Ageing and reproduction: is polycystic ovary syndrome an exception?

Melatonin as Potential Targets for Delaying Ovarian Aging

In previous studies, oxidative stress damage has been solely considered to be the mechanism of ovarian aging, and several antioxidants have been used to delay ovarian aging. But recently, more reports have found that endoplasmic reticulum stress, autophagy, sirtuins, mitochondrial dysfunction, telomeres, gene mutation, premature ovarian failure, and polycystic ovary syndrome are all closely related to ovarian aging, and these factors all interact with oxidative stress. These novel insights on ovarian aging are summarized in this review. Furthermore, as a pleiotropic molecule, melatonin is an important antioxidant and used as drugs for several diseases treatment. Melatonin regulates not only oxidative stress, but also the various molecules, and normal and pathological processes interact with ovarian functions and aging. Hence, the mechanism of ovarian aging and the extensive role of melatonin in the ovarian aging process are described herein. This systematic review supply new insights into ovarian aging and the use of melatonin to delay its onset, further supply a novel drug of melatonin for ovarian aging treatment.

Fecundity among women with polycystic ovary syndrome (PCOS)—a population-based study

STUDY QUESTION

Does the long-term fecundity of women with polycystic ovary syndrome (PCOS) differ from those without PCOS?

SUMMARY ANSWER

Cumulative probability of childbirth is similar between women with and without PCOS.

WHAT IS KNOWN ALREADY

PCOS is the main cause of anovulatory infertility in women after menarche. Previous studies indirectly suggest that fecundity in women with PCOS over the longer term may not be lower than in women without PCOS.

STUDY DESIGN, SIZE, DURATION

This is a population-based study using four linked Swedish national registries. A total of 45 395 women with PCOS and 217 049 non-PCOS women were included. Follow-up began at the age of 18 years and continued for a maximum of 26 years, from 1989 to the end of 2015. Childbirth was the main outcome, as identified from the Medical Birth Register.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All women born between 1971 and 1997 who were identified with a PCOS diagnosis in the Swedish Patient Registry between 1 January 2001 and 31 December 2016 were included in the study population. Five controls per women with PCOS were randomly drawn from the Total Population Registry. The control women were born in the same year and living in the same municipality as the patient. The fecundity ratio (FR) was calculated by clustered Cox regression using a robust variance, adjusted for maternal birth period, country of birth and level of education.

MAIN RESULTS AND THE ROLE OF CHANCE

The cumulative probability of childbirth was 80.2% (95% CI, 79.5–80.9%) in women with PCOS and 78.2% (95% CI, 77.9–78.5%) in those without PCOS. Adjusted FR was 0.81 (95% CI, 0.80–0.82) for first childbirth and 0.58 (95% CI, 0.57–0.60) for first childbirth following a spontaneous pregnancy. The FR for second childbirth was 0.79 (95% CI, 0.77–0.80). Women with PCOS had more than one child less frequently than the comparison group. Within the PCOS group, early age at diagnosis, later birth year, Nordic country of origin and low educational level positively influenced the FR.

LIMITATIONS, REASONS FOR CAUTION

Results are not adjusted for BMI, and time from intention to conceive to first childbirth could not be captured. Data on pregnancies, miscarriages or abortions and fertility treatment are unknown for women who did not give birth during the study period. Women with PCOS who did not seek medical assistance might have been incorrectly classified as not having the disease. Such misclassification would lead to an underestimation of the true association between PCOS and outcomes.

WIDER IMPLICATIONS OF THE FINDINGS

While cumulative probability of childbirth is similar between groups, women with PCOS need longer time to achieve their first childbirth. Women with PCOS have a lower FR and give birth to fewer children per woman than women without PCOS. Early diagnosis of and information about PCOS may improve affected women’s reproductive potential.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Swedish Society of Medicine. Inger Sundström Poromaa has, over the past 3 years, received compensation as a consultant and lecturer for Bayer Schering Pharma, MSD, Gedeon Richter, Peptonics and Lundbeck A/S. The other authors declare no competing interests.

Treatment strategies and cumulative live birth rates in WHO-II ovulation disorders

OBJECTIVE

To assess the live birth rate in women with WHO II anovulation and the proportion of women that need second or third line treatments if the initial therapy fails.

STUDY DESIGN

In this multicenter cohort study we included couples with unfulfilled child wish who were referred to three fertility clinics in the Netherlands and selected women with a WHO II ovulation disorder as the only final infertility diagnosis (n = 468).

RESULTS

The cumulative live birth rate of the total group was 82% (383/468). The majority started with clomiphene-citrate as first-line treatment (n = 378) resulting in 180 (48%) live births. There were 153 couples (40%) who underwent a second-line treatment (recombinant-FSH or laparoscopic electrocoagulation of the ovaries, LEO) and 52 couples (14%) a third-line treatment (IVF/ICSI), resulting in 44% and 63% treatment dependent live births rates, respectively. Of all couples, 92 (20%) conceived naturally, 186 (40%) after clomiphene-citrate, 60 (13%) after recombinant-FSH, nine (2%) after LEO and 36 (8%) after IVF.

CONCLUSION

Subfertile women with a WHO II ovulation disorder have a good prognosis on live birth, and most did so after ovulation induction with clomiphene-citrate. If first-line ovulation induction has failed ovulation induction with gonadotrophins or IVF still result in a live birth in about half of the cases.

Prevalence, clinical characteristics, and reproductive outcomes of polycystic ovary syndrome in older women referred for tertiary fertility care

OBJECTIVE

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women. The clinical symptoms of PCOS vary with female age, as older women tend to have lower hyperandrogenic symptoms and many regain regular cycles. In this study, we aimed to estimate the prevalence of PCOS among older women referred for fertility care, describe their clinical characteristics, and compare their reproductive outcomes to those of matched control group.

METHODS

A retrospective study conducted at a single reproductive center. All women aged ≥ 40, who were referred for in-vitro fertilization (IVF), between the years 2011-2015 were screened for possible inclusion. The PCOS diagnosis (was) made based on the Rotterdam criteria. The reproductive outcomes of the PCOS group were compared to those of matched control with tubal infertility.

RESULTS

During the study period, 1427 women, aged 40 years and over, underwent a total of 2124 IVF cycles. Of these, 72 (5%) women were diagnosed with PCOS. In 69 (95.6%), the PCOS diagnosis was made by a combination of polycystic ovary morphology (PCOM) and anovulation. Compared to women with tubal factor infertility, women with PCOS needed lower doses of gonadotropins, had higher number of retrieved oocytes (16.6 vs. 10.4) and higher number of cycles with embryo cryopreservation (47 vs. 22.9%). This resulted in higher cumulative live birth in the PCOS group (26.3 vs. 15.2%, p = 0.04).

CONCLUSION

PCOS comprised 5% of the infertility diagnosis in women aged ≥ 40; PCOM and anovulation were the most prominent features. The higher oocyte number resulted in improved cumulative live birth rate.

Prevalence of diminished ovarian reserve in Chinese women with polycystic ovary syndrome and sensitive diagnostic parameters

OBJECTIVES

To assess the prevalence of diminished ovarian reserve (DOR) in patients with polycystic ovary syndrome (PCOS) in China, and to search for sensitive diagnostic parameters.

METHODS

Three hundred and thirty eight PCOS women aged 20-39 years were recruited. Basic characteristics, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone and anti-Müllerian hormone (AMH) were measured. The best indices to diagnose PCOS with DOR were assessed.

RESULTS

The prevalence of DOR in our Chinese PCOS patients was 16.9%. The level of E2 and FSH and the FSH/LH ratio had a positive correlation with PCOS and DOR (OR > 1, p < 0.05) independent of age and testosterone, while AMH and baseline antral follicle count had a negative correlation (OR < 1, p < 0.05). AMH was a good parameter to diagnose PCOS with DOR, the cutoff was 2.53 ng/ml, with sensitivity 92.5%, specificity 73.7% and area under curve 0.932. AMH had a significant positive correlation with LH (r = 0.016, p < 0.05) and testosterone (r = 0.209, p < 0.01), while had significant negative correlation with age (r=-0.140, p < 0.05), FSH (r=-0.229, p < 0.01) and FSH/LH ratio (r=-0.240, p < 0.01).

CONCLUSIONS

In our study, AMH was a sensitive parameter to diagnose PCOS with DOR, but to improve the accuracy it will still need further studies.

Changes in the PCOS phenotype with age

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-age women. The diagnosis of PCOS is mainly based on the following three components: (1) hyperandrogenism, (2) oligo-amenorrhea, and (3) the observation of polycystic ovaries on a sonogram. The comorbidities may include insulin resistance, type II diabetes mellitus, hypertension and cardiovascular disease. Importantly, the diagnostic criteria and complications related to PCOS are age-dependent. Androgen production in women may decrease because of ovarian aging or decreased production by the adrenal glands over time. The prevalence of hirsutism and acne decreases with age. Ovarian volume and follicle number also decrease with age, with the age-related decrease in follicle number seemingly greater than that of ovarian volume. Aging may also be associated with increased risk of insulin resistance and metabolic disturbances. Therefore, these age-related changes may affect the observed incidence and complications of PCOS. In adolescent patients, the criteria described above pose particular diagnostic problems because the characteristics of normal puberty often overlap with the signs and symptoms of PCOS. Hyperandrogenism and chronic anovulation are the primary disturbances in younger women with PCOS; whereas, obesity, insulin resistance, and metabolic disturbances are predominant in older women with PCOS. The deterioration of insulin resistance during the reproductive life of women with PCOS appears to be mainly attributable to the increase in obesity. Therefore, if body weight could be controlled properly, younger hyperandrogenic PCOS women might reduce their risk of insulin resistance and metabolic disturbances later in life.

Sustained fertility from 22 to 41 years of age in women with polycystic ovarian syndrome

BACKGROUND

Subfertility due to chronic anovulation is common in women with polycystic ovary syndrome (PCOS) and is often treated with IVF. Women with PCOS have an increased ovarian follicle and oocyte count, increased ovarian reserve and/or a slower rate of follicle atresia. If so, one would expect women with PCOS to display a delayed reduction in fertility with advancing age as compared with eumenorrheic women.

METHODS

To test this hypothesis, we compared oocyte count and live birth rates among two groups undergoing IVF, 500 women with PCOS and 500 eumenorrheic women with infertility due to tubal factor only.

RESULTS

Across the age range of 22-41 years, oocyte count and live birth rates remained stable in women with PCOS. In the eumenorrheic comparison group, these parameters decreased significantly with age.

CONCLUSIONS

Women with PCOS display sustained fertility with advancing age as compared with infertile eumenorrheic women.