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Thabet M, Abdelhafez MS, Elshamy MR, Albahlol IA, Fayala E, Wageeh A, El-Zayadi AA, Bahgat NA, Mohammed SM, Mohamed AA, Awad MM, El-Menayyer A, El-Sherbiny M, Elsherbini DMA, Albarakati RG, Alshaikh ABA, Edris FE, Bushaqer NJ, Salama YGM, Abdel-razik MM. Competence of Combined Low Dose of Human Chorionic Gonadotropin (HCG) and Clomiphene Citrate (CC) Versus Continued CC during Ovulation Induction in Women with CC-Resistant Polycystic Ovarian Syndrome: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1300. [PMID: 39202581 PMCID: PMC11356540 DOI: 10.3390/medicina60081300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/31/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Polycystic ovarian syndrome (PCOS) is a widespread endocrine disorder affecting 5-18% of females in their childbearing age. The aim of this study is to assess the efficacy of combining a low dosage of human chorionic gonadotropin (HCG) along with clomiphene citrate (CC) for stimulating ovulation in infertile women diagnosed with CC-resistant PCOS. Materials and Methods: A randomized controlled trial was carried out on 300 infertile CC-resistant PCOS women. All participants were assigned to two groups: the CC-HCG group and the CC-Placebo group. Subjects in the CC-HCG group were given CC (150 mg/day for 5 days starting on the 2nd day of the cycle) and HCG (200 IU/day SC starting on the 7th day of the cycle). Subjects in the CC-Placebo group were given CC and a placebo. The number of ovarian follicles > 18 mm, cycle cancellation rate, endometrial thickness, ovulation rate, clinical pregnancy rate, and occurrence of early ovarian hyper-stimulation syndrome were all outcome variables in the primary research. Results: Data from 138 individuals in the CC-HCG group and 131 participants in the CC-Placebo group were subjected to final analysis. In comparison to the CC-Placebo group, the cycle cancellation rate in the CC-HCG group was considerably lower. The CC-HCG group exhibited a substantial increase in ovarian follicles reaching > 18 mm, endometrial thickness, and ovulation rate. The clinical pregnancy rate was higher in the CC-HCG group (7.2% vs. 2.3%; CC-HCG vs. CC-Placebo). Upon adjusting for BMI and age, the findings of our study revealed that individuals in the CC-HCG group who had serum prolactin levels below 20 (ng/mL), secondary infertility, infertility duration less than 4 years, baseline LH/FSH ratios below 1.5, and serum AMH levels more than 4 (ng/mL) had a higher likelihood of achieving pregnancy. In the CC-Placebo group, there was a greater prediction of clinical pregnancy for those with serum AMH (<4), primary infertility, serum prolactin ≤ 20 (ng/mL), baseline LH/FSH < 1.5, and infertility duration < 4 years. Conclusions: The use of a small dose of HCG along with CC appeared to be an effective treatment in reducing cycle cancelation, improving the clinical pregnancy rate and ovulation rate in CC-resistant PCOS patients. The trial was registered with Clinical Trials.gov, identifier NCT02436226.
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Affiliation(s)
- Mahmoud Thabet
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Mohamed Sayed Abdelhafez
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Maged Ragheb Elshamy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Ibrahim A. Albahlol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
- Department of Obstetrics and Gynecology, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Emad Fayala
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Alaa Wageeh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Ahmed Abdelhamid El-Zayadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Nagwan Ahmed Bahgat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Shereen M. Mohammed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Alhussein Ahmed Mohamed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Mahmoud Mohamed Awad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Ahmed El-Menayyer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
| | - Mohamed El-Sherbiny
- Department of Basic Medical Sciences, College of Medicine, AlMaarefa University, P.O. Box 71666, Riyadh 11597, Saudi Arabia;
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | | | - Rayan G. Albarakati
- Department of Clinical Medical Sciences, College of Medicine, AlMaarefa University, P.O. Box 71666, Riyadh 11597, Saudi Arabia;
| | - Ahmed Baker A. Alshaikh
- Department of Obstetrics and Gynecology, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Fawaz E. Edris
- Department of Obstetrics and Gynecology, College of Medicine, Umm AlQura University, Makkah 24382, Saudi Arabia;
| | - Nayla Jamal Bushaqer
- Bahrain Defence Force (BDF) Hospital, Riffa P.O. Box 28743, Bahrain; (N.J.B.); (Y.G.M.S.)
| | | | - Mahmoud Mohamed Abdel-razik
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt; (M.T.); (M.S.A.); (M.R.E.); (I.A.A.); (E.F.); (A.W.); (A.A.E.-Z.); (N.A.B.); (S.M.M.); (A.A.M.); (M.M.A.); (A.E.-M.); (M.M.A.-r.)
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Alkhatib B, Ciarelli J, Ghnenis A, Pallas B, Olivier N, Padmanabhan V, Vyas AK. Early- to mid-gestational testosterone excess leads to adverse cardiac outcomes in postpartum sheep. Am J Physiol Heart Circ Physiol 2024; 327:H315-H330. [PMID: 38819385 DOI: 10.1152/ajpheart.00763.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
Cardiovascular dysfunctions complicate 10-20% of pregnancies, increasing the risk for postpartum mortality. Various gestational insults, including preeclampsia are reported to be associated with adverse maternal cardiovascular outcomes. One such insult, gestational hyperandrogenism increases the risk for preeclampsia and other gestational morbidities but its impact on postpartum maternal health is not well known. We hypothesize that gestational hyperandrogenism such as testosterone (T) excess will adversely impact the maternal heart in the postpartum period. Pregnant ewes were injected with T propionate from day 30 to day 90 of gestation (term 147 days). Three months postpartum, echocardiograms, plasma cytokine profiles, cardiac morphometric, and molecular analysis were conducted [control (C) n = 6, T-treated (T) n = 7 number of animals]. Data were analyzed by two-tailed Student's t test and Cohen's effect size (d) analysis. There was a nonsignificant large magnitude decrease in cardiac output (7.64 ± 1.27 L/min vs. 10.19 ± 1.40, P = 0.22, d = 0.81) and fractional shortening in the T ewes compared with C (35.83 ± 2.33% vs. 41.50 ± 2.84, P = 0.15, d = 0.89). T treatment significantly increased 1) left ventricle (LV) weight-to-body weight ratio (2.82 ± 0.14 g/kg vs. 2.46 ± 0.08) and LV thickness (14.56 ± 0.52 mm vs. 12.50 ± 0.75), 2) proinflammatory marker [tumor necrosis factor-alpha (TNF-α)] in LV (1.66 ± 0.35 vs. 1.06 ± 0.18), 3) LV collagen (Masson's Trichrome stain: 3.38 ± 0.35 vs. 1.49 ± 0.15 and Picrosirius red stain: 5.50 ± 0.32 vs. 3.01 ± 0.23), 4) markers of LV apoptosis, including TUNEL (8.3 ± 1.1 vs. 0.9 ± 0.18), bcl-2-associated X protein (Bax)+-to-b-cell lymphoma 2 (Bcl2)+ ratio (0.68 ± 0.30 vs. 0.13 ± 0.02), and cleaved caspase 3 (15.4 ± 1.7 vs. 4.4 ± 0.38). These findings suggest that gestational testosterone excess adversely programs the maternal LV, leading to adverse structural and functional consequences in the postpartum period.NEW & NOTEWORTHY Using a sheep model of human translational relevance, this study provides evidence that excess gestational testosterone exposure such as that seen in hyperandrogenic disorders adversely impacts postpartum maternal hearts.
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Affiliation(s)
- Bashar Alkhatib
- Department of Pediatrics, Washington University, St Louis, Missouri, United States
| | - Joseph Ciarelli
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Adel Ghnenis
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Brooke Pallas
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Nicholas Olivier
- Department of Veterinary Medicine, Michigan State University, Lansing, Michigan, United States
| | - Vasantha Padmanabhan
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Arpita Kalla Vyas
- Department of Pediatrics, Washington University, St Louis, Missouri, United States
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Manthey C, Cepon-Robins T, Warrener A. Hyperandrogenism associated with polycystic ovary syndrome may have a protective effect against fracture risk in female athletes: A pilot study. Am J Hum Biol 2024; 36:e24070. [PMID: 38488301 DOI: 10.1002/ajhb.24070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 08/03/2024] Open
Abstract
OBJECTIVES Polycystic ovary syndrome (PCOS), characterized by polycystic ovaries, anovulation, and hyperandrogenism, is believed to be an evolutionary mismatch disease. Past research has examined PCOS as a uniform disease, despite variation in phenotypes across diagnostic categories, but establishing an evolutionary mismatch requires a focus on individual traits. We suggest PCOS hyperandrogenism may have been beneficial in ancestral environments because it reduced fracture risk and associated morbidity and mortality due to increased bone mineral density (BMD). We test this hypothesis by assessing fracture frequency, a proxy for BMD, in highly active females with and without PCOS hyperandrogenism. METHODS Sixty-seven reproductive-aged women were surveyed and grouped as: high intensity interval training (HIIT; a proxy for metabolic and physical stress) athletes with hyperandrogenic PCOS (31.24%), HIIT athletes without PCOS (29.85%), and nonathletes with hyperandrogenic PCOS (38.81%). Fracture occurrence was compared between the groups using independent samples Kruskal-Wallis tests for non-normally distributed data, and multiple regression analysis was used to examine anthropometrics, lifestyle and reproductive factors, PCOS status, and exercise frequency on fracture occurrence. RESULTS Fracture occurrence was higher in non-PCOS athletes (3.8 ± 4.3) than PCOS-athletes (1.2 ± 1.4, p = .11) and PCOS-non-athletes (1.0 ± 1.4, p < .01). PCOS-athletes and nonathletes did not differ significantly in fracture occurrence (p = .33). These results were independent of factors associated with bone health. CONCLUSIONS These preliminary findings suggest females with PCOS-related hyperandrogenism may be less likely to experience bone fractures and provide an initial step to explaining why PCOS has persisted despite marked negative reproductive consequences in modern populations.
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Affiliation(s)
- Courtney Manthey
- The University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Tara Cepon-Robins
- The University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Anna Warrener
- The University of Colorado Denver, Denver, Colorado, USA
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Sacca L, Okwaraji G, Densley S, Marciniak A, Knecht M, Wilson C, Pilitsis JG, Kimberly Hopkins D. Polycystic ovary syndrome and chronic pain among females and individuals of childbearing age: A scoping review. SAGE Open Med 2024; 12:20503121241262158. [PMID: 38903491 PMCID: PMC11189018 DOI: 10.1177/20503121241262158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024] Open
Abstract
Objectives The purpose of this scoping review is to explore research studies on the association between chronic pain and polycystic ovary syndrome to create local (U.S.-based) and global recommendations to improve access to and quality of affordable symptom management and treatment options for patients with polycystic ovary syndrome. Methods The study sections used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews as a checklist reference. The review followed the York methodology by Arksey and O'Malley for the extraction, analysis, and presentation of results in scoping reviews. Results Final analysis included two conference abstracts published in peer-reviewed journals and two peer-reviewed articles. The relationship between pain perception and health-related quality of life warrants further investigation in patients with polycystic ovary syndrome as the interconnected pathophysiology of symptoms renders exploring associations between the two factors difficult. A comprehensive understanding of the causes of polycystic ovary syndrome-associated symptoms, particularly those relating to pain perceptions can provide more insight into polycystic ovary syndrome pathophysiology and aid in the development of innovative therapeutic approaches for long-term polycystic ovary syndrome management and care. Conclusion Future studies are necessary to examine associations between the disease and pathophysiological symptoms for a better quality of life for patients with polycystic ovary syndrome.
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Affiliation(s)
- Lea Sacca
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Goodness Okwaraji
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sebastian Densley
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Adeife Marciniak
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Michelle Knecht
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Candy Wilson
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Dawn Kimberly Hopkins
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Saei Ghare Naz M, Ghasemi V, Amirshekari S, Ramezani Tehrani F. Polycystic Ovary Syndrome and Irritable Bowel Syndrome: Is There a Common Pathway? Endocrinol Diabetes Metab 2024; 7:e00477. [PMID: 38494583 PMCID: PMC10944984 DOI: 10.1002/edm2.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE Little is known about how polycystic ovary syndrome (PCOS) is linked to irritable bowel syndrome (IBS). This study aimed to review the existing literature regarding the association between PCOS or its symptoms and complications with IBS. METHODS In this review, studies that investigated the proposed cross-link between features of PCOS and IBS were included. This review collectively focused on recent findings on the mechanism and novel insight regarding the association between IBS and PCOS in future clinical practice. An electronic search of PubMed, Scopus, Epistemonikos, Cochrane Library and Google Scholar was performed. We did not restrict the study setting and publication date. RESULTS The existing evidence has not completely answered the question of whether there is an association between PCOS and IBS and vice versa. Six case-control studies (793 women with PCOS and 547 women in the control group) directly assessed the association between PCOS and IBS. The prevalence of IBS among women with PCOS in these studies has ranged from 10% to 52% compared with 5%-50% in control groups. Evidence suggested the common pathways may have contributed to the interaction between IBS and PCOS, including metabolic syndrome, sex hormone fluctuation, dysregulation of neurotransmitters, psychological problems and environmental and lifestyle factors. To date, it is still ambiguous which of the mentioned components largely contributes to the pathogenesis of both. CONCLUSION Although limited evidence has shown a higher prevalence of IBS in women with PCOS, there are several potential, direct and common indirect pathways contributing to the development of both IBS and PCOS.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | | | - Shabahang Amirshekari
- Reproductive Endocrinology Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
- The Foundation for Research & Education ExcellenceVestavia HillsAlabamaUSA
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Zheng CY, Yu YX, Bai X. Polycystic ovary syndrome and related inflammation in radiomics; relationship with patient outcome. Semin Cell Dev Biol 2024; 154:328-333. [PMID: 36933953 DOI: 10.1016/j.semcdb.2023.02.013] [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: 02/04/2023] [Revised: 02/26/2023] [Accepted: 02/26/2023] [Indexed: 03/19/2023]
Abstract
Polycystic ovary syndrome (PCOS) refers to a condition that often has 'poly' liquid containing sacks around ovaries. It affects reproductive-aged females giving rise to menstrual and related reproductive issues. PCOS is marked by hormonal imbalance often resulting in hyperandrogenism. Inflammation is now considered a central manifestation of this disease with several inflammatory biomarkers such as TNF-α, C-reactive protein and Interleukins-6/18 found to be particularly elevated in PCOS patients. Diagnosis is often late, and MRI-based diagnosis, along with blood-based analyses, are still the best bet for a definitive diagnosis. Radiomics also offers several advantages and should be exploited to the maximum. The mechanisms of PCOS onset and progression are not very well known but pituitary dysfunction and elevated gonadotrophin releasing hormone resulting in high levels of luteinizing hormone are indicative of an activated hypothalamic-pituitary-ovarian axis in PCOS. A number of studies have also identified signaling pathways such as PI3K/Akt, NF-κB and STAT in PCOS etiology. The links of these signaling pathways to inflammation further underline the importance of inflammation in PCOS, which needs to be resolved for improving patient outcomes.
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Affiliation(s)
- Chun-Yang Zheng
- Embryo Laboratory, Jinghua Hospital of Shenyang, No. 83, Zhongshan Road, Heping District, Shenyang 110000, Liaoning Province, China
| | - Yue-Xin Yu
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, No. 5, Guangrong Street, Heping District, Shenyang 110000, Liaoning Province, China
| | - Xue Bai
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, No. 5, Guangrong Street, Heping District, Shenyang 110000, Liaoning Province, China.
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Ionescu OM, Frincu F, Mehedintu A, Plotogea M, Cirstoiu M, Petca A, Varlas V, Mehedintu C. Berberine-A Promising Therapeutic Approach to Polycystic Ovary Syndrome in Infertile/Pregnant Women. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010125. [PMID: 36676074 PMCID: PMC9864590 DOI: 10.3390/life13010125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a disorder with an unknown etiology that features a wide range of endocrine and metabolic abnormalities that hamper fertility. PCOS women experience difficulties getting pregnant, and if pregnant, they are prone to miscarriage, gestational diabetes, pregnancy-induced hypertension and preeclampsia, high fetal morbidity, and perinatal mortality. Insulin, the pancreatic hormone best known for its important role in glucose metabolism, has an underrated position in reproduction. PCOS women who have associated insulin resistance (with consequent hyperinsulinemia) have fertility issues and adverse pregnancy outcomes. Lowering the endogen insulin levels and insulin resistance appears to be a target to improve fertility and pregnancy outcomes in those women. Berberine is an alkaloid with a high concentration in various medicinal herbs that exhibits a hypoglycaemic effect alongside a broad range of other therapeutic activities. Its medical benefits may stand up for treating different conditions, including diabetes mellitus. So far, a small number of pharmacological/clinical trials available in the English language draw attention towards the good results of berberine's use in PCOS women with insulin resistance for improving fertility and pregnancy outcomes. Our study aims to uncover how berberine can counteract the negative effect of insulin resistance in PCOS women and improve fertility and pregnancy outcomes.
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Affiliation(s)
- Oana-Maria Ionescu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Francesca Frincu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
- Correspondence:
| | - Andra Mehedintu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Mihaela Plotogea
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania
| | - Monica Cirstoiu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Aida Petca
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Valentin Varlas
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Claudia Mehedintu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
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Zhang X, Miao H, Zhou J, Chen Y, Ou Y, Song Y, Peng X, Li Y, Li L. Association between preconception anti-androgen therapy and pregnancy outcomes of patients with PCOS: A prospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1109861. [PMID: 36793270 PMCID: PMC9923094 DOI: 10.3389/fendo.2023.1109861] [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: 12/12/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) not only increases fertility challenges for women of reproductive age, but also leads to increased complications during pregnancy and even affects the birth weight of newborns. Also, hyperandrogenemia is associated with lower pregnancy rates and lower live birth rates and may even play a role in preterm delivery and pre-eclampsia in patients with PCOS. However, it is still controversial whether PCOS patients are treated with androgen-lowering therapy before pregnancy. OBJECTIVE To assess the effect of anti-androgen therapy prior to ovulation induction on maternal and infant pregnancy outcomes in patients with PCOS. METHODS Prospective cohort study. RESULTS A total of 296 patients with PCOS were enrolled in the study. The prevalence of adverse pregnancy outcomes, and neonatal complications was lower in DRSP(with drospirenone ethinyl estradiol tablets (II) pretreatment) group than in NO-DRSP(without drospirenone ethinyl estradiol tablets (II) pretreatment) groups (DRSP vs. NO-DRSP: adverse pregnancy outcomes, 12.16% vs. 27.03%, P=0.001; neonatal complications, 17.16% vs. 36.67%, P<0.001). No significant difference was found in maternal complications. Further subgroup analysis revealed that PCOS with pretreatment decreased the risk of preterm delivery (2.99% vs. 10.00%; Adjusted RR, 3.80; 95% CI, 1.19-12.13), pregnancy loss (9.46% vs. 18.92%; Adjusted RR, 2.07; 95% CI, 1.08-3.96), low birth weight (0.75% vs 7.50%; Adjusted RR, 12.08; 95% CI, 1.50-97.31), fetal malformations(1.49% vs. 8.33%; Adjusted RR, 5.63; 95% CI, 1.20-26.33).There were no significant differences in the incidence of DM and PIH as pregnancy complications between the two groups (P>0.05). CONCLUSION Our findings suggest that preconception androgen-lowering therapy in patients with PCOS improves pregnancy outcomes and reduces neonatal complications.
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Affiliation(s)
- Xiaowei Zhang
- Department of Obstetrics and Gynecology,Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- Department of Obstetrics and Gynecology,Dongguan Maternal and Child Health Care Hospital, Dongguan, Dongguan, Guangdong, China
| | - Huazhang Miao
- Department of Obstetrics and Gynecology,Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Jiahe Zhou
- Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuan Chen
- Department of Obstetrics and Gynecology,Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yanlan Ou
- Department of Obstetrics and Gynecology,Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yue Song
- Department of Obstetrics and Gynecology,Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Xiuhong Peng
- Department of Obstetrics and Gynecology,Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yuancheng Li
- Department of Obstetrics and Gynecology,Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Li Li
- Department of Obstetrics and Gynecology,Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- *Correspondence: Li Li,
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9
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Bahri Khomami M, Teede HJ, Joham AE, Moran LJ, Piltonen TT, Boyle JA. Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion. Clin Endocrinol (Oxf) 2022; 97:227-236. [PMID: 35383999 PMCID: PMC9544149 DOI: 10.1111/cen.14723] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/28/2022] [Accepted: 03/06/2022] [Indexed: 12/16/2022]
Abstract
Polycystic ovary syndrome (PCOS) is associated with a higher risk for pregnancy and birth complications according to the specific features associated with PCOS. The features include obesity before and during pregnancy, hyperandrogenism, insulin resistance, infertility, cardiometabolic risk factors, and poor mental health. PCOS is not often recognized as a risk factor for poor pregnancy and birth outcomes in pregnancy care guidelines, while its associated features are. Pregnancy-related risk profile should ideally be assessed for modifiable risk factors (e.g., lifestyle and weight management) at preconception in women with PCOS. Hyperglycaemia should be screened using a 75-g oral glucose tolerance test at preconception or within the first 20 weeks of pregnancy if it has not been performed at preconception and should be repeated at 24-28 weeks of pregnancy. In the absence of evidence of benefit for strategies specific to women with PCOS, the international evidence-based guidelines for the assessment and management of PCOS recommend screening, optimizing, and monitoring risk profile in women with PCOS (at preconception, during and postpregnancy) consistent with the recommendations for the general population. Recommended factors include blood glucose, weight, blood pressure, smoking, alcohol, diet, exercise, sleep and mental health, emotional, and sexual health among women with PCOS. The guidelines recommend Metformin in addition to lifestyle for assisting with weight management and improving cardiometabolic risk factors, particularly in those with overweight or obesity. Letrozole is considered the first-line pharmacological treatment for anovulatory infertility in PCOS. Individualized approach should be considered in the management of pregnancy in PCOS.
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Affiliation(s)
- Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health SciencesMonash UniversityClaytonLevel 1, 43‐51 Kanooka GroveAustralia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health SciencesMonash UniversityClaytonLevel 1, 43‐51 Kanooka GroveAustralia
- Monash HealthMelbourneAustralia
| | - Anju E. Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health SciencesMonash UniversityClaytonLevel 1, 43‐51 Kanooka GroveAustralia
- Monash HealthMelbourneAustralia
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health SciencesMonash UniversityClaytonLevel 1, 43‐51 Kanooka GroveAustralia
| | - Terhi T. Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University HospitalUniversity of OuluOuluFinland
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health SciencesMonash UniversityClaytonLevel 1, 43‐51 Kanooka GroveAustralia
- Monash HealthMelbourneAustralia
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10
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Wei SQ, Bilodeau-Bertrand M, Auger N. Association of PCOS with offspring morbidity: a longitudinal cohort study. Hum Reprod 2022; 37:2135-2142. [PMID: 35830879 DOI: 10.1093/humrep/deac154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/15/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Do children whose mothers have polycystic ovary syndrome (PCOS) have an increased risk of morbidity? SUMMARY ANSWER Maternal PCOS is associated with an increased risk of infection, allergy and other childhood morbidity. WHAT IS KNOWN ALREADY PCOS is associated with higher rates of gestational diabetes, pre-eclampsia and preterm delivery, but the long-term impact on child health is poorly understood. STUDY DESIGN, SIZE, DURATION We conducted a retrospective longitudinal cohort study of 1 038 375 children in Quebec between 2006 and 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS We included 7160 children whose mothers had PCOS and 1 031 215 unexposed children. Outcomes included child hospitalization for infectious, allergic, malignant and other diseases before 13 years of age. We estimated hazard ratios (HRs) and 95% CI for the association of PCOS with childhood morbidity in adjusted Cox proportional hazards regression models. MAIN RESULTS AND THE ROLE OF CHANCE Children exposed to PCOS were hospitalized at a rate of 68.9 (95% CI 66.2-71.8) per 1000 person-years, whereas unexposed children were hospitalized at a rate of 45.3 (95% CI 45.1-45.5) per 1000 person-years. Compared with no exposure, maternal PCOS was associated with 1.32 times the risk of any childhood hospitalization (95% CI 1.26-1.40), 1.31 times the risk of infectious disease hospitalization (95% CI 1.25-1.38) and 1.47 times the risk of allergy-related hospitalization (95% CI 1.31-1.66). Risk of hospitalization was also elevated for childhood metabolic (HR 1.59, 95% CI 1.16-2.18), gastrointestinal (HR 1.72, 95% CI 1.53-1.92), central nervous system (HR 1.74, 95% CI 1.46-2.07) and otologic disorders (HR 1.34, 95% CI 1.26-1.43). Subgroup analyses suggested that there was little difference in the association of PCOS with hospitalization among boys (HR 1.31, 95% CI 1.24-1.39) and girls (HR 1.34, 95% CI 1.26-1.43). LIMITATIONS, REASONS FOR CAUTION We analyzed severe childhood morbidity requiring hospitalization, not mild diseases treated in ambulatory clinics. We lacked data on ethnicity, education and physical activity, and cannot rule out residual confounding. WIDER IMPLICATIONS OF THE FINDINGS Our findings suggest that maternal PCOS is associated with an increased risk of childhood morbidity. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grant PJT-162300 from the Canadian Institutes of Health Research. N.A. acknowledges a career award from the Fonds de recherche du Québec-Santé (296785). The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Shu Qin Wei
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Canada.,Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Canada
| | - Marianne Bilodeau-Bertrand
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Canada
| | - Nathalie Auger
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada
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11
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Kaguta M, Jusabani A, Gregory N, Jaiswal S, Fidaali Z, Ally P, Rubagumya D, Mgonja M, Seif F. Heterotopic gestation in polycystic ovary disease: Termination of tubal pregnancy and intrauterine pregnancy progressing to term. SAGE Open Med Case Rep 2022; 10:2050313X221094427. [PMID: 35495291 PMCID: PMC9039427 DOI: 10.1177/2050313x221094427] [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: 11/16/2021] [Accepted: 03/29/2022] [Indexed: 12/03/2022] Open
Abstract
Heterotopic pregnancy is rare. We report a 27-year-old lady with polycystic ovarian disease. She presented at our health facility with acute abdomen. Her evaluation revealed heterotopic pregnancy. High index of suspicion for heterotopic pregnancy in any woman with early pregnancy presenting with acute abdomen is crucial. Therefore, correct and early diagnosis allows appropriate management while it preserves the intrauterine pregnancy as in the index case.
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Affiliation(s)
- Munawar Kaguta
- Department of Obstetrics and Gynecology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Ahmed Jusabani
- Department of Radiology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Ntiyakuze Gregory
- Department of Obstetrics and Gynecology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Shweta Jaiswal
- Department of Obstetrics and Gynecology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Zainab Fidaali
- Department of Radiology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Pilly Ally
- Department of Radiology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Davis Rubagumya
- Department of Family Medicine, The Aga Khan University, Dar es Salaam, Tanzania
- Department of Family Medicine, Premier Care Clinic-Masaki, Dar es Salaam, Tanzania
| | - Miriam Mgonja
- Department of Obstetrics and Gynecology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Farhat Seif
- Department of Obstetrics and Gynecology, The Aga Khan Hospital, Dar es Salaam, Tanzania
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12
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Kadoura S, Alhalabi M, Nattouf AH. Conventional GnRH antagonist protocols versus long GnRH agonist protocol in IVF/ICSI cycles of polycystic ovary syndrome women: a systematic review and meta-analysis. Sci Rep 2022; 12:4456. [PMID: 35292717 PMCID: PMC8924277 DOI: 10.1038/s41598-022-08400-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
Gonadotropin-releasing hormone (GnRH) analogues are commonly used in clinical practice to prevent premature luteinizing hormone (LH) surge during In-Vitro Fertilization/ Intra-Cytoplasmic Sperm Injection (IVF/ICSI) cycles. This review aimed to summarize the available evidence comparing the effects of conventional GnRH antagonist protocols, the most commonly used GnRH antagonist protocols, and GnRH agonist protocols on IVF/ICSI outcomes in women with polycystic ovary syndrome (PCOS). A comprehensive electronic search was carried out in Pubmed, Cochrane CENTRAL, Scopus, Web of Science, CINAHL, TRIP, ClinicalTrials.gov and ISRCTN registry from inception until 24 November 2020 without any language or date restrictions. In addition, reference lists of eligible studies and previous meta-analyses were hand-searched to identify relevant studies. Eligible randomized controlled trials were those designed to compare the effects of conventional GnRH antagonist protocols and GnRH agonist protocols on IVF/ICSI outcomes in PCOS subjects. The Cochrane ROB 2.0 tool was used to assess the risk of bias of each study, and the GRADE assessment was used to evaluate the overall quality of evidence. Data synthesis and analyses were done using Review Manager 5.3 with the assistance of Revman Web. A random-effects model was used for all meta-analysis. Dichotomous outcomes were reported as Relative Risk (RR) and continuous outcomes as Weighted Mean Difference (WMD), both with 95% CIs. The primary outcomes were Live birth rate, Ongoing pregnancy rate, and Ovarian hyperstimulation syndrome (OHSS) rate. Other IVF outcomes were considered secondary outcomes. We included ten studies with 1214 randomized PCOS women. Using GnRH antagonist protocols led to a significantly lower OHSS rate (RR = 0.58; 95% CI: [0.44 to 0.77], P = 0.0002), shorter stimulation duration (WMD = - 0.91; 95% CI: [-1.45 to - 0.37] day, P = 0.0009), lower gonadotropin consumption (WMD = - 221.36; 95% CI: [- 332.28 to - 110.45] IU, P < 0.0001), lower E2 levels on hCG day (WMD = - 259.21; 95% CI: [- 485.81 to - 32.60] pg/ml, P = 0.02), thinner endometrial thickness on hCG day (WMD = - 0.73; 95% CI: [- 1.17 to - 0.29] mm, P = 0.001), and lower number of retrieved oocytes (WMD = - 1.82; 95% CI: [- 3.48 to - 0.15] oocytes, P = 0.03). However, no significant differences in live birth rate, ongoing pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, miscarriage rate and cycle cancellation rate were seen between the GnRH antagonist protocols and the long GnRH agonist one. Although more cycles were cancelled due to poor ovarian response in the GnRH antagonist protocol (RR = 4.63; 95% CI: [1.49 to 14.41], P = 0.008), similar rates of cancellation due to risk of OHSS were noticed in both groups. The differences in IVF/ICSI outcomes may arise from the different patterns of gonadotropins suppression that the GnRH analogues exhibit during the early follicular phase of IVF/ICSI cycles and the divergent direct impacts of these analogues on ovaries and endometrial receptivity. The main evidence limitation was Imprecision. Conventional GnRH antagonist protocols represent a safer and more cost-effective treatment choice for PCOS women undergoing IVF/ICSI cycles than the standard long GnRH agonist protocol without compromising the IVF/ICSI clinical outcomes. The study had no sources of financial support and was prospectively registered at PROSPERO (International Prospective Register of Systematic Reviews) under registration number (CRD42021242476).
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Affiliation(s)
- Sally Kadoura
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Damascus University, Damascus, Syrian Arab Republic.
| | - Marwan Alhalabi
- Department of Embryology and Reproductive Medicine, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.,Assisted Reproduction Unit, Orient Hospital, Damascus, Syrian Arab Republic
| | - Abdul Hakim Nattouf
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Damascus University, Damascus, Syrian Arab Republic
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13
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Bishop A, Cartwright JE, Whitley GS. Stanniocalcin-1 in the female reproductive system and pregnancy. Hum Reprod Update 2021; 27:1098-1114. [PMID: 34432025 PMCID: PMC8542996 DOI: 10.1093/humupd/dmab028] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 06/15/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Stanniocalcin-1 (STC-1) is a widely expressed glycoprotein hormone involved in a diverse spectrum of physiological and pathophysiological processes including angiogenesis, mineral homeostasis, cell proliferation, inflammation and apoptosis. Over the last 20 years, numerous studies have reported STC-1 expression within female reproductive tissues including the uterus, ovaries and placenta and implicated STC-1 in processes such as ovarian follicular development, blastocyst implantation, vascular remodelling in early pregnancy and placental development. Notably, dysregulation of STC-1 within reproductive tissues has been linked to the onset of severe reproductive disorders including endometriosis, polycystic ovary syndrome, poor trophoblast invasion and placental perfusion in early pregnancy. Furthermore, significant changes in tissue expression and in maternal systemic concentration take place throughout pregnancy and further substantiate the vital role of this protein in reproductive health and disease. OBJECTIVE AND RATIONALE Our aim is to provide a comprehensive overview of the existing literature, to summarise the expression profile and roles of STC-1 within the female reproductive system and its associated pathologies. We highlight the gaps in the current knowledge and suggest potential avenues for future research. SEARCH METHODS Relevant studies were identified through searching the PubMed database using the following search terms: ‘stanniocalcin-1’, ‘placenta’, ‘ovary’, ‘endometrium’, ‘pregnancy’, ‘reproduction’, ‘early gestation’. Only English language papers published between 1995 and 2020 were included. OUTCOMES This review provides compelling evidence of the vital function that STC-1 plays within the female reproductive system. The literature presented summarise the wide expression profile of STC-1 within female reproductive organs, as well as highlighting the putative roles of STC-1 in various functions in the reproductive system. Moreover, the observed link between altered STC-1 expression and the onset of various reproductive pathologies is presented, including those in pregnancy whose aetiology occurs in the first trimester. This summary emphasises the requirement for further studies on the mechanisms underlying the regulation of STC-1 expression and function. WIDER IMPLICATIONS STC-1 is a pleiotropic hormone involved in the regulation of a number of important biological functions needed to maintain female reproductive health. There is also growing evidence that dysregulation of STC-1 is implicated in common reproductive and obstetric disorders. Greater understanding of the physiology and biochemistry of STC-1 within the field may therefore identify possible targets for therapeutic intervention and/or diagnosis.
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Affiliation(s)
- Alexa Bishop
- Centre for Vascular Biology, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Judith E Cartwright
- Centre for Vascular Biology, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Guy S Whitley
- Centre for Vascular Biology, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
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14
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Wu J, Chen X. Acupuncture therapy protects PCOS patients with diabetes by regulating miR-32-3p/PLA2G4A pathway. Am J Transl Res 2021; 13:8819-8832. [PMID: 34539997 PMCID: PMC8430091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the potential miRNA-mRNA network co-expressed in polycystic ovary syndrome (PCOS) and diabetes, and explore the molecular mechanism of traditional acupuncture treatment of PCOS. METHODS Patients with PCOS and diabetes who had undergone acupuncture treatment from January 2019 to June 2020 were recruited in this study. The potential miRNA-mRNA network co-expressed in PCOS and diabetes was obtained through bioinformatics analysis. The expression levels of candidate gen es were determined using quantitative qRT-PCR to study the effectiveness of acupuncture approach. Further, the mechanism of action of acupuncture method was determined using luciferase assay. RESULTS A total of 44 patients were included in this study. The miRNA-mRNA network for PCOS was then constructed based on the results of the bioinformatics analysis. Acupuncture treatment could significantly down-regulate miR-32-3p levels and up-regulate expression of PLA2G4A. Luciferase experiments showed that miR-32-3p could affect glucose metabolism in PCOS patients through down-regulating PLA2G4A expression. Functional and pathway enrichment analysis further suported this finding. CONCLUSIONS MiR-32-3p regulates PLA2G4A protein expression, which is vital in the pathogenesis of PCOS and diabetes. Further, this research proved that the potential mechanism of traditional acupuncture treatment may be the downregulation of miR-32-3p, thus inhibiting PCOS and diabetes progression.
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Affiliation(s)
- Jia Wu
- The First Clinical Medical College of Guangzhou University of Chinese MedicineGuangzhou, Guangdong Province, China
- Department of TCM Gynecology, Shunde Women and Children’s Hospital of Guangdong Medical UniversityFoshan, Guangdong Province, China
| | - Xinghua Chen
- Rehabilitation Care Center, The First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou, Guangdong Province, China
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15
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Khatun M, Arffman RK, Lavogina D, Kangasniemi M, Laru J, Ahtikoski A, Lehtonen S, Paulson M, Hirschberg AL, Salumets A, Andersson LC, Piltonen TT. Women with polycystic ovary syndrome present with altered endometrial expression of stanniocalcin-1†. Biol Reprod 2021; 102:306-315. [PMID: 31494675 PMCID: PMC7016287 DOI: 10.1093/biolre/ioz180] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 08/06/2019] [Accepted: 08/30/2019] [Indexed: 12/13/2022] Open
Abstract
Stanniocalcin-1 (STC-1) is a pro-survival factor that protects tissues against stressors, such as hypoxia and inflammation. STC-1 is co-expressed with the endometrial receptivity markers, and recently endometrial STC-1 was reported to be dysregulated in endometriosis, a condition linked with endometrial progesterone resistance and inflammation. These features are also common in the endometrium in women with polycystic ovary syndrome (PCOS), the most common endocrine disorder in women. Given that women with PCOS present with subfertility, pregnancy complications, and increased risk for endometrial cancer, we investigated endometrial STC-1 expression in affected women. Endometrial biopsy samples were obtained from women with PCOS and controls, including samples from overweight/obese women with PCOS before and after a 3-month lifestyle intervention. A total of 98 PCOS and 85 control samples were used in immunohistochemistry, reverse-transcription polymerase chain reaction, or in vitro cell culture. STC-1 expression was analyzed at different cycle phases and in endometrial stromal cells (eSCs) after steroid hormone exposure. The eSCs were also challenged with 8-bromo-cAMP and hypoxia for STC-1 expression. The findings indicate that STC-1 expression is not steroid hormone mediated although secretory-phase STC-1 expression was blunted in PCOS. Lower expression seems to be related to attenuated STC-1 response to stressors in PCOS eSCs, shown as downregulation of protein kinase A activity. The 3-month lifestyle intervention did not restore STC-1 expression in PCOS endometrium. More studies are warranted to further elucidate the mechanisms behind the altered endometrial STC-1 expression and rescue mechanism in the PCOS endometrium.
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Affiliation(s)
- Masuma Khatun
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Riikka K Arffman
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Darja Lavogina
- Department of Bioorganic Chemistry, Institute of Chemistry, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia
| | - Marika Kangasniemi
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Johanna Laru
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Anne Ahtikoski
- Department of Pathology, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Siri Lehtonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mariana Paulson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia.,Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Tartu, Estonia.,Department of Biomedicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Leif C Andersson
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
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16
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Heo JY, Cho MK, Kim S. Data mining for detecting signals of adverse drug reaction of doxycycline using the Korea adverse event reporting system database. J DERMATOL TREAT 2021; 33:2192-2197. [PMID: 34057876 DOI: 10.1080/09546634.2021.1937480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Doxycycline is one of the most prescribed antibiotics by dermatologists. However, the concern regarding adverse events of doxycyline has been rising. OBJECTIVE To detect the adverse events of doxycycline using the Korea Adverse Events Reporting System (KAERS) database from January 2014 to December 2018 through a data mining method. METHODS A signal was defined as one satisfying all three indices; a proportional reporting ratio, a reporting odds ratio, and an information component. We further checked whether the detected signals exist in drug labels in Korea and five developed countries, the United States, the United Kingdom, Germany, Canada, and Japan. RESULTS A total of 3,365,186 adverse event-drug pairs were reported and of which 3,075 were associated with doxycycline. Among the thirty-seven signals, nineteen (malaise, ileus, confusion, malignant neoplasm, ectopic pregnancy, ovarian hyperstimulation, vaginal hemorrhage, bone necrosis, acne, rosacea, seborrheic dermatitis, folliculitis, skin ulceration, crusting, dry skin, paronychia, mottled skin, application site reaction, and application site edema) were not included on any of the drug labels of the six countries. CONCLUSION We identified nineteen new doxycycline signals that did not appear on drug labels in six countries. Further studies are warranted to evaluate the causality of the adverse events with doxycycline.
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Affiliation(s)
- Jae Young Heo
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, Korea
| | - Moon Kyun Cho
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, Korea
| | - Sooyoung Kim
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, Korea
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Sanchez Ortiz S, Huerta C, Llorente-García A, Ortega P, Astasio P, Cea-Soriano L. A Validation Study on the Frequency and Natural History of Miscarriages Using the Spanish Primary Care Database BIFAP. Healthcare (Basel) 2021; 9:healthcare9050596. [PMID: 34069788 PMCID: PMC8157258 DOI: 10.3390/healthcare9050596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/17/2022] Open
Abstract
(1) Background: There is a major gap of knowledge towards the natural history of miscarriages in electronic medical records. We aimed to calculate the frequency of miscarriages using data from BIFAP database. (2) Methods: We identified all pregnancy losses and carried out a multistep validation exercise. Potential cases with positive predictive values (PPV) of miscarriage confirmation <85% or those confirming other pregnancy loss were excluded. Kaplan–Meier figures and incidence rates (IRs) of miscarriage with 95% confidence intervals (CIs) expressed by 1000 person-weeks were calculated. Stratifying analysis by age, specific high-risk groups, and drug exposure within the pre-pregnancy period were performed restricted to women with recording last menstrual period (LMP). (3) Results: Women with confirmed miscarriage (N = 18,070), tended to be older, with higher frequency of comorbidities and drug utilization. Restricting to women with LPM recorded, IR of miscarriage was 10.89 (CI 95% 10.68–11.10) per 1000 women-weeks, with a median follow-up of 10 weeks (IQR: 8–12). The IR according to age was: 2.71 (CI 95% 2.59–2.84) in those aged <30 years compared to 9.11 (CI 95% 8.55–9.70) in women aged ≥40 years. Advanced maternal age (Hazard Ratio (HR, 95% confidence interval) CI 95%: 3.34 (3.08–3.62)), use of antihypertensives (1.49 (1.21–1.84), and use of drugs classified as D or X during pregnancy (1.17 (1.07–1.29)) showed to be positive predictors associated with increased risk of miscarriages. (4) Conclusion: BIFAP database can be used to identify women suffering from miscarriages, which will serve to further study risk factors associated with miscarriages with special attention to drug utilization.
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Affiliation(s)
- Sara Sanchez Ortiz
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (S.S.O.); (C.H.); (P.O.); (P.A.)
| | - Consuelo Huerta
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (S.S.O.); (C.H.); (P.O.); (P.A.)
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), 28040 Madrid, Spain;
| | - Ana Llorente-García
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), 28040 Madrid, Spain;
| | - Paloma Ortega
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (S.S.O.); (C.H.); (P.O.); (P.A.)
| | - Paloma Astasio
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (S.S.O.); (C.H.); (P.O.); (P.A.)
| | - Lucía Cea-Soriano
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (S.S.O.); (C.H.); (P.O.); (P.A.)
- Correspondence: ; Tel.: +34-91-531-3404
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Zhang Q, Bao ZK, Deng MX, Xu Q, Ding DD, Pan MM, Xi X, Wang FF, Zou Y, Qu F. Fetal growth, fetal development, and placental features in women with polycystic ovary syndrome: analysis based on fetal and placental magnetic resonance imaging. J Zhejiang Univ Sci B 2020; 21:977-989. [PMID: 33843163 PMCID: PMC7759450 DOI: 10.1631/jzus.b2000350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS), a common endocrine-metabolic dysfunction in reproductive-aged women, may be involved in compromised pregnancy and offspring outcomes. This study aimed to investigate whether maternal PCOS affects fetal growth, fetal development, and placental features. METHODS This retrospective case-control study included 60 pregnant women with PCOS (PCOS group) and 120 healthy pregnant women without PCOS (control group). Fetal magnetic resonance imaging (MRI) was performed followed by an ultrasound examination and indications for imaging, including known or suspected fetal pathology, history of fetal abnormality in previous pregnancy or in a family member, and concern for placenta accreta. Fetal MRI images were analyzed for head circumference (HC), abdomen circumference (AC), lung-to-liver signal intensity ratio (LLSIR, a prenatal marker of fetal lung maturity), lengths of liver and kidney diameters in fetuses, and placental relative signal intensity on T2-weighted single-shot fast spin echo (SSFSE) imaging (rSISSFSE), and placental relative apparent diffusion coefficient value (rADC). Data on height and weight of offspring were collected through telephone follow-up. RESULTS Compared to the control group, the PCOS group showed the following characteristics: (1) smaller biparietal diameter and femur length in fetuses (P=0.026 and P=0.005, respectively), (2) smaller HC in fetuses (evident after 32 weeks; P=0.044), (3) lower LLSIR and smaller dorsoventral length of liver in fetuses (evident before 32 weeks; P=0.005 and P=0.019, respectively), and (4) smaller placental thickness (evident before 32 weeks; P=0.017). No significant differences in placental rSISSFSE or rADC were observed between the groups (all P>0.05). No significant differences in height and weight of offspring during childhood existed between the groups (all P>0.05). CONCLUSIONS There exist alterations of fetal growth, fetal development, and placental features from women with PCOS.
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Affiliation(s)
- Qing Zhang
- School of Obstetrics and Gynecology, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Zhong-kun Bao
- Department of Radiology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Mei-xiang Deng
- Department of Radiology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Qiong Xu
- Department of Radiology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Dan-dan Ding
- Department of Radiology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Man-man Pan
- School of Obstetrics and Gynecology, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Xi Xi
- School of Obstetrics and Gynecology, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Fang-fang Wang
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Yu Zou
- Department of Radiology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Fan Qu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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19
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Rasheedy R, Sammour H, Elkholy A, Salim Y. The efficacy of vitamin D combined with clomiphene citrate in ovulation induction in overweight women with polycystic ovary syndrome: a double blind, randomized clinical trial. Endocrine 2020; 69:393-401. [PMID: 32363556 DOI: 10.1007/s12020-020-02315-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to assess the effect of vitamin D supplementation on ovulation rate in overweight subfertile women with PCOS undergoing ovulation induction. METHODS This was a single center, parallel-groups, double-blind, and placebo-controlled randomized trial involving 186 eligible women undergoing induction of ovulation with clomiphene citrate (Clomid®, Aventis) 50 mg tablet twice daily starting from the third day of menstrual cycle and for 5 days combined with either oral Vitamin D (ossofortin®, EVA PHARMA) 10,000 IU twice weekly and calcium (calciprex®, Marcyrl Pharmaceutical Industries) 1250 mg twice daily or to receive a placebo with calcium for three successive induction cycles. The vitamin D or placebo supplementation started 1 month before induction cycles (total four cycles). Cycles were monitored with ultrasound follicle tracking and mid-luteal serum progesterone measurement. The primary outcome was the ovulation rate after three induction cycles. RESULTS The study was performed during the period between January 2018 and September 2018, Eighty six (92.5%) women in the treatment group and 73 (78.5%) in the control group had successful ovulation (p = 0.007). The absolute and relative risk reduction was 14% and 65% respectively. Biochemical and clinical pregnancy occurred in 61.3 and 50.5% in the treatment group, and in 49.5 and 39.8% in the control group (p = 0.105 and 0.141 respectively). CONCLUSION In subfertile women with PCOS undergoing induction of ovulation, vitamin D supplementation significantly improved the ovulation rate; however, there was no effect on clinical or biochemical pregnancy.
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Affiliation(s)
- Radwa Rasheedy
- Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Hazem Sammour
- Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdellatif Elkholy
- Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abdalla M, Deshmukh H, Atkin SL, Sathyapalan T. miRNAs as a novel clinical biomarker and therapeutic targets in polycystic ovary syndrome (PCOS): A review. Life Sci 2020; 259:118174. [PMID: 32745529 DOI: 10.1016/j.lfs.2020.118174] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in females of the reproductive age. PCOS is commonly manifested as ovulatory dysfunction, clinical and biochemical excess androgen level, and polycystic ovaries. Metabolic sequelae associated with PCOS, including insulin resistance (IR), type 2 diabetes (T2DM), obesity and increased cardiometabolic risk. The underlying pathology of PCOS is not fully understood with various genetic and environmental factors have been proposed. MicroRNAs (miRNAs), are endogenously produced, small non-coding, single-stranded RNAs that capable of regulating gene expression at the post-transcriptional level. Altered miRNAs expression has been associated with various disorders, including T2DM, IR, lipid disorder, infertility, atherosclerosis, endometriosis, and cancer. Given that PCOS also present with similar features, there is an increasing interest to investigate the role of miRNAs in the diagnosis and management of PCOS. In recent years, studies have demonstrated that miRNAs are present in various body fluids, including follicular fluid of women with PCOS. Therefore, it may act as a potential biomarker and could serve as a novel therapeutic target for the diagnosis and treatment of PCOS. This review aims to summarise the up to date research on the relation between miRNAs and PCOS and explore its potential role in the diagnosis and the management of PCOS.
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Affiliation(s)
- Mohammed Abdalla
- Hull York Medical School, Academic Diabetes, Endocrinology and Metabolism, University of Hull, Hull, UK.
| | - Harshal Deshmukh
- Clinical lecturer at Hull York Medical School, Academic Diabetes, Endocrinology and Metabolism, University of Hull, Hull, UK.
| | - Stephen L Atkin
- Head of School Postgraduate Studies and Research, RCIS-Bahrain, Medical University of Bahrain, Bahrain.
| | - Thozhukat Sathyapalan
- Honorary Consultant Endocrinologist at Hull University Teaching Hospital NHS Trust, UK; Chair in Academic Diabetes, Endocrinology and metabolism in Hull York Medical School, University of Hull, UK.
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21
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Sun Q, Yang Y, Peng X, Zhang Y, Gao Y, Wang F, Zhang Y, Feng W, Yang W, Kang X. Coagulation parameters predictive of polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2019; 240:36-40. [PMID: 31226575 DOI: 10.1016/j.ejogrb.2019.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/06/2019] [Accepted: 06/12/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To explore coagulation parameters in association with polycystic ovarian syndrome (PCOS) and establish a model for predicting the risk of PCOS. STUDY DESIGN This study included 181 outpatients with PCOS. A total of 301 women who attempted to seek pre-pregnancy consultation at the Department of Gynecology of our hospital were included in the control group, and six coagulation parameters were measured for all included subjects. A logistic regression model was built based on the training dataset using the purposeful selection method to select important predictors. The performance of the established model was validated on the test dataset. RESULTS There were statistically significant differences found among all coagulation parameters except D-Dimer (DD, P = 0.080). The purposeful selection method selected age (odds ratio [OR] = 0.89; p = 0.008), prothrombin time (PT, OR = 0.68, p < 0.0001), thrombin time (TT, OR = 3.30; p = 0.0005), and fibrin degradation products (FDP, OR = 0.24; p = 0.0002) as important predictors of PCOS risk. The receiver operating characteristic (ROC) curve analysis indicated that the area under the ROC curve (AUC) of the model was 0.81 for the training dataset with an optimal cut-off point of the predicted probability of 0.45, leading to a sensitivity of 0.71 and a specificity of 0.82. The AUC was 0.79 for the test data. CONCLUSIONS It was found that the coagulation parameters, including PT, TT, and FDP, are predictive of PCOS. These results highlight the potential of anti-coagulation therapies to lower the risk of adverse outcomes in women with PCOS.
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Affiliation(s)
- Qian Sun
- Department of Gynecology, The First People's Hospital of Lianyungang, Lianyung, Jiangsu, China
| | - Yan Yang
- Department of Laboratory, The First People's Hospital of Lianyungang, Lianyung, Jiangsu, China
| | - Xuenan Peng
- Department of Clinical Medicine, Medical College of Soochow University, Soochow, Jiangsu, China
| | - Yunyan Zhang
- Department of Laboratory, The First People's Hospital of Lianyungang, Lianyung, Jiangsu, China
| | - Yuan Gao
- Department of Gynecology, The First People's Hospital of Lianyungang, Lianyung, Jiangsu, China
| | - Fang Wang
- Department of Gynecology, The First People's Hospital of Lianyungang, Lianyung, Jiangsu, China
| | - Yang Zhang
- Department of Gynecology, The First People's Hospital of Lianyungang, Lianyung, Jiangsu, China
| | - Wen Feng
- Department of Gynecology, The First People's Hospital of Lianyungang, Lianyung, Jiangsu, China
| | - Wen Yang
- Department of Gynecology, The First People's Hospital of Lianyungang, Lianyung, Jiangsu, China.
| | - Xiaomin Kang
- Department of Reproductive Medical Centre, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China.
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Holton S, Hammarberg K, Johnson L. Fertility concerns and related information needs and preferences of women with PCOS. Hum Reprod Open 2018; 2018:hoy019. [PMID: 30895260 PMCID: PMC6276660 DOI: 10.1093/hropen/hoy019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/07/2018] [Accepted: 10/14/2018] [Indexed: 01/09/2023] Open
Abstract
STUDY QUESTION What are the fertility and childbearing concerns and related information needs and preferences of women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Women with PCOS have concerns about fertility and childbearing mainly because they believe that it will be difficult for them to conceive, and identify a need for evidence-based information and preconception care so that they can make informed decisions about having children and achieve their reproductive goals. WHAT IS KNOWN ALREADY Women with chronic conditions seek reproductive health information from a range of sources, including their healthcare provider, the internet, other women with the condition, patient associations and support groups, and scientific publications. Little is known about the fertility concerns and information needs of women with PCOS or their preferences for how and when to receive information about the effect of their condition and its treatment on fertility and childbearing. STUDY DESIGN SIZE DURATION A qualitative study of 13 women of reproductive age with self-reported PCOS living in Australia participated in an online discussion group conducted from May to June 2018. Women were recruited via targeted advertisements on social media. PARTICIPANTS/MATERIALS SETTING METHODS In a closed-group moderated discussion, participants responded to questions about fertility concerns and the related information needs and preferences of women with PCOS. Non-identifiable demographic information was sought via a separate online anonymous survey. The discussion transcript was analysed thematically. MAIN RESULTS AND THE ROLE OF CHANCE Women identified a number of concerns about childbearing including whether they could become pregnant, how to prepare for pregnancy and what they should do before trying to conceive given their PCOS. Women reported seeking information about fertility and PCOS from a range of sources, and views about the most useful types and sources of fertility information for women with PCOS varied. LIMITATIONS REASONS FOR CAUTION Due to the small sample size and recruitment of participants via advertisements on Facebook, women who participated in the study may not be representative of women with PCOS in the general population. Women currently contemplating childbearing or who have recently had children or fertility difficulties may also have been more likely to participate in the study. Women in this study self-reported PCOS, and this may not necessarily reflect a confirmed diagnosis of PCOS. No formal diagnostic criteria were used to confirm their PCOS status. WIDER IMPLICATIONS OF THE FINDINGS Women with PCOS would benefit from evidence-based information in a range of formats to help them make informed decisions about childbearing and achieving their reproductive goals. Preconception care, including counselling and information about appropriate interventions and self-management strategies to optimise health and improve chances of conception, may be of particular assistance to women with PCOS. STUDY FUNDING/COMPETING INTERESTS The Victorian Assisted Reproductive Treatment Authority (VARTA) commissioned researchers at Monash University to generate evidence to guide the development of resources to assist women with PCOS make informed fertility and childbearing decisions and achieve their reproductive goals. The authors have no conflict of interests to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- S Holton
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, 4/553 St Kilda Rd, Melbourne, Victoria, Australia
| | - K Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, 4/553 St Kilda Rd, Melbourne, Victoria, Australia
- Victorian Assisted Reproductive Treatment Authority, Level 30/570 Bourke Street Melbourne, Victoria, Australia
| | - L Johnson
- Victorian Assisted Reproductive Treatment Authority, Level 30/570 Bourke Street Melbourne, Victoria, Australia
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