Polycystic Ovarian Syndrome (PCOS): Exploring Its Impact on Obstetrical Outcomes

Polycystic ovarian syndrome (PCOS) disrupts ovulation leading to both infertility and miscarriage;yet, its impact on obstetrical outcomes remains largely uncertain due to conflicting findings. We analyzed data from the CDC Pregnancy Risk Assessment of Monitoring System, specifically Standard Core and Phase 8 responses, with 9549 respondents across the United States through SPSS 28 software in this cross-sectional study. Two variables assessed PCOS status in respondents: history of PCOS and PCOS during pregnancy. With a history of PCOS, there were significantly increased odds of diabetic (OR 1.665, p < 0.001), hypertensive disorders (OR 1.589, p < 0.001) during pregnancy, neonatal mortality (OR 1.550, p < 0.001), cesarean section (C/S) (OR 1.489, p < 0.001), and preterm prelabor rupture of membranes (PPROM) (OR 2.081, p < 0.001). With PCOS diagnosed during pregnancy, there were significantly greater odds of diabetes (OR 3.278, p < 0.001), hypertensive disorders (OR 2.935, p < 0.001) during pregnancy, and significantly decreased risk for small for gestational age (2 standard deviations) (OR 0.337, p = 0.024). PCOS is a significant risk factor that contributes to maternal morbidity. Our results support the hypothesis that PCOS’ impact extends well into a woman’s obstetrical journey, with varying degrees of associated adverse maternal and fetal risks. Preliminary pathophysiologic explanations associated with PCOS gestational diabetes include pre-existing insulin resistance. Meanwhile, altered placentation and endovascular changes associated with PCOS secondary to a baseline deranged metabolic environment predispose patients to developing hypertensive disorders, PPROM, and preterm delivery. Associations between neonatal mortality and C/S can be attributed to elevated maternal body mass index. The pathophysiologic link between PCOS and the above obstetrical outcomes still remains unknown, necessitating further investigation;however, this study identifies the outcomes that require the most attention at this time.

Association between the Different Phenotypes of Polycystic Ovary Syndrome and the Outcome in in Vitro Fertilization at Human Reproductive Center Paul et Chantal Biya-Yaoundé

Background: In Vitro Fertilization/Intracytoplasmic Sperm Injection (IVF/ICSI) represents the final step in the management of Polycystic Ovarian Syndrome (PCOS). Our objective was to study the association between PCOS phenotypes and IVF/ICSI results in women admitted to Gynaecological Endoscopic Surgery and Human Reproductive Teaching Hospital (CHRACERH). Material and Method: We carried out a cohort study with historical-prospective data collection over a period of seven years (January 2016 to March 2023) at Chracerh. PCOS patients were subdivided into 4 subgroups A, B, C and D. Results: We recruited 128 patients including 64 PCOS patients divided into four phenotypes and 64 non-PCOS patients constituting the control group. Phenotype D without hyperandrogenism had used the lowest dose of gonadotropins, i.e. 1939.7 ± 454.3 IU, and had produced a greater quantity of estradiol on the day ovulation was triggered (6529.8 ± 4324.8 ng/ml). The average number of punctured follicles and mature oocytes were higher in the phenotype D group. Ovarian hyperstimulation syndrome (OHSS) occurred mainly in phenotype D (3/35), with an estimated prevalence of 2.3%. The fertilization rate seemed lower in the hyperandrogenic phenotypes A, B, C compared to the group without hyperandrogenism without significant difference (p = 0.461). The biological pregnancy rate and live birth rate were comparable between the different groups. Conclusion: Phenotype D used less dose of gonadotropins. Biological pregnancy and live birth rates were comparable between the different phenotypes.

A novel herbal combination ameliorates ovarian dysfunction and regulates altered biochemical parameters in rats with letrozole-induced polycystic ovary syndrome

Objective:To investigate the potential activity of novel herbal combination and novel herbal formulation(syrup)in female Sprague Dawley rats with letrozole-induced polycystic ovary syndrome(PCOS).Methods:Forty-two rats were randomly divided into seven groups with six rats in each group.Group 1 received 0.5%carboxy methylcellulose orally for 37 days and served as the normal control group.Group 2 was orally administered with letrozole of 1 mg/kg for 21 days and served as the PCOS induction group without treatment.Group 3 to 7 were administered with letrozole of 1 mg/kg for 21 days orally to induce PCOS,and then respectively received clomiphene citrate at 1 mg/kg,100 and 200 mg/kg of novel herbal combination,200 mg/kg of novel herbal formulation(syrup),and 400 mg/kg of marketed formulation of Pushyanuga churna,once daily for 15 days.Effects of the novel herbal combination and its syrup formulation were evaluated on the hormonal profile,the levels of antioxidants,the lipid profile and on the ovarian morphology,using letrozole-induced PCOS model in rats.Results:Letrozole caused alterations in hormonal levels and lipid levels similar to PCOS and ovarian histology showed presence of ovarian cysts confirming the induction of PCOS in rats.On treatment with the novel herbal combination and its syrup formulation in PCOS-induced rats,the altered hormonal and lipid profiles showed significant recovery to normal levels.Ovarian histology confirmed the restoration of folliculogenesis in the PCOS-induced rats.The treatment with the syrup formulation of novel herbal combination was found to be more effective than novel herbal combination and showed better recovery in various parameters evaluated.The results of the study,however,suggested that treatment with novel herbal combination and its syrup formulation provided minimal protection against oxidative stress caused due to the induction of PCOS.Conclusions:The integrated approach for management of PCOS is to counterbalance the limitations associated with modern therapy.Both the novel herbal combination and the syrup formulation of novel herbal combination show efficacy in the management of PCOS in rats and restore folliculogenesis in the ovary.The syrup formulation of novel herbal combination is most effective in the management of PCOS and shows potential to be developed as an adjuvant therapeutic agent.

Automatic Diagnosis of Polycystic Ovarian Syndrome Using Wrapper Methodology with Deep Learning Techniques

One of the significant health issues affecting women that impacts their fertility and results in serious health concerns is Polycystic ovarian syndrome(PCOS).Consequently,timely screening of polycystic ovarian syndrome can help in the process of recovery.Finding a method to aid doctors in this procedure was crucial due to the difficulties in detecting this condition.This research aimed to determine whether it is possible to optimize the detection of PCOS utilizing Deep Learning algorithms and methodologies.Additionally,feature selection methods that produce the most important subset of features can speed up calculation and enhance the effectiveness of classifiers.In this research,the tri-stage wrapper method is used because it reduces the computation time.The proposed study for the Automatic diagnosis of PCOS contains preprocessing,data normalization,feature selection,and classification.A dataset with 39 characteristics,including metabolism,neuroimaging,hormones,and biochemical information for 541 subjects,was employed in this scenario.To start,this research pre-processed the information.Next for feature selection,a tri-stage wrapper method such as Mutual Information,ReliefF,Chi-Square,and Xvariance is used.Then,various classification methods are tested and trained.Deep learning techniques including convolutional neural network(CNN),multi-layer perceptron(MLP),Recurrent neural network(RNN),and Bi long short-term memory(Bi-LSTM)are utilized for categorization.The experimental finding demonstrates that with effective feature extraction process using tri stage wrapper method+CNN delivers the highest precision(97%),high accuracy(98.67%),and recall(89%)when compared with other machine learning algorithms.

Metformin effect on internal carotid artery blood flow assessed by area under the curve of carotid artery Doppler in women with polycystic ovarian syndrome

BACKGROUND Insulin resistance(IR)was reported in most polycystic ovarian syndrome(PCOS)cases.Metformin,a biguanide drug,successfully reduced IR.Homeostatic Model Assessment for IR(HOMA-IR)and Doppler parameters assessed metformin's effectiveness.AIM To verify whether the area under the curve of the internal carotid artery(AUC-ICA)Doppler wave can be a useful marker for assessing IR among PCOS cases who presented with menstrual irregularity and were treated with metformin over 6 mo.METHODS An observational,cross-sectional study recruited 54 eligible PCOS women;the anthropometrics were as follows:age,body mass index(BMI),menstrual cycle days,biochemical serum cholesterol,low and high-density lipoprotein,sex hormone-binding globulin,fasting blood glucose,and HOMA-IR,hormonal testosterone,luteinizing hormone over follicle-stimulating hormone ratio,and ultrasonic pulsatility index(PI)and resistance index(RI),carotid artery intima-media thickness(CIMT)and(AUC-ICA)parameters were initially recorded and repeated 3 mo and 6 mo later with metformin tab 500 mg;three times/day for 6 mo.In addition,AUC-ICA was assessed by taking repeated systolic and diastolic wave height measurements.RESULTS Metformin caused a progressive reduction in BMI,menstrual cycle days,biochemical hormonal,and Doppler parameters(CIMT,PI,RI,and AUC-ICA).AUC-ICA correlated strongly to all PCOS parameters.AUC-ICA correlated inversely with treatment time(r=-0.98,P<0.001)and positively with HOMA-IR(r=0.98,P<0.0001).Via the best subset regression model,the AUC-ICA had the highest predictive value for HOMA-IR.CONCLUSION AUC-ICA preceded PI,RI,and CIMT with a strong,meaningful correlation to all PCOS parameters,making it a reliable marker for the assessment of IR,especially during metformin therapy.Further studies are recommended to promote the application in practice.

Apoptosis and Expression of Protein TRAIL in Granulosa Cells of Rats with Polycystic Ovarian Syndrome

The relationship between apoptosis of granulosa cells and follicle development arrest in polycystic ovarian syndrome (PCOS) rats, and the contribution of tumor necrosis factor related apoptosis inducing ligand (TRAIL) in apoptosis of granulosa cells were explored. By using sodium prasterone sulfate rat PCOS model was induced. The apoptosis of granulosa cells in ovaries of rats was observed by TdT-mediated dUTP-biotin nick end-labeling (TUNEL), and the expression of TRAIL protein and mRNA in granulosa cells was detected by using immunhistochemical staining and reverse transcription polymerase chain reaction (RT-PCR) respectively. The apoptotic rate and the expression of protein TRAIL in granulosa cells were significantly higher in antral follicles from the PCOS rats than in those from the control rats (P<0.01, P<0.05). There was no significant difference in apoptotic rate and the expression of TRAIL protein in granulosa cells of preantral follicles between the PCOS rats and the control rats (P>0.05). No apoptosis and the expression of TRAIL protein in granulosa cells of primordial follicles were found in the two groups. The expression of TRAIL mRNA was significantly stronger in granulosa cells from the PCOS rats than in those from the con- trol rats (P<0.01). It was suggested that the apoptotic rate in granulosa cells was significantly higher in antral follicle from the PCOS rats than in those from the control rats. TRAIL played a role in regu- lating the apoptosis of granulosa cells in PCOS rats.

Myo-inositol versus metformin effects on clinical features, endocrine and metabolic profiles in infertile women with polycystic ovary syndrome: A randomized controlled trial

Objective:To compare the effectiveness of inositol and metformin on the clinical characteristics,and endocrine and metabolic profiles of infertile polycystic ovarian syndrome(PCOS)women from Vietnam.Methods:From June 2018 to August 2022,a randomized trial was undertaken at the Hue Center for Endocrinology and Reproduction on infertile women aged 18 to 40 years with polycystic ovarian syndrome.The clinical,endocrine,and metabolic features of these individuals were assessed before and after 3 months of treatment with 2 g of inositol or 1700 mg of metformin per day.Natural pregnancy rates,adverse effects,and tolerance of inositol were recorded.Results:The study included 171 infertile PCOS women who were eligible to participate and took part in the baseline assessment,of whom 132 women participated in data analysis after 3 months.After metformin treatment,42.1%of women with oligomenorrhea experienced regular menstruation.Metformin significantly lowered body mass index(BMI),waist circumference and testosterone levels,but had no effect on other clinical characteristics,endocrine profiles,or metabolic profiles.29.2%Of women reported experiencing side effects.21%Of them attained pregnancy,which resulted in 17.1%of live births.In the inositol group,the rate of regular cycle increased by 18.2%and the total testosterone concentration significantly decreased.In overweight/obese women with PCOS,inositol significantly decreased weight,BMI,waist and hip circumferences(P<0.05).100%Of women tolerated inositol and continued treatment.18.9%Of them became pregnant,leading to 17%of live births.Conclusions:Metformin and inositol can improve weight and waist circumference in overweight/obese infertile women with PCOS.Metformin is associated with a higher rate of regular menstruation,whereas inositol is associated with a lower rate of adverse effects.The spontaneous conception,clinical pregnancy,and live birth rates between two groups are comparable.

Vitamin E modulates androgen receptor gene expression to attenuate ovarian dysfunctions in a rat model of dehydroepiandrosterone-induced polycystic ovary

Objective:To investigate the protective effect of vitamin E in dehydroepiandrosterone(DHEA)-induced polycystic ovary in rats.Methods:Premature female Wistar rats were randomly allocated into four groups,with 7 rats in each group.Group栺received corn oil(vehicle)and served as the control group;group栻received 0.2 mL of 0.06 mg/g DHEA in corn oil;group栿received 200 mg/kg vitamin E;group桇received DHEA plus vitamin E.All treatments lasted for 15 days,with DHEA administered subcutaneously,while vitamin E and corn oil were administered orally.After the experiment,serum samples and ovaries were harvested for biochemical,immunohistochemical,hormonal,and histological analysis.The ovarian mRNA expression of androgen receptor was analyzed by reverse transcriptase quantitative polymerase chain reaction(qPCR).Results:The antioxidant and metabolic enzyme activity significantly decreased in the DHEA-treated rats compared to the control rats(P<0.05).Administration of vitamin E to DHEAtreated rats significantly decreased cytokines and malondialdehyde compared to the DHEA-treated rats.The histological analysis showed reduced atretic and cystic ovaries,increased E-cadherin and Bcl-2 expression,and reduced expression of Bax in the DHEAtreated rats co-treated with vitamin E.The mRNA expression of androgen receptor was upregulated in the DHEA-treated rats compared to the control rats.Conclusions:Vitamin E ameliorates the hyperandrogenic effect of DHEA-induced polycystic ovaries via metabolic,antioxidant,and anti-apoptotic pathways.

Clinical Value of Serum Anti-Mullerian Hormone and Inhibin B in Prediction of Ovarian Response in Patients with Polycystic Ovary Syndrome

The present study aimed to investigate the clinical value of serum anti-mullerian hormone（AMH） and inhibin B（INHB） in predicting the ovarian response of patients with polycystic ovary syndrome（PCOS）. A total of 120 PCOS patients were enrolled and divided into three groups in terms of the ovarian response： a low-response group（n=36）, a normal-response group（n=44）, and a high-response group（n=40）. The serum AMH and INHB levels were measured by enzyme-linked immunosorbent assay（ELISA）. The follicle stimulating hormone（FSH）, luteinizing hormone（LH）, and estradiol（E2） levels were determined by chemiluminescence microparticle immunoassay. The correlation of the serum AMH and INHB levels with other indicators was analyzed. A receiver operating characteristic（ROC） curve was established to analyze the prediction of ovarian response by AMH and INHB. The results showed that there were significant differences in age, body mass index（BMI）, FSH, total gonadotropin-releasing hormone（Gn RH）, LH, E2, and antral follicle counts（AFCs） between the groups（P〈0.05）. The serum AMH and INHB levels were increased significantly with the ovarian response of PCOS patients increasing（P〈0.05）. The serum AMH and INHB levels were negatively correlated with the age, BMI, FSH level, Gn, and E2 levels（P〈0.05）. They were positively correlated with the LH levels and AFCs（P〈0.05）. ROC curve analysis of serum AMH and INHB in prediction of a low ovarian response showed that the area under the ROC curve（AUC） value of the serum AMH level was 0.817, with a cut-off value of 1.29 ng/m L. The sensitivity and specificity were 71.2% and 79.6%, respectively. The AUC value of serum INHB was 0.674, with a cut-off value of 38.65 ng/m L, and the sensitivity and specificity were 50.7% and 74.5%, respectively. ROC curve analysis showed when the serum AMH and INHB levels were used to predict a high ovarian response, the AUC value of the serum AMH level was 0.742, with a cut-off value of 2.84 ng/m L, and the sensitivity and specificity were 72.7% and 65.9%, respectively; the AUC value of the serum INHB level was 0.551 with a cut-off of 45.76 ng/m L, and the sensitivity and specificity were 76.3% and 40.2%, respectively. It was suggested the serum AMH and INHB levels have high clinical value in predicting the ovarian response of PCOS patients.

Expression of Resistin mRNA in Adipose Tissue of Rat Model with Polycystic Ovarian Syndrome and Its Implication

Summary: To investigate the relationship between the insulin resistance (IR) of polycystic ovarian syndrome (PCOS) rat model induced by dehydroeplandrosterone (DHEA) and hormonal changes in the ovarium and the resistin mRNA levels in adipose tissue, 21-day-old female SD rats were divided into two groups in pairs. The rats in group 1 were injected daily (s.c) with DHEA for up to 20 days and the rats in group 2 injected with oil at the same time. Ovarian weight, serum insulin levels and sex hormone levels in rat blood of both groups were determined. Oral glucose tolerance tests, light microscopic and electronic microscopic examination were performed. The levels of resistin mRNA in adipose tissue were measured by reverse transcription-polymerase chain reaction (RT-PCR). Our results showed that the ovarian weight in group 1 was greater than that in group 2 (P<0.05). The ovaria in group 1 showed multiple follicular cysts, The serum testeosterone and etrasdiol concentration were significantly higher in group 1 than those in group 2 (P<0.001 and P<0.05 respectively), so as the fasting serum glucose (P<0.001) and fasting serum insulin (P<0.05). The value of 1/FINS×FGC was significantly higher in group 1 than that in group 2 (P<0.001). Moreover, the resistin mRNA level of white adipose tissue in the DHEA-induced group was significantly higher than that in the control rats (P<0.05). It is concluded that the DHEA-induced PCOS rat models were similar to those of the patients with PCOS, and the IR was observed. Resistin secreted by adipose tissue may mediate IR in PCOS, and it is likely involved in the pathogenesis and development of PCOS.

Study on Treatment of Polycystic Ovarian Syndrome with Infertility by Combined Therapy of Chinese Herbal Medicine and Compound Cyproterone Acetate

Objective: To evaluate the effect of combined therapy of Chinese herbal medicine and compound cyproterone acetate (CPA) in treating non-obesity polycystic ovarian syndrome (PCOS) and to explore its mechanism in improving withdrawal ovulation. Methods: Eighty-six patients of non-obesity P-COS, typed as Shen-deficiency with blood stasis Syndrome or Shen-deficiency with Phlegm-Dampness Syndrome by Syndrome Differentiation in traditional Chines medicine, were randomly divided into three groups: (1) The TCM group (n = 26) was treated with Chinese drugs for 6 menstrual cycles; (2) The western medicine (WM) group (n=30) was treated with 1 tablet of CPA for 21 days, with the treatment beginning from the 5th day of menstruation. The treatment was given for 3 menstrual cycles by repetitious medication, which stopped and restarted on the 5th day of withdrawal bleeding. Then the ovulation promoting therapy was applied by using clomifene citrate and human chorionic gonadotropin (CC/hCG) for 3 menstrual cycles; (3) The TCM-WM group (n=30) was treated with the medications used for the above two groups. The menstrual cycle, the volume and duration of the menstruation, as well as the improvement of acne and pilosis [Ferriman-Gallway (F-G) scoring] were observed after 3 cycles ended. Moreover, condition of ovulation was monitored by B-ultrasonography at the 4th- 6th cycle and status of pregnancy was observed. Results: Compared with before treatment, the blood level of luteinizing hormone (LH) and testosterone (T) in all 3 groups after treatment significantly decreased (P<0. 05), with its ratio to follicle-stimulating hormone (LH/FSH) recovered to normal, but without markedly change in levels of FSH, estradiol (E2) and prolactin (PRL). The menstrual cycle in most patients got regular and acne significantly alleviated (P<0. 05), and the improvement of infrequent menstruation and acne was better in the WM group and the TCM-WM group than that in the TCM group, but pilosis showed no significant improvement in all three groups. The periodical ovulation rate in the TCM-WM group (73. 1%) and the WM group (68. 3%) was significantly higher than that in the TCM group (40%). The pregnancy rate in the TCM-WM group (53. 8%) was significantly higher than that in the other two groups (26.1% and 25% respectively, all P<0.05). Conclusion: Using combined therapy of TCM and composite CPA followed by o-vulation promoting agents of TCM and WM to treat patients of non-obesity PCOS could relieve the clinical symptoms, improve the abnormal blood level of sex hormones and significantly elevate the pregnancy rate.

Study of Mutation in Tyrosine Protein Kinase of Insulin Receptor Gene in Patients with Polycystic Ovarian Syndrome

Objective To explore the molecular mechanism of insulin resistance in the patients with polycystic ovarian syndrome (PCOS)Methods Polymerase chain reaction, silver staining-single strand conformation poly-morphism(PCR-SSCP) and DNA direct sequencing were used to detect the mutation of insulin receptor (INSR) gene in exon 17-21 with the abdominal wall adipose tissue from 31 patients with PCOS (PCOS Group) and 30 patients with pure hysteromyoma in reproductive lift (Control Group).Results Tiventy-two variant SSCP patterns in exon 17 of INSR gene were detected. Direct sequence analysis of exon 17 showed that homozygous nonsense mutation was two alleles single nucleotide polymorphism (SNP) at the codon 1058 (CAC→CAT). Exons 18-21were not detected with any significantly mutation. The INSR gene His1058C→ T substitution collecting rate and insulin resistance were significantly higher in the PCOS group than in the control group (P = 0. 0293, P<0. 05, P<0. 01). Conclusion It is suggested that the SNP in codon 1058 of the INSR gene might be related with the insulin resistance in PCOS patients, which has hereditary tendency. And the missense mutation,nonsense mutation and frameshift mutation at exons 18-21 in tyrosine protein kinase region of INSR gene for PCOS patients were not frequently observed.

Combined effects of Gymnema sylvestre and Pergularia daemia on letrozole-induced polycystic ovarian syndrome in rats

Objective:To investigate the combined therapeutic potential of Gymnema(G.)sylvestre and Pergularia(P.)daemia on letrozole-induced polycystic ovarian syndrome(PCOS)in rats.Methods:Thirty six healthy female Wistar rats with regular estrus cycles were randomly divided into six groups each of 6.GroupⅠreceived 1 mL of 0.5%carboxyl methyl cellulose orally and served as the vehicle control group,while groupsⅡtoⅥwere treated with letrozole(1 mg/kg body weight p.o.)for 21 days to induce PCOS.After induction of PCOS,groupⅡserved as the PCOS control group,without treatment;groupⅢreceived metformin(20 mg/kg body weight p.o.)as the standard group,and groupsⅣtoⅥreceived G.sylvestre(100 mg/kg body weight p.o.),P.daemia(300 mg/kg body weight p.o.),and the combination of G.sylvestre and P.daemia,respectively,for 28 days.Vaginal smears were collected from all rats daily throughout the study to determine the phases of the estrus cycle.After completing the treatment schedule,oral glucose tolerance test,serum lipid profile and reproductive hormonal analysis were carried out.Subsequently,the rats were sacrificed to collect ovary and uterus for histopathological examination.Results:The PCOS control rats showed a significant irregularity in the estrus cycle,hyperglycemia,and the altered serum lipid profile such as the increased low and very low density lipoprotein,triglyceride,and decreased high density lipoproteins.In addition,the PCOS control rats showed a significant increase in serum luteinizing hormone,testosterone,and estrogen,and decrease in follicle stimulating hormone and progesterone.These changes were significantly revoked in all the treatment groups.The test drugs also significantly reduced the gained ovary weight(P<0.001),and histopathology of the ovary showed almost normal ovary.Among the treatment groups,the group of combination treatment of G.sylvestre and P.daemia showed superior ameliorative results in PCOS parameters.Conclusions:Combination of G.sylvestre and P.daemia presents potent synergistic activity against hyperandrogenism,hyperinsulinemia,anovulation and follicular cysts in letrozole-induced PCOS rats.

Effects of Metformin Combined with Cyproterone Acetate on Clinical Features, Endocrine and Metabolism of Non-obese Women with Polycystic Ovarian Syndrome

Summary: In order to explore the effects of metformin combined with cyproterone acetate (CPA) on the clinical features, endocrine and metabolism of the patients with polycystic ovarian syndrome (PCOS), 50 cases of non-obese PCOS were randomly subjected to CPA (CPA treatment group, n=25) and CPA+metformin (n=25) treatment for 6 months. Before and after treatment the body mass index (BMI), waist:hip ratio (WHR), ovarian volume, serum gonadotrophin, androgen and sex hormone-binding globulin (SHBG) levels, and fasting lipid, glucose and insulin levels were measured. The results showed that all of the parameters in two groups were similar before treatment. After treatment for 6 months in the CPA+ metformin group, BMI and WHR were significantly decreased, while insulin sensitivity was significantly decreased as compared with those before treatment. In CPA group, no significant changes were found before and after treatment. Combined use of CPA and metformin could result in the reduction of serum androstenedione and increases of serum SHBG levels as compared with the CPA treatment alone. It was concluded that combined use of CPA and metformin could improve the insulin sensitivity, and further suppress the hyperandrogenism in non-obese women with PCOS.

Efficacy of Jianpi Bushen Huatan Recipe in the treatment of obese polycystic ovarian syndrome:A meta-analysis

Objective:To evaluate the effects of Jianpi Bushen Huatan Recipe on sex hormone levels、blood lipid and blood glucose levels in the treatment of obese poly-cystic ovarian syndrome(PCOS).Methods:Data bases including the CNKI、Vip、Wanfang were searched.Studies about randomized controlled trials(RCT)of the effectiveness of Jianpi Bushen Huatan Recipe Combined with Metformin in the Treatment of obese PCOS were included.Rev Man 5.3 software was used for meta analysis.Results:A total of 11 studies were enrolled.Meta-analysis showed that Jianpi Bushen Huatan Recipe Combined with Metformin significantly improved the clinical total effective rate of patien ts(RR=1.32,95%CI(1.20,1.45),P<0.00001);reduced the body mass index(BMI)(SMD=-0.92,95%CI(-1.13,-0.72),P<0.00001),luteinizing hormone(LH)(SMD=-1.00,95%CI(-1.37,-0.62),P<0.00001),LH/FSH(SMD=-1.03,95%CI(-1.34,-0.71),P<0.00001),insulin resistant index(HOMA-IR)(SMD=-0.59,95%CI(-0.79,-0.40),P<0.00001),fasting insulin(FIN)(SMD=-0.77,95%CI(-1.19,-0.35),P=0.0003),total cholesterol(TC)(SMD=-0.63,95%CI(-0.88,-0.38),P<0.00001),triglycerides(TG)(SMD=-0.60,95%CI(-0.83,-0.36),P<0.00001),highdensity lipoprotein(HDL)(SMD=-0.41,95%CI(-0.51,-0.32),P<0.00001).However,there was no statistically significant in waist-to-hip ratio(WHR),follicle stimulating hormone(FSH),fasting blood sugar(FBS)and low density lipoprotein(LDL).Conclusions:Jianpi Bushen Huatan Recipe Combined with Metformin in the treatment of obese PCOS has an advantage in improving the sex hormone level,blood lipid and blood glucose level,and is superior to metformin alone.

The application of in vitro maturation of oocytes in the infertile patients with polycystic ovarian syndrome

Objective:To evaluate the effects of in vitro maturation(IVM)of oocytes in the infertile pa-tients with polyeystic ovarian syndrome(PCOS).Methods:The infertile patients with PCOS who underwent IVM or IVF/ICSI from January2004 to August 2005 were studied retrospectively.68 unstimulated cycles(48 cases)underwentIVM as IVM group,42 cycles(39 cases)underwent IVF/ICSI as control group.Main outcomesincluding the number of oocytes retrival,the rates of fertilization,embryo cleavage,implanta-tion,pregnancy,miscarriage,ovarian hyperstimulation syndrome(OHSS)and multiple pregnan-cy were assessed.Results:No FSH was administered in IVM group and the mean number of FSH used was(25±6.2)ampoules in control group.When compared with control group,women in IVM grouphad significant increase in fertilization rate(70.7% versus 63.9%)and decrease in cleavage rate(87.9% versus 99.4%)and ovarian hyperstimulation syndrome(0 versus 7.1%).No significantdifferences between IVM group and control group were found in the number of oocytes obtained,implantation rate,clinical pregnancy rate,miscarriage rate and multiple pregnancy rate.Conclusion:Our results suggested that for infertile PCOS women who required assisted con-ception treatment,IVM is a more economical method with less OHSS complication than that ofconventional IVF treatment.

ATP Synthase β-subunit Abnormality in Pancreas Islets of Rats with Polycystic Ovary Syndrome and Type 2 Diabetes Mellitus

This study investigated the abnormal expression of ATP synthase β-subunit（ATPsyn-β） in pancreas islets of rat model of polycystic ovary syndrome（PCOS） with type 2 diabetes mellitus（T2DM）,and the secretion function changes after up-regulation of ATP5 b.Sixty female SD rats were divided into three groups randomly and equally.The rat model of PCOS with T2 DM was established by free access to the high-carbohydrate/high-fat diet,subcutaneous injections of DHEA,and a single injection of streptozotocin.The pancreas was removed for the detection of the ATPsyn-β expression by immunohistochemical staining,Western blotting and reverse transcription-PCR（RT-PCR）.The pancreas islets of the rats were cultured,isolated with collagenase Ⅴ and purified by gradient centrifugation,and the insulin secretion after treatment with different glucose concentrations was tested.Lentivirus ATP5 b was successfully constructed with the vector of GV208 and transfected into the pancreas islets for the over-expression of ATPsyn-β.The insulin secretion and intracellular ATP content were determined after transfection of the PCOS-T2 DM pancreas islets with Lenti-ATP5 b.The results showed that the expression of ATPsyn-β protein and m RNA was significantly decreased in the pancreas of PCOS-T2 DM rats.The ATP content in the pancreas islets was greatly increased and the insulin secretion was improved after the up-regulation of ATPsyn-β in the pancreas islets transfected with lenti-ATP5 b.These results indicated that for PCOS,the ATPsyn-β might be one of the key factors for the attack of T2 DM.

Effects of pioglitazone on serum leptin and adiponectin in polycystic ovary syndrome patients with insulin resistance

Objective To investigate the effects of pioglitazone on serum leptin and adiponectin in polycystic ovary syndrome(PCOS)patients with insulin resistance(IR).Methods Thirty-five PCOS patients with IR were treated with pioglitazone 15mg/d for 12 weeks.The results of ovulation induction were observed.The changes of fasting plasma glucose(FPG),fasting serum insulin(FINS),serum levels of leptin,adiponectin,follicle-stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T)and blood fat were examined at the baseline and after the therapy by enzyme-linked immunosorbent assay(ELISA)and radioimmunoassay(RIA).Results After the treatment,the rate of ovulation per cycle was improved in 31(88.5%)out of the 35 patients.After treatment,the level of serum leptin was decreased(P<0.05)while the level of serum adiponectin was increased(P<0.05).After 12 weeks’ treatment,waist-to-hip ratio and F-G score were significantly decreased(P<0.05),BMI declined but without significant difference(P>0.05).The levels of LH,T,FINS,Homa-IR,total cholesterol,triglyceride and low density lipoprotein-cholesterol were significantly decreased(P<0.01,P<0.05),whereas the level of high density lipoprotein-cholesterol was significantly increased(P<0.01).No significant difference was seen in FSH and FPG following treatment(P>0.05).Conclusion Pioglitazone treatment can effectively improve PCOS with IR patients’ clinical syndromes,insulin sensitivity,glucose and lipid metabolism at least partly through improving the profiles of leptin and adiponectin.

Peripheral Hematological Parameters in Sudanese Women with Polycystic Ovary Syndrome

The aim of this study is to assess the association between polycystic ovarian syndrome (PCOS) and hematological parameters [hemoglobin, red cell parameters, white blood cells (WBCs), platelets volume (MPV)]. This is a matched case-control study (60 women in each arm of the study) which was conducted in Saad Abualila infertility center Hospital in Khartoum, Sudan. Infertile women with PCOS were the cases and healthy non pregnant women were the controls. The gynecological characteristics were gathered through questionnaire and blood samples were analyzed for different blood parameters by automated hematology analyzer. While the two groups were matched in their age;body mass index was significantly higher in women with PCOs compared to the normal control. The investigated different hematological parameters (hemoglobin, RBCs, RDW, WBCs, platelets and MPV) showed no statistical difference between the women with PCOS and the controls.

Gut microbiota and female health

The gut microbiota is recognized as an endocrine organ with the capacity to influence distant organs and associated biological pathways.Recent advan-cements underscore the critical role of gut microbial homeostasis in female health;with dysbiosis potentially leading to diseases among women such as polycystic ovarian syndrome,endometriosis,breast cancer,cervical cancer,and ovarian cancer etc.Despite this,there has been limited discussion on the underlying mechanisms.This editorial explores the three potential mechanisms through which gut microbiota dysbiosis may impact the development of diseases among women,namely,the immune system,the gut microbiota-estrogen axis,and the metabolite pathway.We focused on approaches for treating diseases in women by addressing gut microbiota imbalances through probiotics,prebiotics supple-mentation,and fecal microbiota transplantation(FMT).Future studies should focus on determining the molecular mechanisms underlying associations between dysbiosis of gut microbiota and female diseases to realize precision medicine,with FMT emerging as a promising intervention.