Clinical effect of under the diaphragm by stasis soup combinated with point thread-embedding on infertility patients with obesity-type polycystic ovary syndrome

Objective:To study the clinical effect of under the diaphragm by stasis soup combinated with point thread-embedding on infertility patients with obesity-type polycystic ovary syndrome (PCOS) and evaluate the the rate of ovulation and pregnancy.Method:Selecting 100 infertility patients with obesity-type PCOS, then they were randomly divided into control group (n=80) and observation group (n=80). The control group patients were given metformin+ under the diaphragm by stasis soup, the observation group were given metformin + exenatide + point thread-embedding, they were treated 3 months. Before and after treatment, we observed the changes of body mass index (BMI), waist-to-hipratio (WHR), fasting plasma glucose (FBG), 2-hour postprandial blood glucose (2hPBG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma insulin (FINS), follicule-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, estrogen (E2), and testosterone (T). At last, we assessed the rate of ovulation and pregnancy.Results: After the treatment, the FBG, 2hPBG, TC, LDL-C, TG, BMI, WHR, HOMA-IR, FINS, LH, LH/FSH, E2, and T were lower than before treatment in both groups, and the difference had statistical significance, and the observation group were lower than control group, and the difference had statistical significance;the HDL-C and FSH were higher than before treatment in both groups, and the difference had statistical significance, and the observation group were higher than control group, and the difference had statistical significance. The rate of ovulation and pregnancy in the observation group were higher than control group, and the difference had statistical significance.Conclusions:Under the diaphragm by stasis soup combinated with point thread-embedding can improve the metabolize of carbohydrate and lipid, and the abnormity of sex hormones, through this process, the rate of ovulation and pregnancy can be raised.

Association between Metal(loid)Exposure and Risk of Polycystic Ovary Syndrome Mediated by Anti-Müllerian Hormone among Women Undergoing In Vitro Fertilization and Embryo Transfer

Objective To investigate the relationship and potential pathways between metal(loid)exposure and the risk of polycystic ovary syndrome(PCOS)in women of childbearing age.Methods This case-control study included 200 patients with PCOS(cases)and 896 non-PCOS controls with the age of 25-37 years.The concentrations of 29 metal(loid)s in the follicular fluid(FF)and clinical indicators in the serum were measured in all participants.Logistic regression analysis and mediation analysis were conducted to evaluate the associations between metal(loid)exposure and PCOS risk and investigate the possible roles of clinical indicators,respectively.Results Logistic regression analysis revealed an association between high copper levels in FF and increased PCOS risk(highest vs.lowest quartile:adjusted odds ratio=2.94,95%confidence interval:1.83-4.72).A high luteinizing hormone/follicle-stimulating hormone ratio and elevated levels of testosterone and anti-Müllerian hormone(AMH)were strongly associated with increased PCOS risk induced by high copper exposure.The mediation analysis indicated a mediating effect of AMH in the association between copper exposure and PCOS risk.Conclusion Copper may affect PCOS risk through the hypothalamic-pituitary-ovarian axis,mediated by AMH.Copper exposure and internal AMH levels are important indicators for early warning of PCOS development.

Correlation between IL-1β,IL-1Ra gene polymorphism and occurrence of polycystic ovary syndrome infertility

Objective:To explore the relationship between IL-1β.IL-1Ra gene polymorphism and the occurrence of polycystic ovary syndrome(PCOS) infertility.Methods:A total of 59 PCOS infertility cases visiling the reproductive center of our hospital from Mar.2010 to Mar.2012 and 56 healthy women were selected.ELISA method was used lor the detection of IL-1β.IL-1Ra lewis,and the levels of serum supersensitivity C reaction protein(US-CRP).insulin(FINS),follieule-stimulating hormone(FSH) and fasting blood—glucose(FRG) were detected.PCR analysis technology was adopted to detect the gene polymorphism of the.511 site of IL-1βand the second introne of IL- 1Ra.Results:The levels of IL-1β.IL-1Ra.US-CRP.FINS and FBG in blood scrum of patients in PCOS group were significantly higher than those in control group(P【0.05 or P【0.01).The level of FSH in PCOS group was significantly lower than that in control group(P【0.05).The genotypic frequency of T/T.the 511 site of IL-1βin PCOS group was 42.37%.significantly higher than 1250%in control group 【P【0.01).The frequency of T allele was also significantly higher than that in control group(P【0.01).The genotypic frequency ofⅠ/Ⅴ.the second introne of IL-1Ra in PCOS group was 20.34%,signicianlly higher than 3.57%in control group(P【0.05).The frequency of V allele in PCOS group was significantly higher than that in control group(P【0.05).Conclusions: T allele of the 511 site of IL-1βgene and V allele of the second inlrone of IL-1Ra gene might be the genetic basis of the rising of IL-1β.IL-1Ra and US-CRP levels in blood serum of PCOS patients,and are associated with the infertility occurrence of PCOS patients.

Management strategy of infertility in polycystic ovary syndrome

Polycystic ovary syndrome(PCOS)is the most common endocrine and metabolic disease in women of reproductive age.PCOS is characterized by ovulatory disruption,which can lead to infertility.Patients with PCOS are also more likely to have poor pregnancy outcomes.For obese women,lifestyle interventions are recommended first,which have general health benefits.For women who have difficulty changing their lifestyle,drugs for the treatment of obesity or bariatric surgery could be considered.Clomiphene citrate is the first-line medication after weight loss that has been utilized in the past.Letrozole is supplanting clomiphene as the best option for ovulation induction for now,particularly in patients with PCOS.Metformin can improve ovulation and pregnancy rates;however,it has minimal effects in terms of raising live birth rates.Second-line therapies include gonadotropins and laparoscopic ovary drilling.In vitro fertilization can be utilized as a third-line treatment for patients with PCOS who have failed ovulation induction therapy or have other infertility factors.In summary,to achieve fertility,patients with PCOS require standardized individualized therapy.

Endometrial Thickness as a Predictor of Endometrial Hyperplasia in Infertile Patients with Polycystic Ovary Syndrome

Background: Women with polycystic ovary syndrome (PCOS) are at higher risk of developing endometrial hyperplasia (EH). This study determined the prevalence of EH among women with infertility due to PCOS and assessed the predictive value of endometrial thickness (ET) measurement by trans-vaginal scan (TVS). Study Type & Population: This was a prospective study on infertile women with and without PCOS in which clinical data, hormonal profile, ET and endometrial biopsy (EB) for histopathological examination were collected. Methods: Thirty-seven women with PCOS and 23 women without PCOS presenting with infertility and/or abnormal uterine bleeding underwent TVS, hysteroscopy, laparoscopy and EB. Results: The overall prevalence of EH was 23.3 % while in PCOS group: 18.3 %. The mean ET (14.8 mm) was significantly higher in patients with EH (t = -2.74, P value = 0.009). The lower value of ET among women with EH was 10 mm. A cut-off point of 9.5 mm was set. An ET of >9.5 mm had 92.9% sensitivity and 51.85% specificity for the presence of EH. Women with ET ≥ 9.5 mm were 1.28 times more at risk of EH than women with ET 9.5 mm. Women with oligomenorrhea and irregular cycles were 5.5 and 13.7 times more at risk of EH compared to those with regular cycles, respectively. ET was positively correlated with insulin resistance (r = 0.439, P = 0.007). Conclusion: ET ≥ 9.5 mm predicts EH in infertile women with PCOS, with a high degree of sensitivity and a moderate degree of specificity. In PCOS patients with oligomenorrhea or irregular cycles, the risk of EH is higher than women with regular cycles.

Polycystic Ovary Syndrome-Related Infertility Based on the Theory of“Liver and Kidney Homology”

Polycystic ovary syndrome(PCOS)is an endocrine disorder caused by hypothalamic-pituitary-ovarian(HPO)axis dysfunction.In the field of gynecology and reproduction,PCOS has emerged as both a research hot spot and a challenging area of study.According to Chinese medicine,this disease is related to kidney deficiency,phlegm and dampness obstruction,blood stasis and interconnection,Chong pulse impassability,the lack of Ren pulse,and the loss of uterine nourishment,all of which affect the normal development and maturation of eggs as well as the duration at which menstrual blood stores.In this paper,based on the theoretical basis of“liver collects blood,regulates the flow of qi,and is the master of drainage,”we explore the rationality of the treatment of this disease from the perspective of“liver and kidney have the same origin”and the development of PCOS-related infertility in relation to dysfunctional internal organs.We also explore the feasibility of treatment from the perspective of“liver and kidney homology,”expand the ideas for treatment,as well as develop and innovate the application of organ identification in PCOS in relation to infertility.

Mental Health Status Assessment in Polycystic Ovarian Syndrome Infertility Patients: A Pilot Study

Polycystic ovary syndrome（PCOS） is a major endocrine disorder afflicting women of reproductive age. Women with PCOS are more likely to suffer from mental health disturbances than healthy women. The ＂infertility＂ suffered by PCOS patients would also lead to mental health disturbances. Symptom Checklist 90（SCL-90） and questionnaire which includes patients＇ socio-economic and demographic data were used to assess the mental health status of PCOS（n=103） and non-PCOS（n=110） infertile patients. Logistic regression analysis and t-tests were used for comparative analysis. The data demonstrated that scores of depression, interpersonal sensitivity, obsessive-compulsive, and hostility symptoms in PCOS infertile patients were significantly higher than those in the non-PCOS infertile patients（P〈0.05）. Logistic regression analysis revealed that acne had negative effect on mental health status（P〈0.05）. Secondary infertile PCOS patients were more easily to suffer from somatization, interpersonal sensitivity, obsessive-compulsive, anxiety, hostility and paranoid ideation symptoms than the primary infertile PCOS patients（P〈0.05）. The results suggested that the PCOS patients especially the secondary infertile PCOS patients had obvious mental health disturbances. The acne might play an importance role in the occurrence of mental health disturbances in PCOS patients. PCOS related symptoms may be risk factors of mental health status in PCOS patients with infertility. More attention should be paid to the PCOS infertile patients, and mental health therapy should be considered if necessary.

Integrative techniques using acupuncture,Chinese herbal medicine,diet,and supplements for polycystic ovary syndrome:a case report

Patients with a diagnosis of polycystic ovary syndrome （PCOS） are on the rise. About 4%-12% of women are currently estimated to have this condition. It is hypothesized that PCOS appears in women who have long-standing insulin resistance （1R）, which leads to high androgen and testosterone levels; this ultimately disrupts their menstrual cycles. Some researchers attribute IR to genetic factors, although there have been only minute changes in the human genome in the past 20 000 years. However, even with a stable gene pool, genes can be turned on and offby the environment, food and air quality and toxin exposure.

Endocrine Indices of PCOS in Women with Polycystic Ovaries but without Diagnostic Features of PCOS: A Study of an Infertility Clinic Population

Background: The presence of polycystic ovarian morphology (PCO) without the other characteristics of the polycystic ovarian syndrome (PCOS) is insufficient for the diagnosis of PCOS and there is little justification for follow up in endocrine clinics for women with PCO morphology alone. A few studies have been reported regarding the endocrine features of asymptomatic women with PCO with conflicting data about endocrine profiling. The aim of this study was to assess whether women with PCO, but who have no symptoms of PCOS differ, endocrinologically, from women with normal ovaries.?Methods: We analysed the results of ultrasound and endocrine investigations in 576 consecutive women who attended the infertility clinic between 1993 and 1995 at the Reproductive Medicine Unit of St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK. Results: Three hundred and twenty eight women had PCO and 248 had normal ovaries. Among the 328 women with PCO, 169 (51.5%) had PCOS according to Rotterdam criteria. The remaining women with PCO had no symptoms of the syndrome (n = 159);they had a history of regular menses, had proven ovulatory cycles and had neither clinical nor biochemical evidence of hyperandrogenism. However, these women had higher timed LH [median (IQR) 5.3 (4.2) IU/l vs 4.8 (3.4) IU/l, respectively;p = 0.044] and testosterone [2.0 (0.8) nmol/l vs 1.8 (0.8), respectively;p = 0.009] compared with women with normal ovaries (although by definition within the normal range). There was no difference in BMI or FSH between the two groups. Among the 169 women with PCOS, 45.0% (n = 76) were anovulatory without hyperandrogenism, 34.3% (n = 58) fulfilled the NIH criteria and 20.7% (n = 35) were ovulatory with hyperandrogenism. The proportion of hyperandrogenism among anovulatory women with PCO is 43.3% (58 out of 134).?Conclusions: Women with PCO, but no symptoms of the syndrome, differ endocrinologically compared with women with normal ovaries: they had higher timed LH and testosterone (although by definition within the normal range). These data suggest that despite the lack of symptoms of PCOS, women presenting to an infertility clinic with PCO represent a milder phenotype of those with overt PCOS, but fall on the same spectrum.

Polycystic Ovary Syndrome (PCOS) and Fertility

The polycystic ovary syndrome (PCOS) is defined as a combination of hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding), with or without the presence of polycystic ovaries on ultrasound. It represents the main endocrine disorder in the reproductive age, affecting 6% - 15% of women in menacme. It is the most common cause of infertility due to anovulation, and the main source of female infertility. When in the presence of a menstrual disorder, the diagnosis of PCOS is reached in 30% - 40% of patients with primary or secondary amenorrhoea and in 80% of patients with oligomenorrhea. PCOS should be diagnosed and treated early in adolescence due to reproductive, metabolic and oncological complications which may be associated with it. Treatment options include drugs, diet and lifestyle improvement.

Polycystic Ovarian Syndrome and Female Infertility

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, associated with chronic anovulation and hyperandrogenism. The cause of PCOS is multi-factorial and the mechanism is still unclear. A number of complications are closely related with PCOS such as infertility, hairy and obesity. Approximately up to one-third of females with PCOs have issues with infertility. Obesity is an independent factor which exacerbates infertility in PCOS, reduces the efficacy of infertility treatment and provokes a greater risk of miscarriage. Preconception counseling and guidelines play an initial major role in infertility treatment. The option of the most appropriate treatment depends upon various factors such as age, tubal patency, quality of sperm, experience, and duration of previous treatments and the level of anxiety of the couple. Tubal patency test and semen analysis are mandatory to decide the suitable treatment. Treatment modalities have two measures—non-pharmacological and the pharmacological. Oral clomiphene citrate remains the first line treatment to trigger ovulation. Gonadotrophin and laparoscopic ovarian drilling (LOD) surgery are the other treatment option. In vitro fertilization (IVF) and embryo transfer are the third line treatment and IVF remains the first option in the patient with diagnosed and established bilateral tubal occlusion and/or concentration of recovered motile sperm less than or equal to 5 million. Here, etiology, pathophysiology and molecular mechanisms of PCOS are reviewed, and perspectives are given for further research. The recent development, treatment, and diagnosis of PCOS are also highlighted. The summary will be of guiding significance in the prevention and treatment of PCOS.

Clinical effectiveness of the various approaches for infertility treatment in women with PCOS and hyperprolactinemia

【Objective】To evaluate the clinical efficiency of different treatments cancellation and infertility in women with PCOS and hyperprolactinemia.【Method】We performed retrospective analysis of 502consecutive case histories during 5 years of reproductive results of treatment of women is with anovulatory infertility,caused by different factors.Aim of the study was to determine the efficiency of conservative and surgical treatment.【Result】Differentiated application of conservative medical therapy allows to attain the effect of proceeding in a fertile function in 33,8%of patients.It is found that surgical induction of ovulation by ovarian laparoscopic partial degradation is an option in the management of female infertility associated with PCOS,especially as a second-line treatment after the failure of clomiphene citrate treatment,enhancing the efficiency of complex infertility treatment to 40%.【Conclusions】It is feasible to develop an algorithm differentiated use of infertility treatments in women with PCOS and hyperprolactinemia.

Induction of Ovulation with Clomiphene Citrate Combined with Bromocriptine in Polycystic Ovary Syndrome Patients with Infertility: A Prospective, Randomized, and Controlled Clinical Trial

Background:To investigate the therapeutic effects of bromocriptine(BCT)combined with clomiphene citrate(CC)in the induction of ovulation in polycystic ovary syndrome(PCOS)patients with infertility.Methods:A prospective,randomized,and controlled clinical trial was performed on 100 PCOS patients with infertility.Patients were randomly divided into two groups(n=50),patients in control group were treated with 50 mg CC from day 3 to day 7 of the menstrual cycle,and those in observation group(CC+BCT)were given 50 mg of CC from day 3 to day 7 of the menstrual cycle along with 2.5 mg of BCT daily for the full cycle.Patients in both groups were treated for one cycle.Blood was extracted from patients on day 3 of the menstrual cycle,the day of human chorionic gonadotrophin(hCG)injection,and day 7 after hCG injection to measure serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),prolactin(PRL),estradiol(E_(2)),total testosterone(T)and progestin(P).Vaginal ultrasound was used to determine the thickness of endometrium and follicle size and count.Results:There was no significant difference in basal hormone levels between two groups.The success rate of ovulation induction in control group and observation group was 72.0%and 75.4%,respectively,no significant difference was found between two groups(P>0.05).The ongoing pregnancy rate(18.4%)in observation group was significantly higher than that in control group(8.0%).On the day of hCG injection,no significant differences in the levels of FSH,E_(2),and P were found between two groups,while LH was lower,and levels of PRL and T were significantly lower in observation group than those in control group(all P=0.00).On day 7 after hCG injection,no significant differences in the levels of E_(2) and P were found between two groups,while PRL level was significantly lower in observation group than that in control group,and the endometrial thickness in observation group(10.20±1.92 mm)was significantly higher than that in control group(9.22±1.88 mm)(P=0.01).Conclusions:Compared with the use of CC alone,BCT combined with CC can increase the success rate of ovulation induction-assisted pregnancy in PCOS patients,decrease the levels of PRL,LH,and T and increase the endometrial thickness in implantation window.Those data suggest that dopamine agonist BCT may reduce the pituitary hormone and androgen levels,reduce endometrial vascular resistance,and increase endometrial blood supply to improve the infertility outcomes of PCOS patients with infertility.

Comparison of Drospirenone-with Cyproterone Acetate-Containing Oral Contraceptives, Combined with Metformin and Lifestyle Modifications in Women with Polycystic Ovary Syndrome and Metabolic Disorders： A Prospective Randomized Control Trial

Background：While combined oral contraceptives （COCs） are commonly used to treat polycystic ovary syndrome （PCOS）,comparative data regarding metabolic effects of different progestogens on this patient population are missing.This study aimed to compare the different effects of drospirenone （DRP）-containing COCs with cyproterone acetate （CPA）-containing COCs,combined with metformin and lifestyle modifications in women with PCOS and metabolic disorders.Methods：Ninety-nine women with PCOS and a metabolic disorder between January 2011 and January 2013 were enrolled into this prospective randomized clinical trial.Participants were randomized into two groups such as DRP-containing COCs,and CPA-containing COCs.Participants took COCs cyclically for 6 months,combined with metformin administration （1.5 g/d） and lifestyle modifications （diet and exercise）.Clinical measures and biochemical and hormone profiles were compared.Comparisons for continuous variables were evaluated with paired and unpaired Student＆#39;s t-tests.The Wilcoxon signed rank test was used when the data were not normally distributed.Analysis of covariance was used to control for age,body mass index （BMI）,and baseline data of each analyzed parameter when compared between the two groups.Results：A total of 68 patients have completed the study.The combination regimen of COCs,metformin,and lifestyle modifications in these patients resulted in a significant decrease in BMI,acne,and hirsutism scores when compared to baseline levels in both groups （P 〈 0.05）.Blood pressure （BP） was significantly different in the CPA group when compared to baseline （75.14 ± 6.77 mmHg vs.80.70 ± 5.60 mmHg,P 〈 0.01）,and after 6 months of treatment,only the change in systolic BP was significantly different between the two groups （4.00 [-6.00,13.00] mmHg vs.-3.50 [-13.00,9.00] mmHg,P =0.009）.Fasting glucose,fasting insulin,and homeostasis model assessment-insulin resistance decreased significantly in the DRP group （5.40 ± 0.41 mmol/L vs.5.21 ± 0.32 mmol/L,P =0.041;13.90 [10.50,18.40] μU/ml vs.10.75 [8.60,13.50] μU/ml,P =0.020;3.74 [2.85,4.23] vs.2.55 [1.92,3.40],P =0.008） but did not differ between the two groups.While individual lipid profiles increased in both groups,no statistically significant difference was observed.Conclusions：DRP-containing COCs combined with metformin and lifestyle modifications could better control BP and correct carbohydrate metabolism in women with PCOS and metabolic disorders compared with CPA-containing COCs.

班氏促卵助孕汤改善多囊卵巢综合征小鼠卵母细胞的质量

背景:班氏促卵助孕汤改善多囊卵巢综合征卵母细胞质量的分子机制亟待完善补充。目的:探讨班氏促卵助孕汤对多囊卵巢综合征小鼠卵母细胞质量的影响和分子机制。方法:21 d龄雌性昆明小鼠颈部皮下注射硫酸脱氢表雄酮构建多囊卵巢综合征模型,连续给药21 d,记录动情周期及妊娠情况,ELISA检测血清性激素水平,Annexin V染色检测卵母细胞凋亡率,DCFH-DA荧光探针检测卵母细胞内活性氧水平,免疫荧光法观察卵母细胞纺锤体及染色体情况,网络药理学及分子对接验证班氏促卵助孕汤核心有效成分与卵母细胞成熟相关因子(生长分化因子9和骨形态发生蛋白15)结合活性,实时荧光定量PCR和Western blot检测卵母细胞中生长分化因子9和骨形态发生蛋白15的mRNA及蛋白表达水平。结果与结论:①班氏促卵助孕汤中的成分(槲皮素、山奈酚、β-谷甾醇)与生长分化因子9、骨形态发生蛋白15具有良好的结合活性;②班氏促卵助孕汤能恢复小鼠动情期,改善性激素紊乱和妊娠情况,降低细胞凋亡率、活性氧水平、纺锤体组装异常率、染色体丢失率(P<0.01,P<0.05),促进生长分化因子9、骨形态发生蛋白15 mRNA和蛋白表达(P<0.01,P<0.05)。结果表明,班氏促卵助孕汤可能通过调控生长分化因子9和骨形态发生蛋白15的基因表达,改善多囊卵巢综合征小鼠卵母细胞质量,提高生育力。

Therapeutic efficacy of moxibustion plus medicine in the treatment of infertility due to polycystic ovary syndrome and its effect on serum immune inflammatory factors

Objective:To explore the effects and related mechanism of heat-sensitive moxibustion plus clomifene citrate capsules for infertility due to polycystic ovary syndrome(PCOS).Methods:A total of 70 patients were randomized into a control group and an observation group by the random number table method,with 35 cases in each group.The control group was treated with clomifene citrate capsules,while the observation group was treated with heat-sensitive moxibustion on the basis of the medications in the control group.The treatment course lasted for 6 menstrual cycles.The endometrial thickness and ovarian volume of the patients were measured before and after treatment.The levels of serum sex hormones,tumor necrosis factor-α(TNF-α)and nuclear factor-κB(NF-κB)were detected.Follow-up was performed for 1 year after treatment,and the pregnancy rate was recorded.Results:After treatment,the endometrium of the patients in both groups was significantly thickened,the ovarian volume was significantly reduced,and the intra-group differences were statistically significant(all P<0.05).The endometrium thickness and ovarian volume in the observation group were significantly different from those in the control group(both P<0.05).After treatment,the levels of serum testostrn(T)and luteinizing hormone(LH)in both groups decreased significantly,the level of estradiol(E2)increased obviously,and the intra-group differences were statistically significant(all P<0.05).The levels of serum T and LH in the observation group were lower than those in the control group,and the E2 level in the observation group was higher than that in the control group,and the between-group differences were statistically significant(all P<0.05).After treatment,the levels of serum TNF-αand NF-κB of the patients in both groups decreased,and the intra-group differences were statistically significant(all P<0.05).The levels of serum TNF-αand NF-κB in the observation group were significantly lower than those in the control group(both P<0.05).After 1-year follow-up,the pregnancy rate was 20.0%in the control group,versus 51.5%in the observation group.The pregnancy rate in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:The treatment of heat-sensitive moxibustion plus clomifene citrate capsules can increase the endometrium thickness,reduce the ovarian volume,improve the status of serum sex hormone disorders,and increase the conception rate in patients with infertility due to PCOS,which may be related to the adjustment of the levels of immune inflammatory factors such as serum TNF-αand NF-κB.

Consensus on Infertility Management and Fertility Preservation Related to Polycystic Ovary Syndrome

There is currently no universally accepted unified diagnostic standard for infertility treatment and maternity protection related to polycystic ovary syndrome (PCOS) worldwide,and the treatment options vary greatly.To improve the understanding of PCOS-related infertility among Chinese obstetricians and gynecologists at all levels for better patient diagnosis and management,we have referred to the international expert recommendations and literature and taken into account the Chinese clinical practice to develop the "Consensus on infertility management and fertility preservation related to PCOS."

Association of sleep characteristics and night shift work with self-reported diagnosis of polycystic ovary syndrome:a questionnaire-based cross-sectional study

Objective:To examine the association between sleep characteristics and night shift work and the risk of polycystic ovary syndrome(PCOS)in Chinese women and to investigate their relationship with infertility in PCOS.Methods:From March 21,2021 to April 31,2021,3927 Chinese women with or without PCOS were recruited online.All participants completed WeChat-based electronic questionnaires.Sleep characteristics were measured using the Pittsburgh sleep quality index.Results:A total of 2871 women were included in the final analysis.Sleep duration(odds ratio[OR],0.857;95%confidence interval[CI],0.763-0.963),sleep midpoint(OR,1.142;95%CI,1.049-1.244),sleep disturbance(OR,1.320;95%CI,0.957-1.146),daytime dysfunction(OR,1.136;95%CI,1.030-1.253),and night shift work(OR,1.628;95%CI,1.264-2.097)were associated with a higher risk of PCOS.After adjusting for confounders,including age,body mass index,smoking status,and coffee and tea drinking status,sleep disturbance(OR,1.314;95%CI,1.111-1.555),daytime dysfunction(OR,1.143;95%CI,1.034-1.264),and night shift work(OR,1.800;95%CI,1.388-2.333)remained associated.In addition,sleep disturbance(OR,1.887;95%CI,1.400-2.542)and subjective sleep quality(OR,1.299;95%CI,1.037-1.627)were associated with infertility in women with PCOS,and sleep disturbance(OR,1.750;95%CI,1.281-2.390)remained significant after adjusting for confounders.Conclusions:Sleep disturbance,daytime dysfunction,and night shift work are significantly associated with PCOS.Screening for sleep disturbances and providing appropriate treatment could be potential strategies for managing PCOS and its long-term complications.

Physicians’ Attitude toward the Use of Metformin Prior to Clomiphene Citrate in Infertile Women with PCOS in Saudi Arabia

The goal of this study is to assess the different approaches gynecologists take while treating women with PCOS related infertility. Methodology: This is a quantitative cross-sectional study that involves 46 specialists and consultants from all over the kingdom of Saudi Arabia. The sample size was calculated based on the number of consultants and specialists members in the Saudi Obstetrical & Gynecology society “SOGS”, we could not find any statistics on how many Ob/Gyne doctors we have in Saudi Arabia. The paper is approved by the Unit of Biomedical Ethics, King Abdulaziz University. The research team prepared an online survey of 13 questions, sent to all Consultants and Specialists in the “SOGS” during the year of 2016. The SPSS was used for the analysis. Conclusion: There is no significant difference between the different approaches of the first line of management. Comparing between Metformin and Clomiphene Citrate, Thirty Seven percent of participants preferred to start by a combination while 32% preferred to start with the former and 30.4% with the latter. Most of the doctors preferred to use Metformin for the Obese patients 76.1%, a lower percentage prefers to use it with Overweight patients 54.3%.

Gestational Diabetes and Infertility

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications which affect the mother and offspring. In addition to adverse perinatal outcomes, it may lead to permanent health problems for the mother, such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), while increasing the risk of future obesity, CVD, T2DM and GDM in the child. Approximately 15% of women seek fertility treatment. Over the last decade, it has come to attention that patients with an infertility history are more prone to having GDM during their pregnancies, and this review examines the relationship between GDM and infertility. The elevated estrogen, progesterone, leptin, placental lactogen and growth hormone are the main reasons for increased insulin resistance during pregnancy. Despite some confounding factors in the mechanism of GDM in patients with an infertility history, infertility treatment increases the risk, according to numerous studies. The obesity epidemic and associated disorders have become a significant public health concern worldwide. Lifestyle modification for weight loss before pregnancy is encouraged, but there is no strong evidence for improvement in perinatal results. GDM, infertility and infertility treatment have a potential risk of alteration in the embryo’s environment and cause epigenetic reprogramming, which may be inherited to the next generation. The fertility treatment impacts the patient’s and offspring’s health. Patients should be informed about the risks so that they consent and get involved in the decision. Infertility treatment may be accepted as a reason for high-risk pregnancy, and patients can be screened for GDM in early pregnancy.