Effect of sex hormone-binding globulin polymorphisms on the outcome of in vitro fertilization-embryo transfer for polycystic ovary syndrome patients: A case-control study

Follicular fluid composition and reproductive outcomes of women with polycystic ovary syndrome undergoing in vitro fertilization: A systematic review

Polycystic ovary syndrome (PCOS) is recognized as one of the most prevalent endocrinopathy in women at reproductive age. As affected women tend to have poorer assisted reproductive technology (ART) outcomes, PCOS has been suggested to endanger oocyte quality and competence development. The aim of this systematic review was to summarize the available evidence on how the follicular fluid (FF) profile of women with PCOS undergoing in vitro fertilization (IVF) treatment differs from the FF of normo-ovulatory women. For that, an electronic search in PubMed and Web of Science databases was conducted (up to December 2021). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA guidelines were followed, and the Newcastle-Ottawa Scale was used to assess the risk of bias in the included studies. Data retrieved from papers included (n=42), revealed that the FF composition of women with PCOS compared to those without PCOS predominantly diverged at the following molecular classes: oxidative stress, inflammatory biomarkers, growth factors and hormones. Among those biomarkers, some were proposed as being closely related to pathophysiological processes, strengthening the hypothesis that low-grade inflammation and oxidative stress play a critical role in the pathogenesis of PCOS. Notwithstanding, it should be noticed that the available data on PCOS FF fingerprints derives from a limited number of studies conducted in a relatively small number of subjects. Furthermore, phenotypic heterogeneity of PCOS hampers wider comparisons and weakens putative conclusions. Therefore, future studies should be focused at comparing well characterized patient subgroups according to phenotypes.

Is elevated baseline SHBG associated with increased ovulation?

Sexual hormone binding globulin (SHBG) is associated with the endocrine and reproductive systems. We aimed to investigate the role of SHBG in the reproductive process. Therefore, we conducted a secondary analysis of the PCOSAct (Polycystic Ovary Syndrome and Acupuncture Clinical Trial) study, which involved 21 sites in China and a total of 1000 women with PCOS. Out of these, 954 women with SHBG were included in the analysis. Through multivariate analysis of ovulation predictors, we found that age, BMI, estradiol, testosterone, and SHBG all showed a positive predictive value for ovulation (p = 0.0211, 0.0011, 0.0211, 0.0029, 0.0434, respectively). However, the LH to FSH ratio had a negative predictive value (p = 0.0539). Higher quartiles of SHBG were associated with a higher rate of ovulation, and per quartile increased was statistically significant (HR = 1.138, 95%CI [1.054,1.229]). The association remained significant even after adjusting for testosterone (HR = 1.263, 95%CI [1.059, 1.507]). On the other hand, quartiles of testosterone and estradiol did not exhibit any significant tendency toward ovulation. SHBG demonstrated predictive ability for ovulation, conception, pregnancy, and live birth (p < 0.05), and this correlation remained significant after adjusting intervention. Kaplan-Meier curves illustrated that increased levels of SHBG were a factor in high rates of ovulation, conception, and pregnancy. In comparison to other sexual hormones, a higher baseline level of SHBG was related to increased ovulation.

Association of blood lead with estradiol and sex hormone-binding globulin in 8-19-year-old children and adolescents

BACKGROUND

Metals can interfere with hormonal functioning through indirect mechanisms and by binding at the receptor site; thus, they may be associated with hormonal changes. However, there have been few studies on the health impact of metal exposure among children and adolescents. Thus, we aimed to examine the associations of blood lead level (BLL) with estradiol (E2) and sex hormone-binding globulin (SHBG) among children and adolescents aged 8-19 years in the National Health and Nutrition Examination Survey (NHANES) database.

METHODS

This was a cohort study of 2188 individuals from the NHANES. BLL was taken as independent variables, E2 and SHBG as dependent variable. We conducted weighted multivariate linear regression models and smooth curve fittings to evaluate the association between them.

RESULTS

The BLL was significantly positively associated with serum SHBG level in females, especially when the LnBLL quartiles are between Q3 and Q4. There was an inverted U-shaped association between BLL and E2 with the point of inflection at 1.86 μg/L and a U-shaped association between BLL and SHBG with the point of inflection at 1.86 μg/L in female adolescents aged 16-19 years. Meanwhile, In males, there was a positive trend of correlation between BLL and E2 in the 8-11 years, and 16-19 years groups.

CONCLUSIONS

This study found an inverted U-shaped association of BLL with E2 and a U-shaped association between BLL and SHBG in female adolescents aged 16-19 years. This indicates that adjusting blood lead exposure to mitigate the effects of lead on growth and development is important for adolescents aged 16-19 years. Controlling the BLL below 1.86 μg/L may minimize the damage to E2.

The association between serum sex hormone-binding globulin changes during progestin-primed ovarian stimulation and embryo outcomes: a retrospective cohort study

Objective: This study is aimed to examine the associations between embryo outcomes and serum sex hormone-binding globulin (SHBG) changes during progestin-primed ovarian stimulation (PPOS) protocols in IVF/ICSI cycles.Research methods: This study included 2790 eligible consecutive cycles of patients aged 21-53 years undergoing PPOS treatment. Multivariable linear regression analysis was performed to explore the association between SHBG changes and embryo outcomes.Results of the study: Our results showed that the SHBG-increase rate on the HCG day and in the late follicular phase were positively and linearly correlated with available embryos in day3, with adjusted regression coefficients (β) for the SHBG-increase rate on the HCG day, in the late follicular phase were 0.6 (0.4, 0.9), 0.4 (0.2, 0.6), but in the middle follicular phase and in the early follicular phase, this correlation was not significant (p > 0.05).Conclusion: Our results indicate that serum SHBG increment may serve as a biomarker of the developmental potential of the oocytes from patients undergoing the PPOS protocol.

The Association of CYP17A1, CYP19A1, and SHBG Gene Polymorphisms in Polycystic Ovary Syndrome Susceptibility: A Systematic Review and Meta-Analysis

Objective: To elucidate the relationship between CYP17A1/CYP19A1/SHBG gene polymorphisms and PCOS susceptibility.

Methods: We searched multiple databases from inception to December 2020 and meta analysis was conducted to elucidate the relationship between gene polymorphisms and PCOS risk.

Results: 26 studies were included, comprising 4860 PCOS and 4043 controls. CYP17A1 rs743572 polymorphisms were found to be negatively associated with PCOS risk under dominant model (p = 0.017, OR = 0.83, 95%CI 0.72–0.97, I² = 74.80%, P_{heterogeneity} = 0.000) in the general population while neither CYP19A1 rs2414096 polymorphisms (p = 0.578, OR = 0.87, 95%CI 0.54–1.41, I² = 95.90%, P_{heterogeneity} = 0.000) nor SHBG rs6529 polymorphisms (p = 0.752, OR = 0.99, 95%CI 0.94–1.05, I² = 60.90%, P_{heterogeneity} = 0.012) was associated with PCOS susceptibility under dominant model in the general population.

Conclusion: CYP17A1 rs7435721 polymorphisms might be protective factors against PCOS in general populations.

Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD4202122640.

Serum Sex Hormone Binding Globulin Concentration as a Predictor of Ovarian Response During Controlled Ovarian Hyperstimulation

Purpose: Serum concentrations of sex hormone binding globulin (SHBG), a glycated homodimeric plasma transport protein, correlate positively with the total number of follicles in women with infertility. However, the relationship between serum SHBG concentrations and the ovarian response during controlled ovarian hyperstimulation (COH) and whether this relationship differs between women with and without polycystic ovary syndrome (PCOS) remains unclear.

Methods: The study cohort included 120 participants (60 non-PCOS and 60 PCOS) undergoing in vitro fertilization. Serum samples were collected from each participant every 2–3 days during the COH cycle. The concentrations of serum SHBG and other sex hormones were determined to investigate the relationship between serum SHBG concentrations and the ovarian response in women with and without PCOS.

Results: We found that the serum SHBG concentration was positively correlated with the ovarian response in non-PCOS patients but not in PCOS patients.

Conclusion: The serum SHBG concentration may be clinically useful as a predictor of the ovarian response during COH in patients without PCOS.

Lower androgen levels promote abnormal cartilage development in female patients with adolescent idiopathic scoliosis

Background

Adolescent idiopathic scoliosis (AIS) is a disease characterized by changes in the three-dimensional structure of the spine. Studies have shown that the development of AIS might be associated with genetic, biomechanics, endocrine factors and abnormal bone or cartilage development.

Methods

Blood samples collected from 301 female patients (161 females with AIS and 140 females without AIS) were used for genotyping. Forty-eight serum samples from 161 females with AIS and 40 serum samples from 140 females without AIS were subjected to enzyme-linked immunosorbent assays (ELISAs). We also evaluated 32 facet joints (18 females with AIS and 14 females without AIS from the 301 female patients) using immunohistochemistry, Western blotting, and isolation of human primary chondrocytes, among other methods. We treated the AIS primary chondrocytes with dihydrotestosterone (DHT) to verify the relationship among androgen, the androgen receptor (AR), and its downstream pathway proteins.

Results

The serum androgen level in the AIS group was significantly decreased (1.94±0.09 vs. 2.284±0.103) compared with that in the non-AIS (control) group. The single nucleotide polymorphism genotyping results showed that the mutation rates of rs6259 between the AIS and control groups were significantly different (G/G genotype: 48.4% vs. 42.1%, G/A genotype: 40.4% vs. 35.7%, P<0.05). The levels of interleukin (IL)-6 and metalloproteinase (MMP)-13 were increased in the cartilage of AIS patients, and these patients also exhibited decreased AR levels. The cell experiment results showed that androgen reduced the degree of abnormal cartilage development in female AIS patients through the AR/IL-6/signal transducer and activator of transcription 3 (STAT3) signaling pathway.

Conclusions

Our study provides a new perspective on the pathogenesis of AIS and indicates that decreased androgen levels in female AIS patients play a potential role in the development of AIS via the AR/IL-6/STAT3 signaling pathway.

Association between human SHBG gene polymorphisms and risk of PCOS: a meta-analysis

Sex hormone-binding globulin (SHBG) is a plasma glycoprotein that binds androgens and oestrogens, and regulates their bioavailability to target tissues. To date, several human SHBG gene polymorphisms have been identified. Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, and hyperandrogenism has been considered to be a hallmark of PCOS. Many studies have examined the association between SHBG gene polymorphisms and PCOS risk, but the results have been inconclusive or inconsistent. Therefore, the aim of this meta-analysis was to investigate whether SHBG gene polymorphisms are associated with risk of PCOS. Twelve studies were included, involving 4733 participants: 2271 patients with PCOS and 2462 control participants. The results revealed that SHBG polymorphism of eight or more (TAAAA)n pentanucleotide repeats (rs35785886) was associated with PCOS risk (odds ratio [OR] = 1.24, 95% confidence interval [CI] = 1.06, 1.44, Z = 2.77, P = 0.006) and low serum SHBG concentrations in women with PCOS (standardized mean difference = -0.83, 95% CI = -1.54, -0.12, Z = 2.30, P = 0.02). Other SHBG gene polymorphisms (rs6259, rs6257, rs727428 and rs1799941) were not significantly associated with either PCOS risk or serum SHBG concentrations. These findings suggest that the presence of a polymorphism of eight or more SHBG (TAAAA)_n may be a predictive factor for the risk of PCOS.

Association of the Genetic Polymorphisms rs6259 and rs727428 of the SHBG Gene with Polycystic Ovary Syndrome Risk: A Meta-Analysis

Background: Studies investigating the relationship between polymorphisms of the sex hormone-binding globulin (SHBG) gene and polycystic ovary syndrome (PCOS) have reported differing results. Therefore, the present meta-analysis was performed to clarify the effects of the SHBG rs6259 and rs727428 polymorphisms on PCOS risk. Materials and Methods: Published English language studies were selected through an extensive search of the Web of Science, PubMed, and EMBASE databases. Chinese studies were identified using Wan Fang, VIP, and the Chinese National Knowledge Infrastructure (CNKI) databases. The pooled odds ratio and 95% confidence interval were calculated using the random-effects model. Subgroup analyses and heterogeneity analyses were also performed. Results: A total of 1660 cases and 1312 controls were included in this meta-analysis. We found that the SHBG rs6259 polymorphism was not significantly associated with an increased risk of PCOS in any of the genetic models with significant heterogeneity; the results were consistent for all subgroups. A nonsignificant association between the rs727428 polymorphism and an increased risk of PCOS was also detected in all genetic models. Conclusions: The findings of this meta-analysis suggest that neither the SHBG rs6259 nor rs727428 polymorphism are associated with susceptibility to PCOS. However, because of the considerable heterogeneity and the small sample size, these pooled results should be interpreted with caution.