of study setting, population characteristics, follow-up period, effect measures used and laboratory testing approaches. WIDER IMPLICATIONS OF THE FINDINGS Understanding the natural history of PCOS and changes in diagnostic, reproductive, psychological and oncological features of PCOS across the lifespan is still a challenge and the existing literature is both limited and conflicting. It is important that future long-term prospective longitudinal studies are conducted in unselected and well-characterized populations. STUDY FUNDING/COMPETING INTEREST(S) This specific study was not funded. S.K. is supported by scholarships from the Research Training Program of the Commonwealth of Australia and Monash University; H.J.T. is supported by an Australian National Health and Medical Research Council fellowship; and A.E.J. is supported by the Australian National Health and Medical Research Council's Centre for Research Excellence in Women's Health in Reproductive Life. R.A. was employed by the American Society for Reproductive Medicine and is a consultant to Spruce Biosciences and Fortress Biotech. The other authors have no conflicts of interest to declare. REGISTRATION NUMBER Prospero registration number: CRD42020165546.
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Affiliation(s)
- Sylvia Kiconco
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Chau Thien Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Departments of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Kate Louise Rassie
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Ricardo Azziz
- Department of Obstetrics and Gynaecology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Healthcare Organization & Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Health Policy, Management, and Behaviour, School of Public Health, University at Albany, SUNY, Rensselaer, New York, USA
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Departments of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Departments of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
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147
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Emekçi Özay Ö, Özay AC, Gün İ. Comparison of stromal thickness and doppler findings in polycystic ovary syndrome and healthy women with ultrasonographic evidence of polycystic ovaries? A cross-sectional study. J OBSTET GYNAECOL 2022; 42:2367-2372. [PMID: 35611830 DOI: 10.1080/01443615.2022.2054684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of the study was to compare the ovarian stromal blood flow and stromal thickness (ST) of polycystic ovary syndrome (PCOS) patients, with healthy women with polycystic ovarian morphology (PCOM) and normal ovarian morphology (NOM). A total of 220 participants were recruited and the three study groups were determined by diagnostic criteria (PCOS n = 106, PCOM n = 68, NOM n = 46). Clinical, hormonal and ultrasonographic measurements of ovaries were assessed and compared. PCOS patients showed statistically higher androgen levels, insulin resistance, hirsutism score, ovarian ST and stromal blood flow compared to PCOM and NOM. The correlation between free androgen index (FAI) and ST was measured. FAI was significantly highly correlated with left ovarian ST (0.83; p < .001) and right ovarian ST (0.83; p < .001). According to the results of this study, the ovarian ST which can be considered as ultrasonographic indicator of FAI, can be used in PCOS diagnosis. Also, it can be suggested that there is no statistically significant difference in ovarian ST and doppler findings between healthy women with PCOM or NOM. ROC analysis was used to measure diagnostic utility of ST. Impact StatementWhat is already known on this subject? Although it is known that ovarian stromal blood flows and stromal thickness are increased in PCOS disease compared to healthy women, they are not included in the diagnostic criteria.What the results of this study add? In the results of this study, it was determined that ovarian stromal blood flow and stromal thickness were increased in PCOS patients, as previously reported in the literature. In addition, these ultrasound measurements were found to be increased in PCOS patients compared to healthy women with PCO morphology, and stromal thickness measurements were strongly correlated with the free androgen index in PCOS patients.What the implications are of these findings for clinical practice and/or further research? Ovarian ST and/or S/A ratio may be an ultrasonograpic indicator of FAI, and may be used in PCOS diagnostic criterias. In the future, it can be revealed whether they vary in patients with different components of the syndrome, by examining these parameters in different PCOS phenotypes.
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Affiliation(s)
- Özlen Emekçi Özay
- Department of Obstetrics and Gynecology, Near East University Hospital, Nicosia, Cyprus
| | - Ali Cenk Özay
- Department of Obstetrics and Gynecology, Near East University Hospital, Nicosia, Cyprus
| | - İsmet Gün
- Department of Obstetrics and Gynecology, Near East University Hospital, Nicosia, Cyprus
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148
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McCartney CR, Campbell RE, Marshall JC, Moenter SM. The role of gonadotropin-releasing hormone neurons in polycystic ovary syndrome. J Neuroendocrinol 2022; 34:e13093. [PMID: 35083794 PMCID: PMC9232905 DOI: 10.1111/jne.13093] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 01/28/2023]
Abstract
Given the critical central role of gonadotropin-releasing hormone (GnRH) neurons in fertility, it is not surprising that the GnRH neural network is implicated in the pathology of polycystic ovary syndrome (PCOS), the most common cause of anovulatory infertility. Although many symptoms of PCOS relate most proximately to ovarian dysfunction, the central reproductive neuroendocrine system ultimately drives ovarian function through its regulation of anterior pituitary gonadotropin release. The typical cyclical changes in frequency of GnRH release are often absent in women with PCOS, resulting in a persistent high-frequency drive promoting gonadotropin changes (i.e., relatively high luteinizing hormone and relatively low follicle-stimulating hormone concentrations) that contribute to ovarian hyperandrogenemia and ovulatory dysfunction. However, the specific mechanisms underpinning GnRH neuron dysfunction in PCOS remain unclear. Here, we summarize several preclinical and clinical studies that explore the causes of aberrant GnRH secretion in PCOS and the role of disordered GnRH secretion in PCOS pathophysiology.
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Affiliation(s)
- Christopher R. McCartney
- Center for Research in Reproduction and Department of MedicineUniversity of Virginia School of MedicineCharlottesvilleVAUSA
| | - Rebecca E. Campbell
- Centre for Neuroendocrinology and Department of PhysiologySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
| | - John C. Marshall
- Center for Research in Reproduction and Department of MedicineUniversity of Virginia School of MedicineCharlottesvilleVAUSA
| | - Suzanne M. Moenter
- Departments of Molecular & Integrative PhysiologyInternal MedicineObstetrics and GynecologyUniversity of MichiganAnn ArborMIUSA
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149
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Guan C, Zahid S, Minhas AS, Ouyang P, Vaught A, Baker VL, Michos ED. Polycystic ovary syndrome: a "risk-enhancing" factor for cardiovascular disease. Fertil Steril 2022; 117:924-935. [PMID: 35512976 DOI: 10.1016/j.fertnstert.2022.03.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 12/12/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age and is hallmarked by hyperandrogenism, oligo-ovulation, and polycystic ovarian morphology. Polycystic ovary syndrome, particularly the hyperandrogenism phenotype, is associated with several cardiometabolic abnormalities, including obesity, dyslipidemia, elevated blood pressure, and prediabetes or type 2 diabetes. Many, but not all, studies have suggested that PCOS is associated with increased risk of cardiovascular disease (CVD), including coronary heart disease and stroke, independent of body mass index and traditional risk factors. Interpretation of the data from these observational studies is limited by the varying definitions and ascertainment of PCOS and CVD across studies. Recent Mendelian randomization studies have challenged the causality of PCOS with coronary heart disease and stroke. Future longitudinal studies with clearly defined PCOS criteria and newer genetic methodologies may help to determine association and causality. Nevertheless, CVD risk screening remains critical in this patient population, as improvements in metabolic profile and reduction in CVD risk are achievable with a combination of lifestyle management and pharmacotherapy. Statin therapy should be implemented in women with PCOS who have elevated atherosclerotic CVD risk. If CVD risk is uncertain, measurement of subclinical atherosclerosis (carotid plaque or coronary artery calcium) may be a useful tool to guide shared decision-making about initiation of statin therapy. Other medications, such as metformin and glucagon-like peptide-1 receptor agonists, also may be useful in reducing CVD risk in insulin-resistant populations. Additional research is needed to determine the best pathways to mitigate PCOS-associated CVD risk.
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Affiliation(s)
- Carolyn Guan
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York
| | - Anum S Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arthur Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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150
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Wang SJ, Zhang MM, Duan N, Hu XY, Ren S, Cao YY, Zhang YP, Wang ZQ. Using transvaginal ultrasonography and MRI to evaluate ovarian volume and follicle count of infertile women: a comparative study. Clin Radiol 2022; 77:621-627. [PMID: 35636975 DOI: 10.1016/j.crad.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/22/2022] [Indexed: 11/26/2022]
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